Initial clinical experience performing sialendoscopy for salivary glands protection for patients under 225Ac-PSMA-617-RLT

Purpose: Main side effect of prostate-specific membrane antigene targeting alpha-therapy (PSMA-TAT) is the dry-mouthsyndrome. Inflammations of the parotic glands and consecutive reduced salivation function were already reported for patients after radioiodine therapy. Beneficial effects of steroids for radiation inflammation to tissue are well known. Thus, sialendoscopy and injection of steroids (prednisone) were performed before or after 225Ac-PSMA-617-TAT to reduce inflammation effects in the salivary glands and prevent xerostomia. Methods: Eleven male patients with metastatic castration-resistant prostate cancer (mCRPC) and a mean age of 68.5 years (range 58-80 y) underwent sialendoscopy and steroid injection before or after application of 225Ac-PSMA-617-TAT for every cycle. Sialendoscopy and steroid injection was performed by an ENT senior physician. Quality of life assessment was evaluated using a standardized report form. Results: In all 11 patients both parotid- and both submandibular glands were affected due to radiation sialadenitis and sialendoscopic treatment applied. Patients treated with sialendoscopy showed a significant improvement in health related quality of life (HRQOL) measurements regarding 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=0003). Due to our limited number of patients we only describe tendencies. We did not experience any complications after sialendoscopy. Conclusion: Sialendoscopy and steroid injection had beneficial effects to the salivation function and quality of life for patients under 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 the inflammation but also the direct radiation is causative for the dry mouth. Further research is necessary to cope the main side effect of PSMA-TAT.

RATHKE H;  KRATOCHWIL Clemens;  HOHENBERGER R;  GIESEL Frederik;  BRUCHERTSEIFER Frank;  FLECHSIG Paul;  MORGENSTERN Alfred;  PLINKERT Peter;  HABERKORN Uwe;  BULUT Olcay Cem; 

2018-11-12

SPRINGER

JRC113296

1619-7070 (online),   

https://publications.jrc.ec.europa.eu/repository/handle/JRC113296,   

10.1007/s00259-018-4148-3 (online),