D Keizman1, M O Fosboel2, H Reichegger3,4, A Peer5, E Rosenbaum6, M-C Desax3,4, V Neiman6, P M Petersen7, J Mueller3,4, R Cathomas8, M Gottfried1, H Dresler1, D Sarid9, W Mermershtain10, K Rouvinov10, J Mortensen2, S Gillessen3,4, G Daugaard7, A Omlin3,4. 1. Genitourinary Oncology Service, Institute of Oncology, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 2. Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. 3. Department of Oncology and Haematology, Kantonsspital St Gallen, St Gallen, Switzerland. 4. Department of Radiology and Nuclear Medicine, Kantonsspital St Gallen, St Gallen, Switzerland. 5. Department of Oncology, Rambam Medical Center, Haifa, Israel. 6. Department of Oncology, Rabin Medical Center, Petah Tikva, Israel. 7. Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. 8. Department of Oncology, Kantonsspital Chur, Chur, Switzerland. 9. Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 10. Department of Oncology, Soroka Medical Center, Beer-Sheva, Israel.
Abstract
BACKGROUND: The imaging response to radium-223 therapy is at present poorly described. We aimed to describe the imaging response to radium-223 treatment. METHODS: We retrospectively evaluated the computed tomography (CT) and bone scintigraphy response of metastatic castration-resistant prostate cancer (CRPC) patients treated with radium-223, in eight centers in three countries. RESULTS: A total of 130 patients were included, the majority (n=84, 65%) received radium-223 post docetaxel. Thirty-four of 99 patients with available data (34%) received concomitant abiraterone or enzalutamide. A total of 54% (n=70) patients completed the planned six injections of radium-223. In patients with available data, a transient increase in bone metastases-related pain was observed in 27% (n=33/124) and an improvement of bone metastases-related pain on treatment with radium-223 was noted in 49% of patients (n=61/124). At 3 and 6 months of treatment with radium-223, bone imaging showed stable disease in 74% (n=84/113) and 94% of patients (n=93/99) with available data, respectively. An increase in the number of bone lesions was documented at 3 months compared with baseline in 26% (n=29/113) and at 6 months compared with 3 months in 6% of patients (n=6/99), respectively. Radiological extraskeletal disease progression occurred in 46% of patients (n=57/124) with available CT data at 3 and/or 6 months. CONCLUSIONS: Progression of bone metastases during radium-223 therapy is uncommon. A bone flare (pain and/or radiological) may be noted during the first 3 months, and should not be confused with progression. Imaging by CT scan should be considered after three and six doses of radium-223 to rule out extraskeletal disease progression.
BACKGROUND: The imaging response to radium-223 therapy is at present poorly described. We aimed to describe the imaging response to radium-223 treatment. METHODS: We retrospectively evaluated the computed tomography (CT) and bone scintigraphy response of metastatic castration-resistant prostate cancer (CRPC) patients treated with radium-223, in eight centers in three countries. RESULTS: A total of 130 patients were included, the majority (n=84, 65%) received radium-223 post docetaxel. Thirty-four of 99 patients with available data (34%) received concomitant abiraterone or enzalutamide. A total of 54% (n=70) patients completed the planned six injections of radium-223. In patients with available data, a transient increase in bone metastases-related pain was observed in 27% (n=33/124) and an improvement of bone metastases-related pain on treatment with radium-223 was noted in 49% of patients (n=61/124). At 3 and 6 months of treatment with radium-223, bone imaging showed stable disease in 74% (n=84/113) and 94% of patients (n=93/99) with available data, respectively. An increase in the number of bone lesions was documented at 3 months compared with baseline in 26% (n=29/113) and at 6 months compared with 3 months in 6% of patients (n=6/99), respectively. Radiological extraskeletal disease progression occurred in 46% of patients (n=57/124) with available CT data at 3 and/or 6 months. CONCLUSIONS: Progression of bone metastases during radium-223 therapy is uncommon. A bone flare (pain and/or radiological) may be noted during the first 3 months, and should not be confused with progression. Imaging by CT scan should be considered after three and six doses of radium-223 to rule out extraskeletal disease progression.
Authors: Nellie N Nafissi; Heidi E Kosiorek; Richard J Butterfield; Cassandra Moore; Thai Ho; Parminder Singh; Alan H Bryce Journal: Cureus Date: 2020-11-14
Authors: Juan Pablo Sade; Carlos Alberto Vargas Báez; Martin Greco; Carlos Humberto Martínez; Miguel Ángel Álvarez Avitia; Carlos Palazzo; Narciso Hernández Toriz; Patricia Isabel Bernal Trujillo; Diogo Assed Bastos; Fabio Augusto Schutz; Santiago Bella; Lucas Nogueira; Neal D Shore Journal: Med Oncol Date: 2018-03-19 Impact factor: 3.064