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. 2017 Sep;44(10):1671-1678.
doi: 10.1007/s00259-017-3756-7. Epub 2017 Jun 19.

Practical recommendations for radium-223 treatment of metastatic castration-resistant prostate cancer

Yong Du  1 , Ignasi Carrio  2 , Giuseppe De Vincentis  3 , Stefano Fanti  4 , Harun Ilhan  5 , Caroline Mommsen  6 , Egbert Nitzsche  7 , Francis Sundram  8 , Wouter Vogel  9 , Wim Oyen  10   11 , Val Lewington  12
Affiliations

Practical recommendations for radium-223 treatment of metastatic castration-resistant prostate cancer

Yong Du et al. Eur J Nucl Med Mol Imaging. 2017 Sep.

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.

Keywords: Bone metastases; Castration-resistant prostate cancer; Nuclear medicine; Ra-223; Radium dichloride; Targeted alpha therapy.

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Conflict of interest statement

Conflicts of interest

YD: Bayer (financial support for attending symposia and for educational programmes)

IC: has no conflicts to declare

GDV: Bayer (financial support for attending symposia and for educational programmes)

SF: Bayer (honoraria and travel support); Sanofi (honoraria)

HI: Bayer (financial support for attending symposia and has been an advisory board member); Novartis (research funding)

CM: Bayer (advisory board honoraria and consultancy fees)

EN: Bayer (travel expenses and advisory board honoraria)

FS: Bayer (honoraria for speaking at symposia, financial support for attending symposia, and has been an advisory board member)

WV: Bayer (honoraria for participation in advisory board meetings and educational programmes)

WO: Bayer (participation in an advisory board and speakers’ bureau)

VL: Bayer (honoraria for participation in advisory boards, educational meetings and symposia)

Ethical approval

For this type of study, formal consent is not required.

Figures

Fig. 1
Fig. 1
Dual mechanism of action of radium-223. RANKL, receptor activator of nuclear factor kappa-B ligand. Adapted by permission from Macmillan Publishers Ltd.: Nature Reviews Urology (Body et al. [15]), copyright 2015
Fig. 2
Fig. 2
Radium-223 treatment pathway. aDetectable with 99mTc-phosphonate bone scan or 18F-NaF PET/CT scan. CT, computed tomography; F, fluoride; mCRPC, metastatic castration-resistant prostate cancer; NaF, sodium fluoride; NMC, nuclear medicine centre; PET, positron emission tomography; Tc, technetium
See this image and copyright information in PMC

References

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