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Initial clinical experience performing sialendoscopy for salivary gland protection in patients undergoing 225Ac-PSMA-617 RLT

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The main side effect of prostate-specific membrane antigen targeting alpha therapy (PSMA TAT) is dry mouth syndrome. Inflammation of the salivary glands and consequent reduced salivary function have been reported in patients after radioiodine therapy. The beneficial effects of sialendoscopy on radiation-induced inflammation in tissue are well known. Thus sialendoscopy with dilatation, saline irrigation and steroid injections (prednisolone) was performed before and after 225Ac-PSMA-617 TAT to reduce inflammatory effects in the salivary glands and to improve or prevent xerostomia.

Methods

Eleven men with metastatic castration-resistant prostate cancer (mean age 68.5 years, range 58–80 years) underwent sialendoscopy, dilatation, saline irrigation and steroid injection of both submandibular and both parotid glands before or after every cycle of 225Ac-PSMA-617 TAT. Sialendoscopy and steroid injection were performed by a senior ENT physician. Quality of life was evaluated using two health-related quality of life (HRQOL) questionnaires, the Xerostomia Questionnaire (XQ) and the Xerostomia Inventory (XI) before and 3 months after the intervention.

Results

In all 11 patients both parotid and both submandibular glands were affected by radiation sialadenitis and sialendoscopy was performed. The patients experienced no complications after sialendoscopy, and showed a significant improvement in HRQOL as measured using the XQ and XI. After sialendoscopy the XQ score decreased significantly from 77.7 ± 13.6 to 42.7 ± 14.8 (p = 0.003) and the XI score decreased from 44.5 ± 6.9 to 25.8 ± 12.8 (p = 0.003). Due to the limited number of patients we only report tendencies.

Conclusion

Sialendoscopy with dilatation, saline irrigation and steroid injection had beneficial effects on salivary gland function and HRQOL in patients undergoing 225Ac-PSMA-617 RLT. However, even with sialadenoscopic support after multiple cycles of TAT, salivary gland function was reduced and xerostomia was present. Therefore, not only inflammation but also the direct effect of radiation is a putative cause of dry mouth. Further research is necessary to determine the main side effects of PSMA TAT.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany

    Hendrik Rathke, Clemens Kratochwil, Frederik Lars Giesel, Paul Flechsig & Uwe Haberkorn

  2. Department of Otorhinolaryngology, Head and Neck Surgery (ORL-HNS), Heidelberg University Hospital, Heidelberg, Germany

    Ralph Hohenberger, Peter Plinkert & Olcay Cem Bulut

  3. Directorate for Nuclear Safety and Security, European Commission, Joint Research Centre, Karlsruhe, Germany

    Frank Bruchertseifer & Alfred Morgenstern

  4. Department of Otorhinolaryngology, Head and Neck Surgery, SLK Klinikum Am Gesundbrunnen, Heilbronn, Germany

    Matti Hein & Olcay Cem Bulut

  5. Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Uwe Haberkorn

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  1. Hendrik Rathke
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Corresponding author

Correspondence to Hendrik Rathke.

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Conflict of interest

U.H. is the holder of the patent for PSMA-617.

H.R., F.G., P.F. and C.K. are stock holders of Endocyte Inc., West Lafayette, IN, USA.

The other authors declare no conflict of interest.

Ethical approval

All procedures performed in this retrospective evaluation involving human participants were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Rathke, H., Kratochwil, C., Hohenberger, R. et al. Initial clinical experience performing sialendoscopy for salivary gland protection in patients undergoing 225Ac-PSMA-617 RLT. Eur J Nucl Med Mol Imaging 46, 139–147 (2019). https://doi.org/10.1007/s00259-018-4135-8

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  • DOI: https://doi.org/10.1007/s00259-018-4135-8

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