Optimization of Radium-223 Treatment of Castration-resistant Prostate Cancer Based on the Burden of Skeletal Metastasis and Clinical Parameters

Ahmad Shariftabrizi; Shalin Kothari; Saby George; Kristopher Attwood; Ellis Levine; Dominick Lamonica

doi:10.1093/oncolo/oyac245

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Optimization of Radium-223 Treatment of Castration-resistant Prostate Cancer Based on the Burden of Skeletal Metastasis and Clinical Parameters

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Optimization of Radium-223 Treatment of Castration-resistant Prostate Cancer Based on the Burden of Skeletal Metastasis and Clinical Parameters

Ahmad Shariftabrizi, Shalin Kothari, Saby George, Kristopher Attwood, Ellis Levine and Dominick Lamonica

The oncologist (Dayton, Ohio), Vol.28(3), pp.246-251

03/2023

DOI: 10.1093/oncolo/oyac245

PMCID: PMC10020806

PMID: 36651837

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Abstract

Radium-223 dichloride (Ra-223) is now frequently used to treat prostate cancer that has metastasized to bone, although patient selection continues to be suboptimal for determining who will benefit most from this novel treatment modality. Seventy-nine patients with metastatic castration-resistant prostate cancer (mCRPC) were treated with Ra-223 from 2012 to 2016. The burden of skeletal metastasis was determined for each using the Bone Scan Index (BSI) as a ratio of diseased to normal bone. Clinical, laboratory, and survival data were collected and examined for associations with BSI, and treatment tolerability was assessed. Chemotherapy-naïve patients were significantly more likely to complete the full course of treatment. Median follow-up was 31 months (range 0.7-38.8 months) and median overall survival was 15.4 months (range 9.5-20.6 months). Overall survival was significantly associated with findings on bone scans (P < .05). Patients with higher BSI tended toward poorer outcomes. Nearly half the patients with low baseline BSI survived 3 years or more following Ra-223 treatment. By contrast, only 20% of the patients with high baseline BSI lived for 1 year, and none lived for an additional 3. Baseline BSI was significantly associated with decreased hemoglobin, higher serum PSA and alkaline phosphatase levels, and treatment-associated reductions in platelet and absolute neutrophil counts. Our results suggest better outcomes to Ra-223 therapy for patients who are chemotherapy-naïve and who undergo treatment earlier in the course of their disease as reflected by low BSI and concordant laboratory parameters.

radium-223

quantitative bone scan

castration-resistant prostate cancer

Details

Title: Subtitle: Optimization of Radium-223 Treatment of Castration-resistant Prostate Cancer Based on the Burden of Skeletal Metastasis and Clinical Parameters
Creators: Ahmad Shariftabrizi - Roswell Park Cancer Institute
Shalin Kothari - Yale University
Saby George - Roswell Park Cancer Institute
Kristopher Attwood - Roswell Park Cancer Institute
Ellis Levine - Roswell Park Cancer Institute
Dominick Lamonica - Roswell Park Cancer Institute
Resource Type: Journal article
Publication Details: The oncologist (Dayton, Ohio), Vol.28(3), pp.246-251
DOI: 10.1093/oncolo/oyac245
PMID: 36651837
PMCID: PMC10020806
NLM abbreviation: Oncologist
ISSN: 1083-7159
eISSN: 1549-490X
Grant note: Roswell Park Cancer Institute P30CA016056 / NCI NIH HHS
Language: English
Electronic publication date: 01/18/2023
Date published: 03/2023
Academic Unit: Radiology
Record Identifier: 9984360002302771

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