Salivary gland protection with botulinum toxin and scopolamine during tandem PSMA-targeted radioligand therapy. (IMAGE)

Society of Nuclear Medicine and Molecular Imaging

Salivary gland protection with botulinum toxin and scopolamine during tandem PSMA-targeted radioligand therapy.

Caption

Figure 1. Salivary gland protection with botulinum toxin and scopolamine during tandem PSMA-targeted radioligand therapy.

Pre-treatment 68Ga-PSMA PET/CT demonstrated comparable tracer uptake in both parotid and submandibular glands. The patient subsequently received ultrasound-guided botulinum toxin injections (170 units in the parotid gland and 80 units in the contralateral submandibular gland) 30 days prior to TANDEM radioligand therapy, along with 3 mg transdermal scopolamine applied 72 hours before treatment. Post-injection SPECT/CT images revealed a marked reduction in PSMA radioligand uptake in the BTX-treated glands, with parotid gland uptake ratio shifting from 0.93 to 1.15 and submandibular gland ratio from 1.39 to 2.14, confirming targeted protection. The patient tolerated both the intervention and the subsequent PRLT (6.2 GBq 177Lu-PSMA and 5 MBq 225Ac-PSMA) without xerostomia or other significant side effects.

Credit

Images created by Tianzhi Zhao, Jingjing Zhang, et al., National University of Singapore, Singapore / Richard P. Baum et al., Curanosticum Wiesbaden-Frankfurt, Wiesbaden, Germany.

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