Clinical significance of completion of radium-223 treatment and acute adverse events in patients with metastatic castration-resistant prostate cancer

Document Type : Original Article

Authors

1 Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan

2 Department of Radiation Oncology, South Miyagi Medical Center, Ogawara , Japan

3 Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan

4 Department of Radiation Oncology, Osaki Citizen Hospital, Osaki, Japan

5 Department of Radiation Oncology, Iwate Prefectural Isawa Hospital, Oshu, Japan

6 Department of Radiation Oncology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan

7 Department of Radiation Oncology, Tohoku Rosai Hospital, Sendai, Japan

8 Department of Radiation Oncology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan

9 Department of Radiation Oncology, Iwaki City Medical Center, Iwaki, Japan

10 Department of Radiation Oncology, Miyagi Cancer Center, Natori, Japan

11 Department of Radiation Oncology, Iwate Prefectural Iwai Hospital, Ichinoseki, Japan

12 Department of Radiation Oncology, Sendai Medical Center, Sendai, Japan

13 Department of Radiation Oncology, Iwate Prefectural Ofunato Hospital, Ofunato, Japan

Abstract

Objective(s): In the treatment of castration-resistant prostate cancer (CRPC) with bone metastases, radium-223 dichloride (Ra-223) is the only bone-targeted drug that shows survival benefits. Completing six courses of Ra-223 treatment is thought to be associated with better patient survival, but this treatment has a relatively high rate of acute adverse events.
Methods: This retrospective study included 85 patients from 12 institutions in Japan to investigate the clinical significance of the completion of Ra-223 treatment and acute adverse events in CRPC patients.
Results: Six courses of Ra-223 treatment were completed in 65.9% of the patients. Grade 3 or higher acute adverse events were observed in 27.1% of patients. The prostate specific antigen and alkaline phosphatase declined at 26.9% and 87.9%, respectively. The overall survival rates at 12 and 24 months were 80.7% and 63.2%, respectively. Both completion of six courses of Ra-223 treatment and absence of grade 3 or higher acute adverse events were associated with longer overall survival. In univariate analysis, factors related to the history of treatment (five or more hormone therapy agents and cytotoxic chemotherapy) and hematological parameters (Prostate specific antigen (PSA) doubling time, alkaline phosphatase, hemoglobin, albumin, and serum calcium) were associated with completing six courses of Ra-223 treatment without experiencing grade 3 or higher acute adverse events. Multivariate analysis showed that a history of chemotherapy, PSA doubling time, hemoglobin, and serum calcium showed statistical significance. We built a predictive score by these four factors. Patients with lower scores showed higher rates of treatment success (p<0.001) and longer overall survival (p<0.001) with statistical significance.
Conclusions: Accomplishing six courses of Ra-223 treatment without grade 3 or higher acute adverse events was a prognostic factor in patients with mCRPC treated with Ra-223. We built a predictive score of treatment success and need future external validation.

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References

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Asia Oceania Journal of Nuclear Medicine and Biology
Volume 11, Issue 1
January 2023
Pages 13-22

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