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Objectives <p>The number of patients receiving radioligand therapy (RLT) has risen sharply in recent years. This raises concerns about possible risks to dental healthcare workers due to their exposure to the patients and their saliva. We therefore set about to measure the salivary radioactivity in patients undergoing <sup>177</sup>Lu–RLT.</p> Materials and methods <p>We recruited in-house RLT patients receiving [<sup>177</sup>Lu]Lu -DOTA-TOC (<i>n</i> = 6) or [<sup>177</sup>Lu]Lu-PSMA-I&amp;T (<i>n</i> = 14). We measured the radioactivity concentrations in 1&#xa0;ml saliva samples collected before and 0.5, 2, 4, 21, 27, and 45&#xa0;h post application of the radioligands, with additional samples collected at 51 and 69&#xa0;h for [<sup>177</sup>Lu]Lu-PSMA-I&amp;T patients. The biological half-life (BHL) and area under the curve (AUC) were calculated for the radioactivity of the saliva for both cohorts.</p> Results <p>Both cohorts exhibited increases in salivary radioactivity, attaining peaks at 2&#xa0;h p.i. of [<sup>177</sup>Lu]Lu-DOTA-TOC and 4&#xa0;h p.i. of [<sup>177</sup>Lu]Lu-PSMA-I&amp;T, and presenting with a significant decrease until the patients discharge. The median peak concentration for [<sup>177</sup>Lu]Lu-PSMA-I&amp;T was four-fold higher than for the [<sup>177</sup>Lu]Lu-DOTA-TOC group. For PSMA-patients, the BHL was 14&#xa0;h and the mean AUC was 895 kBqh/ml. For DOTA-TOC patients, these values were 8.5&#xa0;h and 96 kBqh/ml, respectively.</p> Conclusion <p>Salivary radioactivity peaks earlier and at lower levels in [<sup>177</sup>Lu]Lu-DOTA-TOC patients compared to [<sup>177</sup>Lu]Lu-PSMA-I&amp;T, which shows longer retention and ten times higher radioactivity turnover in saliva. However, radiation exposure to medical staff by the patents saliva can be considered minimal.</p> Clinical relevance <p>Salivary radioactivity of patients undergoing <sup>177</sup>Lu-RLT poses minimal risk to oral healthcare workers.</p>

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Radioactivity levels in the saliva of patients undergoing targeted radioligand therapy with [177Lu]Lu-PSMA-I&T and [177Lu]Lu-DOTA-TOC

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  • 发表日期：

    2025年4月11日

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  • Christian Schedeit,
  • Nasir Gözlügöl,
  • Radi Saiyed Alsheikh,
  • Mohamed Shelan,
  • Robert Seifert,
  • Federico Caobelli,
  • Urs Borner,
  • Tateyuki Iizuka,
  • Benoît Schaller,
  • Axel Rominger,
  • Paul Cumming,
  • Ali Afshar-Oromieh,
  • Konstantinos G. Zeimpekis

摘要

Objectives

The number of patients receiving radioligand therapy (RLT) has risen sharply in recent years. This raises concerns about possible risks to dental healthcare workers due to their exposure to the patients and their saliva. We therefore set about to measure the salivary radioactivity in patients undergoing 177Lu–RLT.

Materials and methods

We recruited in-house RLT patients receiving [177Lu]Lu -DOTA-TOC (n = 6) or [177Lu]Lu-PSMA-I&T (n = 14). We measured the radioactivity concentrations in 1 ml saliva samples collected before and 0.5, 2, 4, 21, 27, and 45 h post application of the radioligands, with additional samples collected at 51 and 69 h for [177Lu]Lu-PSMA-I&T patients. The biological half-life (BHL) and area under the curve (AUC) were calculated for the radioactivity of the saliva for both cohorts.

Results

Both cohorts exhibited increases in salivary radioactivity, attaining peaks at 2 h p.i. of [177Lu]Lu-DOTA-TOC and 4 h p.i. of [177Lu]Lu-PSMA-I&T, and presenting with a significant decrease until the patients discharge. The median peak concentration for [177Lu]Lu-PSMA-I&T was four-fold higher than for the [177Lu]Lu-DOTA-TOC group. For PSMA-patients, the BHL was 14 h and the mean AUC was 895 kBqh/ml. For DOTA-TOC patients, these values were 8.5 h and 96 kBqh/ml, respectively.

Conclusion

Salivary radioactivity peaks earlier and at lower levels in [177Lu]Lu-DOTA-TOC patients compared to [177Lu]Lu-PSMA-I&T, which shows longer retention and ten times higher radioactivity turnover in saliva. However, radiation exposure to medical staff by the patents saliva can be considered minimal.

Clinical relevance

Salivary radioactivity of patients undergoing 177Lu-RLT poses minimal risk to oral healthcare workers.