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Bergeron DE, Cessna JT, Broder BA, Pibida L, Fitzgerald RP, DiGiorgio M, Napoli E, Zimmerman BE. Activity standard and calibrations for 227Th with ingrowing progeny. Appl Radiat Isot 2024; 209:111326. [PMID: 38701595 DOI: 10.1016/j.apradiso.2024.111326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/10/2024] [Accepted: 04/10/2024] [Indexed: 05/05/2024]
Abstract
Thorium-227 was separated from its progeny and standardized for activity by the triple-to-double coincidence ratio (TDCR) method of liquid scintillation counting. Confirmatory liquid scintillation-based measurements were made using efficiency tracing with 3H and live-timed anticoincidence counting (LTAC). The separation time and the efficiency of the separation were confirmed by gamma-ray spectrometry. Calibrations for reentrant pressurized ionization chambers, including commercial radionuclide calibrators, and a well-type NaI(Tl) detector are discussed.
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Affiliation(s)
- Denis E Bergeron
- Physical Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD 20899, USA.
| | - Jeffrey T Cessna
- Physical Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - Brittany A Broder
- Physical Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - Leticia Pibida
- Physical Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - Ryan P Fitzgerald
- Physical Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - Morgan DiGiorgio
- Physical Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | | | - Brian E Zimmerman
- Physical Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
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Akakura K, Uemura H, Kawakami S, Yokomizo A, Nakamura M, Nishimura K, Komori T, Ledesma DA. Metastatic castration resistant prostate cancer patients' experience with Radium-223 treatment in Japan. Future Oncol 2024; 20:781-798. [PMID: 38275149 DOI: 10.2217/fon-2023-0870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Aim: We aimed to determine Japanese metastatic castration resistant prostate cancer (CRPC) patients' Ra-223 treatment experience. Patients & methods: Patients answered the Cancer Therapy Satisfaction Questionnaire (CTSQ domains: Satisfaction with Therapy [SWT], Expectations of Therapy [ET], Feelings about Side Effects [FSE]), the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) and the FACT-Bone Pain (FACT-BP) Questionnaire at baseline, during (vists 3 and 5) and after treatment (end of observation; EOO). Results: Data from 72 patients were included. Baseline median CTSQ scores SWT: 66.1 (IQR19.7), ET: 75.0 (IQR45), and FSE 68.8 (IQR 34.4) were unchanged during vists 3 and 5, but the SWT (-3.57 [IQR17.9]) and ET (-5.0 [IQR30]) decreased while FSE was unchanged (0.0 [IQR31.25]) at EOO. The median MAX-PC (18.0 [IQR 49]) score was unchanged (0.0, IQR 6) while the median FACT BP (54.0 [IQR13]) score decreased by -1.0 (IQR 8) at EOO. Conclusion: Japanese metastatic castration resistant prostate cancer patients' experience is stable during Ra-223 treatment.
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Affiliation(s)
| | - Hiroji Uemura
- Yokohama City University Medical Center, Yokohama, Japan
| | - Satoru Kawakami
- Saitama Medical Center, Saitama Medical University, Saitama, Japan
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3
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Kozempel J, Sakmár M, Janská T, Vlk M. Study of 213Bi and 211Pb Recoils Release from 223Ra Labelled TiO 2 Nanoparticles. Materials (Basel) 2022; 16:343. [PMID: 36614682 PMCID: PMC9821810 DOI: 10.3390/ma16010343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
Nanoparticles of various materials were proposed as carriers of nuclides in targeted alpha particle therapy to at least partially eliminate the nuclear recoil effect causing the unwanted release of radioactive progeny originating in nuclear decay series of so-called in vivo generators. Here, we report on the study of 211Pb and 211Bi recoils release from the 223Ra surface-labelled TiO2 nanoparticles in the concentration range of 0.01-1 mg/mL using two phase separation methods different in their kinetics in order to test the ability of progeny resorption. We have found significant differences between the centrifugation and the dialysis used for labelled NPs separation as well as that the release of 211Pb and 211Bi from the nanoparticles also depends on the NPs dispersion concentration. These findings support our previously proposed recoils-retaining mechanism of the progeny by their resorption on the NPs surface. At the 24 h time-point, the highest overall released progeny fractions were observed using centrifugation (4.0% and 13.5% for 211Pb and 211Bi, respectively) at 0.01 mg/mL TiO2 concentration. The lowest overall released fractions at the 24 h time-point (1.5% and 2.5% for 211Pb and 211Bi respectively) were observed using dialysis at 1 mg/mL TiO2 concentration. Our findings also indicate that the in vitro stability tests of such radionuclide systems designed to retain recoil-progeny may end up with biased results and particular care needs to be given to in vitro stability test experimental setup to mimic in vivo dynamic conditions. On the other hand, controlled and well-defined progeny release may enhance the alpha-emitter radiation therapy of some tumours.
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Abramenkovs A, Hariri M, Spiegelberg D, Nilsson S, Stenerlöw B. Ra-223 induces clustered DNA damage and inhibits cell survival in several prostate cancer cell lines. Transl Oncol 2022; 26:101543. [PMID: 36126563 PMCID: PMC9489499 DOI: 10.1016/j.tranon.2022.101543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 10/24/2022] Open
Abstract
The bone-seeking radiopharmaceutical Xofigo (Radium-223 dichloride) has demonstrated both extended survival and palliative effects in treatment of bone metastases in prostate cancer. The alpha-particle emitter Ra-223, targets regions undergoing active bone remodeling and strongly binds to bone hydroxyapatite (HAp). However, the toxicity mechanism and properties of Ra-223 binding to hydroxyapatite are not fully understood. By exposing 2D and 3D (spheroid) prostate cancer cell models to free and HAp-bound Ra-223 we here studied cell toxicity, apoptosis and formation and repair of DNA double-strand breaks (DSBs). The rapid binding with a high affinity of Ra-223 to bone-like HAp structures was evident (KD= 19.2 × 10-18 M) and almost no dissociation was detected within 24 h. Importantly, there was no significant uptake of Ra-223 in cells. The Ra-223 alpha-particle decay produced track-like distributions of the DNA damage response proteins 53BP1 and ɣH2AX induced high amounts of clustered DSBs in prostate cancer cells and activated DSB repair through non-homologous end-joining (NHEJ). Ra-223 inhibited growth of prostate cancer cells, independent of cell type, and induced high levels of apoptosis. In summary, we suggest the high cell killing efficacy of the Ra-223 was attributed to the clustered DNA damaged sites induced by α-particles.
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Affiliation(s)
- Andris Abramenkovs
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala SE-75185, Sweden
| | - Mehran Hariri
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala SE-75185, Sweden.
| | - Diana Spiegelberg
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala SE-75185, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Sten Nilsson
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Bo Stenerlöw
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala SE-75185, Sweden.
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Liu AJ, Kosiorek HE, Ueberroth BE, Jaeger E, Ledet E, Kendi AT, Tzou K, Quevedo F, Choo R, Moore CN, Ho TH, Singh P, Keole SR, Wong WW, Sartor O, Bryce AH. The impact of genetic aberrations on response to radium-223 treatment for castration-resistant prostate cancer with bone metastases. Prostate 2022; 82:1202-1209. [PMID: 35652618 DOI: 10.1002/pros.24375] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Radium (Ra)-223 is an established treatment option for patients with metastatic castrate-resistant prostate cancer (mCRPC) who have symptomatic bone metastases without soft tissue disease. Studies have indicated genetic aberrations that regulate DNA damage response (DDR) in prostate cancer can increase susceptibility to treatments such as poly ADP-ribose polymerase inhibitors and platinum-based therapies. This study aims to evaluate mCRPC response to Ra-223 stratified by tumor genomics. METHODS This is a retrospective study of mCRPC patients who received Ra-223 and genetic testing within the Mayo Clinic database (Arizona, Florida, and Minnesota) and Tulane Cancer Center. Patient demographics, genetic aberrations, treatment responses in terms of alkaline phosphatase (ALP) and prostate-specific antigen (PSA), and survival were assessed. Primary end points were ALP and PSA response. Secondary end points were progression-free survival (PFS) and overall survival (OS) from time of first radium treatment. RESULTS One hundred and twenty-seven mCRPC patients treated with Ra-223 had germline and/or somatic genetic sequencing. The median age at time of diagnosis and Ra-223 treatment was 61.0 and 68.6 years, respectively. Seventy-nine (62.2%) had Gleason score ≥ 8 at time of diagnosis. 50.4% received prior docetaxel, and 12.6% received prior cabazitaxel. Notable alterations include TP53 (51.7%), BRCA 1/2 (15.0%), PTEN (13.4%), ATM (11.7%), TMPRSS2-ERG (8.2%), RB deletion (3.4%), and CDK12 (1.9%). There was no significant difference in ALP or PSA response among the different genetic aberrations. Patients with a TMPRSS2-ERG mutation exhibited a trend toward lower OS 15.4 months (95% confidence interval [CI] 10.0-NR) versus 26.8 months (95% CI 20.9-35.1). Patients with an RB deletion had a lower PFS 6.0 months (95% CI 1.28-NR) versus 9.0 months (95% CI 7.3-11.1) and a lower OS 13.9 months (95% CI 5.2-NR) versus 26.5 months (95% CI 19.8-33.8). CONCLUSIONS Among mCRPC patients treated with Ra-223 at Mayo Clinic and Tulane Cancer Center, we did not find any clear negative predictors of biochemical response or survival to treatment. TMPRSS2-ERG and RB mutations were associated with a worse OS. Prospective studies and larger sample sizes are needed to determine the impact of genetic aberrations in response to Ra-223.
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Affiliation(s)
- Alex J Liu
- Mayo Clinic Cancer Center, Phoenix, Arizona, USA
| | - Heidi E Kosiorek
- Mayo Clinic Division of Biomedical Statistics and Informatics, Phoenix, Arizona, USA
| | | | - Ellen Jaeger
- Tulane Cancer Center, New Orleans, Louisiana, USA
| | - Elisa Ledet
- Tulane Cancer Center, New Orleans, Louisiana, USA
| | - Ayse T Kendi
- Mayo Clinic Department of Radiology, Rochester, Minnesota, USA
| | | | | | - Richard Choo
- Mayo Clinic Cancer Center, Rochester, Minnesota, USA
| | | | - Thai H Ho
- Mayo Clinic Cancer Center, Phoenix, Arizona, USA
| | | | | | | | | | - Alan H Bryce
- Mayo Clinic Cancer Center, Phoenix, Arizona, USA
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Shimada T, Izumi K, Kano H, Kadomoto S, Makino T, Naito R, Iwamoto H, Yaegashi H, Kadono Y, Mizokami A. Ra-223 and Ethinylestradiol Combination Therapy in Castration-resistant Prostate Cancer. Anticancer Res 2022; 42:1065-1071. [PMID: 35093908 DOI: 10.21873/anticanres.15568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Ra-223 is a therapeutic agent for bone metastatic castration-resistant prostate cancer (mCRPC). We examined the efficacy of a treatment method using Ra-223 together with ethinylestradiol (EE). PATIENTS AND METHODS Patients who received Ra-223 three or more times were included and two groups (with or without EE) were compared retrospectively. RESULTS Eighteen patients were treated with Ra-223 and EE concomitantly (EstRadium therapy) and 13 patients were treated with Ra-223 alone or Ra-223 and agents other than EE (non-EstRadium therapy). The number of patients with decreased serum prostate-specific antigen level was significantly higher in the EstRadium therapy group than in the non-EstRadium therapy group (p=0.029). CONCLUSION The combination of Ra-223 and EE, compared to Ra-223 alone, is an effective treatment option for bone mCRPC patients, in terms of PSA response.
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Affiliation(s)
- Takafumi Shimada
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroshi Kano
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Suguru Kadomoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Tomoyuki Makino
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Renato Naito
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Ostheim P, Miederer M, Schreckenberger M, Nestler T, Hoffmann MA, Lassmann M, Eberlein U, Barsegian V, Rump A, Majewski M, Port M, Abend M. mRNA and small RNA gene expression changes in peripheral blood to detect internal Ra-223 exposure. Int J Radiat Biol 2021; 98:900-912. [PMID: 34882512 DOI: 10.1080/09553002.2021.1998705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Excretion analysis is the established method for detection of incorporated alpha-emitting radionuclides, but it is laborious and time consuming. We sought a simplified method in which changes in gene expression might be measured in human peripheral blood to detect incorporated radionuclides. Such an approach could be used to quickly determine internal exposure in instances of a radiological dispersal device or a radiation accident. MATERIALS AND METHODS We evaluated whole blood samples from five patients with castration-resistant prostate cancer and multiple bone metastases (without visceral or nodal involvement), who underwent treatment with the alpha emitting isotope Radium-223 dichloride (Ra-223, Xofigo®). Patients received about 4 MBq per cycle and, depending on survival and treatment tolerance, were followed for six months. We collected 24 blood samples approximately monthly corresponding to treatment cycle. RESULTS Firstly, we conducted whole genome screening of mRNAs (mRNA seq) and small RNAs (small RNA seq) using next generation sequencing in one patient at eight different time points during all six cycles of Ra-223-therapy. We identified 1900 mRNAs and 972 small RNAs (222 miRNAs) that were differentially up- or down-regulated during follow-up after the first treatment with Ra-223. Overall candidate RNA species inclusion criteria were a general (≥|2|-fold) change or with peaking profiles (≥|5|-fold) at specific points in time. Next we chose 72 candidate mRNAs and 101 small RNAs (comprising 29 miRNAs) for methodologic (n = 8 samples, one patient) and independent (n = 16 samples, four patients) validation by qRT-PCR. In total, 15 mRNAs (but no small RNAs) were validated by methodologic and independent testing. However, the deregulation occurred at different time points, showing a large inter-individual variability in response among patients. CONCLUSIONS This proof of concept provides support for the applicability of gene expression measurements to detect internalized alpha-emitting radionuclides, but further work is needed with a larger sample size. While our approach has merit for internal deposition monitoring, it was complicated by the severe clinical condition of the patients we studied.
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Affiliation(s)
| | - Matthias Miederer
- Clinic and Polyclinic for Nuclear Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mathias Schreckenberger
- Clinic and Polyclinic for Nuclear Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Tim Nestler
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Manuela A Hoffmann
- Clinic and Polyclinic for Nuclear Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Department of Occupational Health & Safety, Federal Ministry of Defense, Bonn, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Uta Eberlein
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Vahe Barsegian
- Institute of Nuclear Medicine, Helios Kliniken, Schwerin, Germany
| | - Alexis Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Mattháus Majewski
- Bundeswehr Institute of Radiobiology, Munich, Germany.,Department of Urology, Armed Services Hospital Ulm, Ulm, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - Michael Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
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Akakura K, Uemura H, Miyazaki K, Stroupe A, Seo C, Uzumcu A, Ledesma DA. A qualitative research study in Japan investigating patients' experience with metastatic castration-resistant prostate cancer: from diagnosis to decision for Ra-223 treatment. Future Oncol 2021; 17:5103-5118. [PMID: 34664992 DOI: 10.2217/fon-2021-0773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This qualitative study aimed to reveal symptoms and impacts among bone metastatic castration-resistant prostate cancer (or mCRPC) Japanese patients, prior to Radium-223 (Ra-223) treatment. Materials & Methods: Twenty-three mCRPC patients designated to receive Ra-223 and three treating physicians (Ra-223 prescribers) in Japan, were interviewed. All interview data were assessed for concept frequency, themes and saturation. Results: Forty-five percent of the patients (mean age: 75.8 years) were symptomatic at the time of enrollment. Interviews with all patients revealed 47 mCRPC symptoms, including back pain and bone-specific pain, and 45 life impacts, including worry about disease progression and the impact on daily, physical activities. Conclusion: The symptoms and impacts of living with mCRPC and the associated burden of bone metastasis and skeletal-related symptoms are varied and are important considerations for treatment.
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Affiliation(s)
- Koichiro Akakura
- Department of Urology, Japan Community Health Care Organization (JCHO) Tokyo Shinjuku Medical Center, 5-1 Tsukudo-cho, Shinjuku, 162-8543, Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Kikuko Miyazaki
- School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Angela Stroupe
- Patient-Centered Outcomes, Open Health, Newton, MA 02458, USA
| | - Caroline Seo
- Patient-Centered Outcomes, Open Health, Bethesda, MD 20814, USA
| | - Alyssa Uzumcu
- Patient-Centered Outcomes, Open Health, Newton, MA 02458, USA
| | - Dianne A Ledesma
- Market Access Oncology, Bayer Yakuhin, Ltd, Marunouchi 1-6-5, Chiyoda-ku, Tokyo, 100-8265, Japan
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Wanke C, Pinkert J, Szermerski B, Geworski L. Assessment of the radiation exposure of relatives and caregivers of patients treated with Ra-223 - Results of a German multicenter study. Z Med Phys 2020; 31:58-64. [PMID: 33309149 DOI: 10.1016/j.zemedi.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/05/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022]
Abstract
A multicenter study was conducted to assess the radiation exposure of relatives and caregivers of patients suffering from castration resistant prostate cancer with bone metastases and treated with Ra-223 dichloride in an outpatient setting. As Ra-223 and most of its progeny emit alpha particles, especially the internal exposure of persons in the patient's vicinity had to be evaluated. METHODS The external radiation was measured in distances of 1 m and 2 m. Wipe-tests were taken in the patients' homes to identify significant contaminations and evaluated by liquid scintillation counting. Samples of saliva and sweat were taken and measured using gamma spectrometry. RESULTS The external exposure from the patients measured 10-20min post injection (p. i.) was<0.080μSv/h in median in 1 m distance (range: below decision threshold (<DT) - 0.208μSv/h). Ra-223 was found in saliva (median 20-30 min p. i.: 27 Bq/g, range: 12.6 - 110 Bq/g) and excreted with sweat (median: 0.121 Bq/cm2, range: 0.020 - 0.524 Bq/cm2) in the first 24h p. i. Contaminations in restrooms and kitchens were low (median: 0.026 - 0.215 mBq/cm2, depending on location; range:<DT - 2.1 mBq/cm2). CONCLUSIONS The potential exposure of relatives by external irradiation and incorporation of Ra-223 excreted by the patient with saliva or sweat is estimated to be well below 1 mSv. No objections are seen regarding outpatient treatment.
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Affiliation(s)
- Carsten Wanke
- Department for Radiation Protection and Medical Physics, Hannover Medical School, Hannover, Germany.
| | | | - Bastian Szermerski
- Department for Radiation Protection and Medical Physics, Hannover Medical School, Hannover, Germany
| | - Lilli Geworski
- Department for Radiation Protection and Medical Physics, Hannover Medical School, Hannover, Germany
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Dionísio MR, Mansinho A, Abreu C, Cavaco‐Silva J, Casimiro S, Costa L. Clinical and translational pharmacology of drugs for the prevention and treatment of bone metastases and cancer-induced bone loss. Br J Clin Pharmacol 2019; 85:1114-1124. [PMID: 30601585 PMCID: PMC6533479 DOI: 10.1111/bcp.13852] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/22/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023] Open
Abstract
Bone disease is a frequent event in cancer patients, both due to cancer spread to bone and to cancer therapies. Bone is the organ most frequently affected by metastatic disease when considering the two most frequent cancers in the Western world (breast and prostate cancers). Bone metastases can have a substantial detrimental effect on patients' quality of life, as well as significant morbidity due to complications collectively known as skeletal-related events (SREs), which include hypercalcaemia, pathological fractures, spinal cord compression, and need of radiotherapy or surgery to the bone. These have been successfully mitigated with the development of bone-targeted agents (BTAs; bisphosphonates and denosumab), focused on inhibiting osteoclast activity. The potential direct antitumour effect of bisphosphonates, as well as the impact of osteoclast inhibition with subsequent decrease in bone metabolism, have also propelled investigation on the role of BTAs in preventing cancer relapse in bone. In this review, the authors aimed to discuss the role of BTAs in the treatment and prevention of bone metastases, as well as their potential value in preventing cancer treatment-induced bone loss (CTIBL). The review will focus on breast and prostate cancers, with the aim of providing the most relevant clinical data emerging from bench to bedside translational research in the field of cancer-induced bone disease.
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Affiliation(s)
| | - André Mansinho
- Oncology DivisionHospital de Santa Maria – CHLNLisbonPortugal
| | - Catarina Abreu
- Oncology DivisionHospital de Santa Maria – CHLNLisbonPortugal
| | | | - Sandra Casimiro
- Luis Costa LabInstituto de Medicina Molecular, Faculdade de Medicina da Universidade de LisboaLisbonPortugal
| | - Luís Costa
- Oncology DivisionHospital de Santa Maria – CHLNLisbonPortugal
- Luis Costa LabInstituto de Medicina Molecular, Faculdade de Medicina da Universidade de LisboaLisbonPortugal
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Dionisi V, Bellarosa C, Cardano R, Rizzini EL, Ghedini P, Morganti AG, Fanti S, Monari F. Use of Radium-223 Dichloride in Patients With Osteonecrosis of the Jaw Induced by Zoledronic Acid: Report of 2 Cases. Clin Genitourin Cancer 2019; 17:e612-e617. [PMID: 30956096 DOI: 10.1016/j.clgc.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Valeria Dionisi
- Radiation Oncology Center, S. Orsola-Malpighi Hospital, Bologna, Italy; DIMES University of Bologna, Bologna, Italy.
| | - Chiara Bellarosa
- Radiation Oncology Center, S. Orsola-Malpighi Hospital, Bologna, Italy; DIMES University of Bologna, Bologna, Italy
| | - Raffaele Cardano
- Radiation Oncology Center, S. Orsola-Malpighi Hospital, Bologna, Italy; DIMES University of Bologna, Bologna, Italy
| | - Elisa Lodi Rizzini
- DIMES University of Bologna, Bologna, Italy; Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Pietro Ghedini
- DIMES University of Bologna, Bologna, Italy; Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology Center, S. Orsola-Malpighi Hospital, Bologna, Italy; DIMES University of Bologna, Bologna, Italy
| | - Stefano Fanti
- DIMES University of Bologna, Bologna, Italy; Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Fabio Monari
- Radiation Oncology Center, S. Orsola-Malpighi Hospital, Bologna, Italy
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Hosono M, Ikebuchi H, Nakamura Y, Yanagida S, Kinuya S. Introduction of the targeted alpha therapy (with Radium-223) into clinical practice in Japan: learnings and implementation. Ann Nucl Med 2018; 33:211-221. [PMID: 30484260 PMCID: PMC6397713 DOI: 10.1007/s12149-018-1317-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 11/27/2022]
Abstract
Radium-223 dichloride (Ra-223) is the first targeted alpha therapy approved for the treatment of patients with castration-resistant prostate cancer (CRPC) with bone metastasis. Ra-223 improved overall survival in the international Phase III ALSYMPCA (ALpharadin in SYMPtomatic Prostate Cancer) study. Ra-223 was also demonstrated to be efficacious and safe in Japanese patients in Phase I and Phase II clinical trials. Ra-223 was approved in Japan for the treatment of patients with CRPC with bone metastasis in 2016. The conduct of clinical studies with radionuclides in Japan involves mandatory compliance with local and international regulations pertaining to radiation protection. Without an existing Japanese framework for the handling of α-emitters in clinical practice, we encountered many challenges to initiate the clinical studies. Therefore, we started on a project to determine best practice on the use of Ra-223 in clinical studies. For this project, we evaluated all applicable laws and regulations on the use of radionuclides in medicine, then examined whether and how the α-emitter Ra-223 could meet these legal and regulatory requirements. This included how to approach the matter of discharging patients administered Ra-223 from hospital and radiation protection for caregivers, general public and medical care professionals. Subsequently, we published Manual on the proper use of radium-223 dichloride injection in clinical trials that summarized the essential requirements necessary to allow the safe use of Ra-223 in clinical trials in Japan. As the result, we succeeded in demonstrating that clinical trials of an α-emitter, Ra-223, could be implemented safely in Japan. Our experience in Japan highlights the importance of a multidisciplinary team-based approach and continued professional training in a clinical setting. This article summarizes the rationale behind the development of this manual. We hope that by sharing our experience and information, we can help other countries considering the introduction of radionuclides for clinical use, and support the future development of radionuclide therapies in a safe and effective manner.
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Affiliation(s)
- Makoto Hosono
- Institute of Advanced Clinical Medicine, Department of Radiology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Osaka Prefecture, Japan.
| | - Hideharu Ikebuchi
- Japanese Society of Nuclear Medicine, 2-28-45 Honkomagome, Bunkyo-ku, Tokyo, 113-0021, Japan
| | - Yoshihide Nakamura
- Japan Radioisotope Association, 2-28-45 Honkomagome, Bunkyo-ku, Tokyo, 113-8941, Japan
| | - Sachiko Yanagida
- Japan Radioisotope Association, 2-28-45 Honkomagome, Bunkyo-ku, Tokyo, 113-8941, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Faculty of Medicine, Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Ishikawa Prefecture, Japan
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Straub M, Pittet PA, Amzalag G, Bochud F, Baechler S, Froidevaux P. Determination of 226Ra at low levels in environmental, urine, and human bone samples and 223Ra in bone biopsy using alpha-spectrometry and metrological traceability to 229Th/ 225Ra or 226Ra. Anal Chim Acta 2018; 1031:178-184. [PMID: 30119737 DOI: 10.1016/j.aca.2018.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 10/17/2022]
Abstract
226Ra is a natural radioelement emitting α and γ radiations. It can be highly concentrated in TENORM materials from the petroleum or fertilizer industries. In Switzerland, 226Ra is currently a radioactive inheritance problem from the watch industry. Furthermore, 223Ra is a radium isotope used in nuclear medicine to treat bone metastasis. There exist several methods to measure radium using alpha or gamma spectrometry or using 222Rn emanation technique. The limitations of these methods are due to the required detection limits and the nature of the samples. When using alpha spectrometry to reach very low detection limits, critical technical hitches often arise because of the difficulties in separating radium from barium, in removing organics eluted from the separating chromatography column, and in plating radium. Moreover, overall chemical recovery of radium is often not reproducible, depending on the studies. Here we propose a method that separates radium from other alkaline-earth cations using cation exchange chromatography and selective complex formation by EDTA and DCTA. Radium is completely free of the 229Th tracer and its daughter products, particularly 225Ac. Organics from the column are removed in a further purification step so that radium can be plated with acceptable yields in a HCl/HNO3/ethanol solution. We successfully applied the method to soil, water, urine and human bone samples and further extended it to the determination of 223Ra in a bone biopsy, using 226Ra as an internal tracer.
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Affiliation(s)
- Marietta Straub
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre-André Pittet
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Gaël Amzalag
- Department of Medical Imaging, Division of Nuclear Medicine, Neuchatel Hospital, La Chaux-de-Fonds, Switzerland
| | - François Bochud
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Sébastien Baechler
- Division of Radiation Protection, Federal Office of Public Health, Bern, Switzerland
| | - Pascal Froidevaux
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland.
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Costa RP, Bordonaro S, Cappuccio F, Tripoli V, Murabito A, Licari M, Valerio MR, Tralongo P. Hematologic toxicity of radium-223 in elderly patients with metastatic Castration Resistant Prostate Cancer: a real-life experience. Prostate Int 2018; 7:25-29. [PMID: 30937295 PMCID: PMC6424691 DOI: 10.1016/j.prnil.2018.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/21/2018] [Accepted: 08/27/2018] [Indexed: 11/15/2022] Open
Abstract
Background Treatment with radium-223 has been shown to increase survival and to delay skeletal events related to bone metastases of patients with metastatic Castration Resistant Prostate Cancer (mCRPC). This treatment has also proved to be well tolerated, and hematological toxicity, in particular anemia, represents the most represented adverse event. Materials and methods We evaluated the hematologic toxicity of Ra-223 treatment in a real-life experience of 38 patients from two Italian cancer centers, with bone metastases from mCRPC. The main endpoint of the study was the evaluation of the efficacy and tolerability of treatment with radium-223, with greater reference to hematological toxicity (especially anemia) as the cause of interruption of treatment, specifically in the elderly patient. Results From August 2016 to October 2017, a total of 38 consecutive nonselected patients, 20 of them aged >75 years, with mCRPC symptomatic bone metastases, were enrolled for radium-223 at standard doses. Hematologic adverse events were recorded more frequently (72.4% with AE), and 36.8% had anemia. The most frequent cause of treatment discontinuation due to AEs was anemia [8/10 patients (80%)], followed by thrombocytopenia (2 patients) and neutropenia (1 patient). Hematologic AEs were more represented in elderly patients with greater disease burden and previously treated with docetaxel. Conclusions Anemia is the most represented AE related to radium-223 treatment in elderly patients with greater disease burden and previously treated with docetaxel, besides representing the main reason for interruption of treatment. Correct patient selection, appropriate timing, and adequate supportive care are elements that could facilitate successful treatment with radium-223, preventing premature interruption of the same. The results of this experience support the opportunity to propose treatment with radium-223 mostly in patients in the earliest stages.
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Affiliation(s)
- Renato P. Costa
- Division of Radioisotopic Clinical Diagnostic, University Hospital “P. Giaccone”, Palermo, Italy
| | | | | | - Vincenzo Tripoli
- Division of Radioisotopic Clinical Diagnostic, University Hospital “P. Giaccone”, Palermo, Italy
| | - Alessandra Murabito
- Division of Radioisotopic Clinical Diagnostic, University Hospital “P. Giaccone”, Palermo, Italy
| | - Maria Licari
- Division of Radioisotopic Clinical Diagnostic, University Hospital “P. Giaccone”, Palermo, Italy
| | - Maria R. Valerio
- Division of Oncology, University Hospital “P. Giaccone”, Palermo, Italy
| | - Paolo Tralongo
- Division of Oncology, “Umberto I” Hospital – RAO, Siracusa, Italy
- Corresponding author. Division of Oncology, “Umberto I” Hospital – RAO – Siracusa, Via Testaferrata, 1, Siracusa, Italy.
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Osvaldo GPF, Salvador MOS, Zael SR, Nora SM. Radium-223 IN metastatic hormone-sensitive high-grade prostate cancer: initial experience. Am J Nucl Med Mol Imaging 2017; 7:236-245. [PMID: 29181271 PMCID: PMC5698617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
Our study evaluates the feasibility of compassionate exemption of Radium-223 (223Ra) treatment in metastatic hormone-sensitive high-grade prostate cancer (mHSHGPC) patients with concomitant androgen deprivation-therapy (ADT). Seven patients with mHSHGPC, were treated with six cycles of 223Ra plus ADT. All patients had undergone to 18F-NaF-PET/CT. A qualitative analyses of the 18F-NaF-PET/CT was performed in conjunction with Alkaline Phosphatase (ALP), Lactate-dehydrogenase (LDH) and Prostatic-Specific Antigen (PSA) values. The mean of SUVmax values were used as a quantitative measure of tumoral burden. Changes in PSA, ALP, LDH from baseline were evaluated, and were defined as increase or decrease of at least 30%. Clinical response was achieved if there was pain reduction using visual analogic scale. Four patients showed a significant reduction in mean SUVmax after 3 cycles of 223Ra, and one after 6 cycles. Patients who showed reductions in mean SUVmax after Ra-223 also showed reductions in PSA, ALP and LDH. Four weeks after the last cycle of 223Ra all patients had decreased total PSA, ALP and LDH values ≥ 30% also significant improvement on pain. No progress disease was documented after 14 ± 4 weeks. We found slight to moderate decreases in neutrophils and hemoglobin in two patients. We concluded that 223Ra plus ADT can be useful in mHSHGPC; the semi-quantitative 18F-NaF-PET/CT as a method effective to monitor the treatment response. Due to concomitant administration of ADT, 18F-NaF-PET/CT cannot differentiate whether the findings were due to androgen blockade or the 223Ra; nevertheless, data supporting the efficacy of 223Ra is the significant improvement on pain.
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Affiliation(s)
| | | | - Santana-Ríos Zael
- Urologic Malignances Department, Instituto Nacional de CancerologíaMexico City, Mexico
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Owaki Y, Nakahara T, Kosaka T, Fukada J, Kumabe A, Ichimura A, Murakami M, Nakajima K, Fukushi M, Inoue K, Oya M, Jinzaki M. Ra-223 SPECT for semi-quantitative analysis in comparison with Tc-99m HMDP SPECT: phantom study and initial clinical experience. EJNMMI Res 2017; 7:81. [PMID: 28975570 PMCID: PMC5626671 DOI: 10.1186/s13550-017-0330-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 09/25/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Image-based measurement of absorbed dose of Ra-223 dichloride may be useful in predicting therapeutic outcome in patients with castration-resistant prostate cancer (CRPC). In general, SPECT has been found to be more accurate than planar imaging in terms of lesion-based analysis. The aims of this study were to assess the feasibility and clinical usefulness of Ra-223 SPECT. The energy spectrum of Ra-223 and SPECT images of a cylindrical phantom with a hot rod were obtained to determine the collimator candidates and energy window settings suitable for clinical Ra-223 SPECT (basic study A). Another phantom with a tube-shaped chamber and two spheres simulating bowel activity and metastatic lesions in the lumbar spine was scanned with medium-energy general-purpose (MEGP) and high-energy general-purpose (HEGP) collimators (basic study B). Ten patients with CRPC underwent SPECT imaging 2 h after Ra-223 injection successively with MEGP and HEGP collimators in random order for 30 min each. Lesion detectability and semi-quantitative analyses of bone metastasis (i.e. lesion-to-background ratio (LBR)) were performed compared to Tc-99m HMDP SPECT. RESULTS Basic study A revealed that an 84-keV photopeak ± 20% using the HEGP collimator offers better SPECT image quality than the other imaging conditions. Basic study B showed that uptake in one of the spheres was overestimated by overlapped activity of the tube-shaped chamber in planar imaging whereas the spheres had similar counts and significantly higher sphere-to-background ratio in SPECT. On both planar and SPECT images, HEGP gave higher image contrast than MEGP (p < 0.01). In the clinical study, Ra-223 SPECT at 84 keV ± 20% depicted more lesions with the HEGP than with the MEGP collimator (51 vs 36, p = 0.013). There was a positive correlation between LBR in Tc-99m SPECT and in Ra-223 SPECT (r = 0.67 with the MEGP and 0.69 with the HEGP collimator, p < 0.01). LBRs were significantly higher with the HEGP than with the MEGP collimator (p < 0.01). CONCLUSIONS We recommended the use of the HEGP collimator at 84 keV ± 20% for Ra-223 SPECT imaging. Lesion-based semi-quantitative analysis in the human study revealed a good correlation between Ra-223 and Tc-99m HMDP SPECT in the early phase (2-3 h post injection).
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Affiliation(s)
- Yoshiki Owaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Radiological Sciences, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo, 116-8551, Japan
| | - Tadaki Nakahara
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Junichi Fukada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Atsuhiro Kumabe
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Akira Ichimura
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mikoto Murakami
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kiyotaka Nakajima
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masahiro Fukushi
- Department of Radiological Sciences, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo, 116-8551, Japan
| | - Kazumasa Inoue
- Department of Radiological Sciences, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo, 116-8551, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Du Y, Carrio I, De Vincentis G, Fanti S, Ilhan H, Mommsen C, Nitzsche E, Sundram F, Vogel W, Oyen W, Lewington V. Practical recommendations for radium-223 treatment of metastatic castration-resistant prostate cancer. Eur J Nucl Med Mol Imaging 2017; 44:1671-1678. [PMID: 28631036 PMCID: PMC5537325 DOI: 10.1007/s00259-017-3756-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/07/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Radium Ra 223 dichloride (radium-223, Xofigo®) is the first targeted alpha therapy for patients with castration-resistant prostate cancer and symptomatic bone metastases. Radium-223 provides a new treatment option for this setting, but also necessitates a new treatment management approach. We provide straightforward and practical recommendations for European nuclear medicine centres to optimize radium-223 service provision. METHODS An independent research consultancy agency observed radium-223 procedures and conducted interviews with all key staff members involved in radium-223 treatment delivery in 11 nuclear medicine centres across six countries (Germany, Italy, the Netherlands, Spain, Switzerland and the UK) experienced in administering radium-223. The findings were collated and discussed at a meeting of experts from these centres, during which key consensus recommendations were defined. RESULTS The recommendations cover centre organization and preparation; patient referral; radium-223 ordering, preparation and disposal; radium-223 treatment delivery/administration; and patient experience. Guidance includes structured coordination and communication within centres and multidisciplinary teams, focusing on sharing best practice to provide high-quality, patient-centred care throughout the treatment pathway. CONCLUSIONS These expert recommendations are intended to complement existing management guidelines. Sharing best practice and experience will help nuclear medicine centres to optimize radium-223 service provision and improve patient care.
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Affiliation(s)
- Yong Du
- Department of Nuclear Medicine & PET/CT, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
| | | | | | | | - Harun Ilhan
- Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Caroline Mommsen
- Praxis für diagnostische und therapeutische Nuklearmedizin Berlin, Berlin, Germany
| | | | - Francis Sundram
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Wouter Vogel
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Wim Oyen
- Department of Nuclear Medicine & PET/CT, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
- The Institute of Cancer Research, London, UK
| | - Val Lewington
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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