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Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Radium-223 in the treatment of bone metastases in patients with castration-resis...
Journal Information
Vol. 37. Issue 5.
Pages 330-337 (September - October 2018)
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25
Vol. 37. Issue 5.
Pages 330-337 (September - October 2018)
Continuing Education
Radium-223 in the treatment of bone metastases in patients with castration-resistant prostate cancer. Review and procedure
Radio-223 en el tratamiento de metástasis óseas en pacientes con cáncer de próstata resistente a la castración. Revisión de la literatura y procedimiento
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J. Orcajo-Rincona, A.P. Caresia-Arózteguib,
Corresponding author
paulacaresia@gmail.com

Corresponding author.
, M. del Puig Cózar-Santiagoc, J.R. García-Garzónd, M. de Arcocha-Torrese, R.C. Delgado-Boltonf, M.J. García-Vellosog, S. Alvarez-Ruizh, A.M. García-Vicentei
a Servicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Servicio de Medicina Nuclear, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
c Servicio de Medicina Nuclear, ERESA – Hospital General Universitario de Valencia, Valencia, Spain
d Unitat PET/TC CETIR-ERESA, Esplugues de Llobregat, Barcelona, Spain
e Unidad de Radiofarmacia, Hospital Universitario Marqués de Valdecilla, Santander, Spain
f Departamento de Diagnóstico por Imagen y Medicina Nuclear, Hospital San Pedro-Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, La Rioja, Spain
g Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, Spain
h Servicio de Medicina Nuclear, Hospital Universitario Miguel Servet, Zaragoza, Spain
i Servicio de Medicina Nuclear, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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Table 1. Prognostic groups.
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Table 2. Recommendation of treatment with 223Ra in the National Comprehensive Cancer Network (NCCN), European Association of Urology (EAU) and the Spanish Association of Urology (AEU) guidelines.
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Table 3. Calculation of the doses of radiation absorbed in the most representative organs.
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Abstract

Bone metastatic disease is the main cause of morbidity/mortality in patients with prostate cancer, presenting frequently as bone pain, pathological fractures or spinal cord compression, which requires early and timely therapy. Although, for the moment, the therapeutic window for its use has not been definitively established, radium-223 (223Ra), an alpha particle emitter, has proved to be an effective therapeutic tool, pre or post-chemotherapy, in patients with castration-resistant prostate cancer with symptomatic bone metastases and absence of visceral metastases, significantly modifying the prognosis of the disease.

It is therefore imperative to define the ideal scenarios and the correct protocol for the use of this therapy and thus offer the greatest possible clinical benefit to the patient.

Keywords:
Castration-resistant prostate cancer
Bone metastases
Radionuclide therapy
223Ra
Resumen

La enfermedad metastásica ósea es la principal causa de morbimortalidad en pacientes con cáncer de próstata, presentándose frecuentemente como dolor óseo, fracturas patológicas o compresión medular, lo que requiere la instauración de una terapia precoz y oportuna. Aunque, por el momento, no se ha establecido de manera definitiva la ventana terapéutica para su utilización, el radio-223, fármaco emisor de partículas alfa, ha demostrado ser un arma terapéutica eficaz, pre o posquimioterapia, en pacientes con cáncer de próstata resistente a la castración con metástasis óseas sintomáticas y ausencia de enfermedad visceral, modificando de manera significativa el pronóstico de la enfermedad.

Resulta, por tanto, imperativo definir los escenarios idóneos y el correcto protocolo para el empleo de esta terapia y así ofrecer el mayor beneficio clínico posible al paciente.

Palabras clave:
Cáncer de próstata resistente a castración
Metástasis óseas
Terapia radiometabólica
223Ra

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