Abstract
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.
References
Rodwell K, Edwards P, Ware RS, Boyd R. Salivary gland botulinum toxin injections for drooling in children with cerebral palsy and neurodevelopmental disability: a systematic review. Dev Med Child Neurol. 2012;54:977–87.
Reddihough D, Erasmus CE, Johnson H, McKellar GMW, Jongerius PH. Botulinum toxin assessment, intervention and aftercare for paediatric and adult drooling: international consensus statement. Eur J Neurol. 2010;17(Suppl 2):109–21.
Teymoortash A, Pfestroff A, Wittig A, Franke N, Hoch S, Harnisch S, et al. Safety and efficacy of Botulinum toxin to preserve gland function after radiotherapy in patients with head and neck cancer: a prospective, randomized, placebo-controlled, double-blinded phase I clinical trial. PLoS One. 2016;11:e0151316.
Kratochwil C, Bruchertseifer F, Rathke H, Bronzel M, Apostolidis C, Weichert W, et al. Targeted α-therapy of metastatic castration-resistant prostate cancer with 225Ac-PSMA-617: dosimetry estimate and empiric dose finding. J Nucl Med. 2017;58:1624–31.
Kratochwil C, Schmidt K, Afshar-Oromieh A, Bruchertseifer F, Rathke H, Morgenstern A, et al. Targeted alpha therapy of mCRPC: dosimetry estimate of (213)bismuth-PSMA-617. Eur J Nucl Med Mol Imaging. 2018;45:31–7.
Acknowledgements
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
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.
Informed Consent
Informed consent was obtained from the patient who was the subject of the study.
Rights and permissions
About this article
Cite this article
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). https://doi.org/10.1007/s13139-017-0508-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13139-017-0508-3