Imaging response during therapy with radium-223 for castration-resistant prostate cancer with bone metastases - Analysis of an international multicenter database

D. Keizman, M. O. Fosboel, H. Reichegger, A. Peer, E. Rosenbaum, M. C. Desax, V. Neiman, P. M. Petersen, J. Mueller, R. Cathomas, M. Gottfried, H. Dresler, D. Sarid, W. Mermershtain, K. Rouvinov, J. Mortensen, S. Gillessen, G. Daugaard, A. Omlin

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

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.

Original languageEnglish
Pages (from-to)289-293
Number of pages5
JournalProstate Cancer and Prostatic Diseases
Volume20
Issue number3
DOIs
StatePublished - 1 Sep 2017
Externally publishedYes

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