Al-Ibraheem Akram, Moghrabi Serin, Sathekge Mike Machaba, Abdlkadir Ahmed Saad
Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Queen Rania Street Al Jubeiha, Amman, 11941, Jordan.
School of Medicine, The University of Jordan, Amman, 11942, Jordan.
Eur J Nucl Med Mol Imaging. 2025 Feb 22. doi: 10.1007/s00259-025-07168-4.
This systematic review and meta-analysis evaluates xerostomia occurrence in prostate cancer (PC) patients undergoing [Ac]Ac-prostate-specific membrane antigen ([Ac]Ac-PSMA) therapy.
Following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines, comprehensive electronic searches were conducted across PubMed, Scopus, and Web of Science. The study included articles addressing xerostomia as a side effect of [Ac]Ac-PSMA therapy in clinical settings, encompassing both tandem and monotherapy strategies. Methodological quality was assessed using the National Institutes of Health (NIH) Assessment Tool. Stata software was employed to perform pooled xerostomia rates, heterogeneity analysis, meta-regression, and publication bias analysis.
Twenty studies met inclusion criteria, comprising 2949 [Ac]Ac-PSMA cycles administered to 1207 PC patients. For [Ac]Ac-PSMA monotherapy, the pooled rate of any-grade xerostomia was 84% (95%CI: 69-94%). Grade 1-2 xerostomia had a pooled rate 83% (95%CI: 71-93%), while therapy discontinuation due to xerostomia was 5% (95%CI: 0-13%). Grade 3 xerostomia was evident in 13% (95%CI: 7-20%). [Ac]Ac/[Lu]Lu-PSMA tandem therapy resulted in lower pooled rate of 68% for grade 1-2 toxicity (95%CI: 17-100%). Indirect comparison revealed a two-fold decrease in xerostomia risk with tandem protocol compared to monotherapy. Significant heterogeneity was observed, primarily influenced by baseline median prostate-specific antigen values (p = 0.04). Publication bias was present in most xerostomia subgroups, with trim-and-fill analysis adjusting for effect size in specific categories.
Xerostomia is most pronounced in patients undergoing [Ac]Ac-PSMA monotherapy. Tandem approach with [Lu]Lu-PSMA could reduce xerostomia rates and improve compliance. Further large-scale, prospective studies are necessary for generalization and result consolidation.
本系统评价和荟萃分析评估接受[锕]锕-前列腺特异性膜抗原（[锕]锕-PSMA）治疗的前列腺癌（PC）患者口干症的发生率。
按照系统评价和荟萃分析方案的首选报告项目（PRISMA-P）指南，在PubMed、Scopus和科学网进行了全面的电子检索。该研究纳入了在临床环境中探讨口干症作为[锕]锕-PSMA治疗副作用的文章，涵盖序贯疗法和单一疗法策略。使用美国国立卫生研究院（NIH）评估工具评估方法学质量。采用Stata软件进行口干症合并发生率、异质性分析、meta回归和发表偏倚分析。
20项研究符合纳入标准，包括对1207例PC患者进行的2949个[锕]锕-PSMA疗程。对于[锕]锕-PSMA单一疗法，任何级别的口干症合并发生率为84%（95%CI：69-94%）。1-2级口干症的合并发生率为83%（95%CI：71-93%），因口干症而停药的比例为5%（95%CI：0-13%）。3级口干症的发生率为13%（95%CI：7-20%）。[锕]锕/[镥]镥-PSMA序贯疗法导致1-2级毒性的合并发生率较低，为68%（95%CI：17-100%）。间接比较显示，与单一疗法相比，序贯方案使口干症风险降低了两倍。观察到显著的异质性，主要受基线前列腺特异性抗原中位数的影响（p = 0.04）。大多数口干症亚组存在发表偏倚，采用修剪填充分析对特定类别中的效应大小进行调整。
口干症在接受[锕]锕-PSMA单一疗法的患者中最为明显。与[镥]镥-PSMA的序贯方法可降低口干症发生率并提高依从性。需要进一步开展大规模前瞻性研究以进行推广和巩固结果。
