Hendrik Rathke1, Clemens Kratochwil2, Ralph Hohenberger3, Frederik Lars Giesel2, Frank Bruchertseifer4, Paul Flechsig2, Alfred Morgenstern4, Matti Hein5, Peter Plinkert3, Uwe Haberkorn2,6, Olcay Cem Bulut3,5. 1. Department of Nuclear Medicine, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany. hendrik.rathke@med.uni-heidelberg.de. 2. Department of Nuclear Medicine, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany. 3. Department of Otorhinolaryngology, Head and Neck Surgery (ORL-HNS), Heidelberg University Hospital, Heidelberg, Germany. 4. Directorate for Nuclear Safety and Security, European Commission, Joint Research Centre, Karlsruhe, Germany. 5. Department of Otorhinolaryngology, Head and Neck Surgery, SLK Klinikum Am Gesundbrunnen, Heilbronn, Germany. 6. Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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.
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.
Authors: Christian Filss; Alexander Heinzel; Berthold Miiller; Andreas T J Vogg; Karl-Josef Langen; Felix M Mottaghy Journal: Nuklearmedizin Date: 2018-02-21 Impact factor: 1.379
Authors: K H Bohuslavizki; W Brenner; S Lassmann; S Tinnemeyer; S Kalina; M Clausen; E Henze Journal: Nuklearmedizin Date: 1997-04 Impact factor: 1.379
Authors: Ian F Tannock; Ronald de Wit; William R Berry; Jozsef Horti; Anna Pluzanska; Kim N Chi; Stephane Oudard; Christine Théodore; Nicholas D James; Ingela Turesson; Mark A Rosenthal; Mario A Eisenberger Journal: N Engl J Med Date: 2004-10-07 Impact factor: 91.245
Authors: A Afshar-Oromieh; A Malcher; M Eder; M Eisenhut; H G Linhart; B A Hadaschik; T Holland-Letz; F L Giesel; C Kratochwil; S Haufe; U Haberkorn; C M Zechmann Journal: Eur J Nucl Med Mol Imaging Date: 2012-11-24 Impact factor: 9.236
Authors: Neeta Pandit-Taskar; Joseph A O'Donoghue; Shutian Ruan; Serge K Lyashchenko; Jorge A Carrasquillo; Glenn Heller; Danny F Martinez; Sarah M Cheal; Jason S Lewis; Martin Fleisher; Jennifer S Keppler; Robert E Reiter; Anna M Wu; Wolfgang A Weber; Howard I Scher; Steven M Larson; Michael J Morris Journal: J Nucl Med Date: 2016-08-11 Impact factor: 10.057
Authors: Ludwike W M van Kalmthout; Marnix G E H Lam; Bart de Keizer; Gerard C Krijger; Tessa F T Ververs; Rememrt de Roos; Arthur J A T Braat Journal: EJNMMI Res Date: 2018-07-03 Impact factor: 3.138
Authors: Florian C Gaertner; Khalil Halabi; Hojjat Ahmadzadehfar; Stefan Kürpig; Elisabeth Eppard; Charalambos Kotsikopoulos; Nikolaos Liakos; Ralph A Bundschuh; Holger Strunk; Markus Essler Journal: Oncotarget Date: 2017-07-06
Authors: Jyoti Roy; Blake M Warner; Falguni Basuli; Xiang Zhang; Karen Wong; Thomas Pranzatelli; Anita T Ton; John A Chiorini; Peter L Choyke; Frank I Lin; Elaine M Jagoda Journal: Cancer Biother Radiopharm Date: 2020-02-19 Impact factor: 3.099
Authors: Wesley R Armstrong; Andrei Gafita; Shaojun Zhu; Pan Thin; Kathleen Nguyen; Rejah Alano; Stephanie Lira; Kiara Booker; Linda Gardner; Tristan Grogan; David Elashoff; Martin Allen-Auerbach; Magnus Dahlbom; Johannes Czernin; Jeremie Calais Journal: J Nucl Med Date: 2021-01-28 Impact factor: 11.082
Authors: Teja Muralidhar Kalidindi; Sang-Gyu Lee; Katerina Jou; Goutam Chakraborty; Myrto Skafida; Scott T Tagawa; Neil H Bander; Heiko Schoder; Lisa Bodei; Neeta Pandit-Taskar; Jason S Lewis; Steven M Larson; Joseph R Osborne; Naga Vara Kishore Pillarsetty Journal: Eur J Nucl Med Mol Imaging Date: 2021-01-25 Impact factor: 10.057
Authors: Lena M Mittlmeier; Matthias Brendel; Leonie Beyer; Nathalie L Albert; Andrei Todica; Mathias J Zacherl; Vera Wenter; Annika Herlemann; Alexander Kretschmer; Stephan T Ledderose; Nina-Sophie Schmidt-Hegemann; Wolfgang G Kunz; Jens Ricke; Peter Bartenstein; Harun Ilhan; Marcus Unterrainer Journal: Front Oncol Date: 2021-05-21 Impact factor: 6.244
Authors: Jyoti Roy; Blake M Warner; Falguni Basuli; Xiang Zhang; Changyu Zheng; Corrine Goldsmith; Tim Phelps; Karen Wong; Anita T Ton; Rick Pieschl; Margaret E White; Rolf Swenson; John A Chiorini; Peter L Choyke; Frank I Lin Journal: EJNMMI Res Date: 2021-07-21 Impact factor: 3.138