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A case report of image-based dosimetry of bone metastases with Alpharadin (223Ra-dichloride) therapy: inter-fraction variability of absorbed dose and follow-up

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Abstract

A 70-year-old man affected by bone metastases from castration resistant prostate cancer underwent Alpharadin (223Ra-dichloride) therapy (6 administrations of 50 kBq per kg i.v., once every 4 weeks). The inter-fraction variability of the absorbed dose to lesions was evaluated for four injections. Dosimetric assessments were performed following the MIRD approach and a recently published methodology. The mean absorbed dose and standard deviation for 4 lesions [mean (σ %)] were: 434 mGy (15 %) and 516 mGy (21 %) for the right and left humeral head, 1205 mGy (14 %) and 781 mGy (8 %) for the right and left glenoid. The estimated total absorbed dose after the whole treatment, considering also the relative-biological effectiveness of alpha particles (RBE = 5), yielded a D RBE range of 13–36 Gy. A good correlation between 99mTc and 223Ra uptake was obtained (R 2 = 0.7613). The tumour–non-tumour (TNT) ratio of 8 lesions (those above, plus 4 additional), monitored by six 99mTc-MDP bone scans over a period of about 10 months, evidenced a TNT reduction in two lesions (−42 and −48 %), but in most lesions the TNT remained fairly constant, evidencing that 223Ra-dichloride therapy tends to prevent further progression of osseous disease, leading to chronicity of the metastatic status.

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Acknowledgments

The patient enrolled in this research was participating in a multicenter study (protocol 88-8223/16216) sponsored by Bayer HealthCare Pharmaceuticals, entitled “Radium-223 chloride in treatment of CRPC patients with bone metastasis”. The authors declare that this study complies with the current law of the country (Italy) where it was performed.

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Authors and Affiliations

  1. Department of Medical Physics, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense No. 87, 00152, Rome, Italy

    Massimiliano Pacilio

  2. Department of Nuclear Medicine, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense No. 87, 00152, Rome, Italy

    Guido Ventroni & Lucio Mango

  3. Health Physics Postgraduate School, “Sapienza” University of Rome, Piazzale Aldo Moro No. 5, 00185, Rome, Italy

    Bartolomeo Cassano & Leda Lorenzon

  4. Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense No. 87, 00152, Rome, Italy

    Pasquale Ialongo

  5. Department of Radiological, Oncological and Anatomo Pathological Sciences, “Sapienza” University of Rome, Viale Del Policlinico No. 155, 00161, Rome, Italy

    Elisabetta Di Castro

  6. Department of Medical Oncology, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense No. 87, 00152, Rome, Italy

    Federica Recine & Cora N. Sternberg

Authors
  1. Massimiliano Pacilio
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  2. Guido Ventroni
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  3. Bartolomeo Cassano
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  7. Federica Recine
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  9. Lucio Mango
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Correspondence to Massimiliano Pacilio.

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Pacilio, M., Ventroni, G., Cassano, B. et al. A case report of image-based dosimetry of bone metastases with Alpharadin (223Ra-dichloride) therapy: inter-fraction variability of absorbed dose and follow-up. Ann Nucl Med 30, 163–168 (2016). https://doi.org/10.1007/s12149-015-1044-9

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  • DOI: https://doi.org/10.1007/s12149-015-1044-9

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