Radium Ra-223 dichloride (radium-223, Xofigo®) is a targeted alpha
therapy approved for the treatment of
castration-resistant
prostate cancer (CRPC) with symptomatic bone
metastases and no known visceral metastatic disease.
Radium-223 is the first targeted alpha
therapy in this indication providing a new treatment option, with evidence of a significant survival benefit, both in overall survival and in the time to the first symptomatic skeletal-related event. The skeleton is the most common metastatic site in patients with advanced
prostate cancer. Bone
metastases are a clinically significant cause of morbidity and mortality, often resulting in bone
pain,
pathologic fracture, or
spinal cord compression necessitating treatment.
Radium-223 is selectively accumulated in the bone, specifically in areas of high bone turnover, by forming complexes with the
mineral hydroxyapatite (the inorganic matrix of the bone). The alpha radiation generated during the radioactive decay of
radium-223 produces a palliative anti-tumour effect on the bone
metastases. The purpose of this guideline is to assist nuclear medicine specialists in evaluating patients who might be candidates for treatment using
radium-223, planning and performing this treatment, understanding and evaluating its consequences, and improving patient management during
therapy and follow-up.