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Injection of Botulinum Toxin for Preventing Salivary Gland Toxicity after PSMA Radioligand Therapy: an Empirical Proof of a Promising Concept


The dose-limiting salivary gland toxicity of 225Ac-labelled PSMA for treatment of metastatic, castration-resistant prostate cancer remains unresolved. Suppressing the metabolism of the gland by intraparenchymal injections of botulinum toxin appears to be a promising method to reduce off-target uptake. A 68Ga-PSMA PET/CT scan performed 45 days after injection of 80 units of botulinum toxin A into the right parotid gland in a 63-year-old patient showed a decrease in the SUVmean in the right parotid gland of up to 64% as compared with baseline. This approach could be a significant breakthrough for radioprotection of the salivary glands during PSMA radioligand therapy.

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We thank Dr. Anthony Chang, Rethink Imaging, USA, for providing 3D reconstructed PET/CT images. We are also grateful to Dr. Guillaume Chaussé, Nuclear Medicine, McGill University, Montreal, Quebec, Canada, for his remarks on pharmacological and cellular mechanisms in the salivary glands after injection of botulinum toxin.

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Correspondence to Thomas Langbein.

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Richard P. Baum, Thomas Langbein, Aviral Singh, Mostafa Shahinfar, Christiane Schuchardt, Gerd Fabian Volk, Harshad Kulkarni declare that they have no conflict of interest.

Ethical Statement

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from the patient who was the subject of the study.

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Baum, R.P., Langbein, T., Singh, A. et al. Injection of Botulinum Toxin for Preventing Salivary Gland Toxicity after PSMA Radioligand Therapy: an Empirical Proof of a Promising Concept. Nucl Med Mol Imaging 52, 80–81 (2018).

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  • Prostate cancer
  • PSMA radioligands
  • Salivary glands
  • Positron emission tomography
  • Botulinum toxin
  • Xerostomia