Prostate-specific membrane antigen positron emission tomography/computed tomography as a potential tool to assess and guide salivary gland irradiation

•PSMA PET/CT allows visualisation of salivary glands with good spatial and contrast resolution.•Evaluable glands include minor and less well-known gland locations.•PSMA PET/CT can visualise damage to salivary glands from external beam radiotherapy.•PSMA PET/CT has the potential to guide optimisation of radiotherapy to the head and neck.•The potential benefit of PSMA PET/CT is to avoid salivary gland toxicity and preserve quality of life. Evaluation of salivary gland damage after head and neck radiotherapy (RT) is difficult with current tools, such as subjective patient-reported outcome measures. We demonstrate the use of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) as an objective non-invasive tool to visualize damage to salivary glands resulting from RT. In three clinical cases, the PSMA-ligand distribution correlates to the RT dose distribution including intra-gland dose gradients and matches patient-reported toxicity, suggesting a dose-response relation. These findings support further exploration of PSMA PET/CT to guide and evaluate RT, with the ultimate aim to reduce salivary gland toxicity.