The influence of saliva flow stimulation on the absorbed radiation dose to the salivary glands during radioiodine therapy of thyroid cancer using 124I PET(/CT) imaging
Abstract
Purpose A serious side effect of high-activity radioiodine therapy in the treatment of differentiated thyroid cancer is radiogenic salivary gland damage. This damage may be diminished by lemon-juice-induced saliva flow immediately after 131I administration. The aim of this study was to assess the effect of chewing lemon slices on the absorbed (radiation) doses to the salivary glands.Methods Ten patients received (pretherapy) 124I PET(/CT) dosimetry before their first radioiodine therapy. The patients underwent a series of six PET scans at 0.5, 1, 2, 4, 48 and ≥96 h and one PET/CT scan at 24 h after administration of 27 MBq 124I. Blood samples were also collected at about 2, 4, 24, 48, and 96 h. Contrary to the standard radioiodine therapy protocol, the patients were not stimulated with lemon juice. Specifically, the patients chewed no lemon slices during the pretherapy procedure and neither ate food nor drank fluids until after completion of the last PET scan on the first day. Organ absorbed doses per administered 131I activity (ODpAs) as well as gland and blood uptake curves were determined and compared with published data from a control patient group, i.e. stimulated per the standard radioiodine therapy protocol. The calculations for both groups used the same methodology.Results A within-group comparison showed that the mean ODpA for the submandibular glands was not significantly different from that for the parotid glands. An intergroup comparison showed that the mean ODpA in the nonstimulation group averaged over both gland types was reduced by 28% compared to the mean ODpA in the stimulation group (p=0.01). Within each gland type, the mean ODpA reductions in the nonstimulation group were statistically significant for the parotid glands (p=0.03) but not for the submandibular glands (p=0.23). The observed ODpAs were higher in the stimulation group because of increased initial gland uptake rather than group differences in blood kinetics.Conclusion The 124I PET(/CT) salivary gland dosimetry indicated that lemon juice stimulation shortly after 131I administration in radioiodine therapy increases the absorbed doses to the salivary glands.
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Planar dosimetry has shown median absorbed dose per administered activity of each single parotid gland to be about 0.15 Gy/GBq (range, 0.1-0.3 Gy/GBq) and of each single submandibular gland to be 0.48 Gy/GBq (range, 0.2-1.2 Gy/GBq).
“Planar dosimetry has shown differences in radiation-absorbed doses between the parotid and submandibular glands, with median absorbed dose per administered activity of each single parotid and submandibular gland to be about 0.15 Gy/GBq (range, 0.1 -0.3 Gy/GBq) and 0.48 Gy/GBq (range, 0.2 -1.2 Gy/GBq) ( 72 ).”
From Normal-Tissue Tolerance to Radiopharmaceutical Therapies, the Knowns and the Unknowns (2021) · cites this paper as [72]
124I PET imaging has shown a radiation-absorbed dose of 0.23 Gy/GBq in salivary glands in patients who do not have thyroid stimulation with lemon drops.
“The dosimetry of salivary glands has been investigated more intensively with the availability of 124 I PET imaging, which has shown a radiation-absorbed dose of 0.23 Gy/ GBq in patients who do not have thyroid stimulation with lemon drops ( 72 ).”
From Normal-Tissue Tolerance to Radiopharmaceutical Therapies, the Knowns and the Unknowns (2021) · cites this paper as [72]
Cites
Haugen, B. R., Alexander, E. K., Bible, K. C., Doherty, G. M., Mandel, S. J., Nikiforov, Y. E., Pacini, F., Randolph, G. W., Sawka, A. M., Schlumberger, M., et al. (2016) · Thyroid® · doi:10.1089/thy.2015.0020 · Cited by 16,535 · see citing works
Cooper, D. S., Doherty, G. M., Haugen, B. R., Kloos, R. T., Lee, S. L., Mandel, S. J., Mazzaferri, E. L., McIver, B., Pacini, F., Schlumberger, M., et al. (2009) · Thyroid · doi:10.1089/thy.2009.0110 · Cited by 6,707 · see citing works
Guidelines for radioiodine therapy of differentiated thyroid cancer
Luster, M., Clarke, S. E., Dietlein, M., Laßmann, M., Lind, P., Oyen, W. J. G., Tennvall, J., & Bombardieri, E. (2008) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-008-0883-1 · Cited by 725 · see citing works
Radioactive Iodine and the Salivary Glands
Mandel, S. J., & Mandel, L. (2003) · Thyroid · doi:10.1089/105072503321582060 · Cited by 376 · see citing works
(2005) · PubMed · Cited by 180 · see citing works
Salivary Gland Toxicity after Radioiodine Therapy for Thyroid Cancer
Hyer, S. L., Kong, A. H., Pratt, B. E., et al. (2006) · Clinical Oncology · doi:10.1016/j.clon.2006.11.005 · Cited by 132 · see citing works
Sialadenitis following I-131 therapy for thyroid carcinoma: concise communication.
Allweiss, P., Braunstein, G. D., Katz, A. D., et al. (1984) · PubMed · Cited by 130 · see citing works
Value of 124I-PET/CT in staging of patients with differentiated thyroid cancer
Freudenberg, L. S., Antoch, G., Jentzen, W., et al. (2004) · European Radiology · doi:10.1007/s00330-004-2350-0 · Cited by 121 · see citing works
Self-citationJentzen, W., Weise, R., Kupferschläger, J., Freudenberg, L. S., Brandau, W., Bares, R., Burchert, W., & Bockisch, A. (2007) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-007-0554-7 · Cited by 93 · see citing works
Self-citationJentzen, W., Hobbs, R. F., Stahl, A. R., et al. (2010) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-009-1351-2 · Cited by 64 · see citing works
Self-citationJentzen, W. (2010) · Physics in Medicine and Biology · doi:10.1088/0031-9155/55/8/016 · Cited by 54 · see citing works
Self-citationSalivary Gland Protection with Sialagogues: A Case Study
Nostrand, D. V., Atkins, F., Bandaru, V. V., et al. (2009) · Thyroid · doi:10.1089/thy.2008.0381 · Cited by 35 · see citing works
Sialadenitis Following Iodine-131 Therapy for Thyroid Carcinoma
Creutzig, H. (1985) · Journal of Nuclear Medicine · Cited by 13 · see citing works
Sialadenitis Following Iodine-131 Therapy for Thyroid Carcinoma—Reply
Allweiss, P., Braunstein, G. D., Katz, A. D., et al. (1985) · Journal of Nuclear Medicine · Cited by 1 · see citing works
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Haugen, B. R., Alexander, E. K., Bible, K. C., Doherty, G. M., Mandel, S. J., Nikiforov, Y. E., Pacini, F., Randolph, G. W., Sawka, A. M., Schlumberger, M., et al. (2016) · Thyroid® · doi:10.1089/thy.2015.0020 · Cited by 16,535 · see citing works
Cooper, D. S., Doherty, G. M., Haugen, B. R., Kloos, R. T., Lee, S. L., Mandel, S. J., Mazzaferri, E. L., McIver, B., Pacini, F., Schlumberger, M., et al. (2009) · Thyroid · doi:10.1089/thy.2009.0110 · Cited by 6,707 · see citing works
Normal-Tissue Tolerance to Radiopharmaceutical Therapies, the Knowns and the Unknowns
Wahl, R. L., Sgouros, G., Iravani, A., Jacene, H., Pryma, D., Saboury, B., Capala, J., & Graves, S. A. (2021) · Journal of Nuclear Medicine · doi:10.2967/jnumed.121.262751 · Cited by 95 · see citing works
- Authors
- Jentzen, W., Balschuweit, D., Schmitz, J., Freudenberg, L., Eising, E., Hilbel, T., Bockisch, A., & Stahl, A.
- Affiliations
- University of Duisburg-Essen (DE)
- Corresponding author
- Jentzen, Walter
- Venue
- European Journal of Nuclear Medicine and Molecular Imaging
- Published
- 2010-07-13
- Volume
- 37
- Issue
- 12
- Pages
- 2298-2306
- ISSN
- 1619-7070 (ISSN-L)
- 1619-7089
- OpenAlex
- W2066033410
- Cited by
- 77
- References
- 14
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 4 · 2022: 6 · 2021: 12 · 2020: 6 · 2019: 4 · 2018: 3 · 2017: 4 · 2016: 8 · 2015: 4 · 2014: 3 · 2013: 8 · 2012: 3
- FWCI
- 4.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- European Journal of Nuclear Medicine and Molecular Imaging (publishedVersion)
- PubMed (publishedVersion)
- Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiopharmaceutical Chemistry and Applications
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiation Dose and Imaging
- Keywords
- radioiodine therapy, salivary gland stimulation, lemon juice, iodine-131, differentiated thyroid cancer, parotid gland, submandibular gland, organ absorbed dose, iodine uptake
- MeSH terms
- Adult, Aged, Citrus, Female, Humans, Iodine Radioisotopes, Male, Middle Aged, Plant Extracts, Radiation Dosage, Saliva, Salivary Glands, Salivation, Sialography, Thyroid Neoplasms, Tomography, X-Ray Computed, Positron-Emission Tomography
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