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Evaluation of two-dimensional total bone uptake (2D-TBU) and bone scan index (BSI) extracted from active bone metastatic burden on the bone scintigraphy in patients with radium-223 treatment

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Abstract

Objective

Radium-223 is a first alpha-emitting radionuclide treatment for metastatic castration-resistant prostate cancer (mCRPC) patients with bone metastases. Although the spread-based bone scan index (BSI) and novel index of the intensity-based two-dimensional total bone uptake (2D-TBU) from bone scintigraphy may provide useful input in radium-223 treatment, they have not been evaluated in detail yet. This study aimed to fill this gap by evaluating BSI and 2D-TBU in patients treated with radium-223.

Methods

Twenty-seven Japanese patients with mCRPC treated with radium-223 were retrospectively analyzed. The patients were evaluated via blood tests and bone scans at baseline and 3 cycles intervals of treatment. BSI and 2D-TBU were analyzed via VSBONE BSI in terms of correlations, response to radium-223 treatment, association with treatment completion, and the Kaplan–Meier survival analysis was performed.

Results

Nineteen patients (70.4%) completed six cycles of radium-223 treatment, whereas eight patients (29.6%) did not complete the treatment regimen. A significant difference in baseline BSI and 2D-TBU was observed between these groups of patients. Both BSI and 2D-TBU were highly correlated (r = 0.96, p < 0.001). Univariate analysis showed an association between radium-223 completion in median BSI and 2D-TBU values (p = 0.015) and completion percentage differences (91.7% vs. 45.5%; p = 0.027). The Kaplan–Meier product limit estimator showed that the median overall survival was 25.2 months (95% CI 14.0–33.6 months) in the completion group and 7.5 months (95% CI 3.3–14.2 months) in the without completion group (p < 0.001). The overall survival based on median cutoff levels showed a significant difference in 2D-TBU (p = 0.007), but not in BSI (p = 0.15).

Conclusions

The 2D-TBU may offer advantages over BSI in classifying patients towards radium-223 treatment based on the degree of progression of bone metastases. This study supports the importance of preliminary assessment of bone metastasis status using BSI and 2D-TBU extracted from VSBONE BSI for radium-223 treatment decisions.

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Data availability

The data that support the findings of this study are available from the corresponding author SF, upon reasonable request.

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Acknowledgements

The authors thank the staff of the Department of Nuclear Medicine, Cancer Institute Hospital of the Japanese Foundation for Cancer Research for their expert technical assistance of clinical radium-223 treatment and helpful discussions on this study.

Funding

Funding was provided by Nihon Medi-Physics.

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Authors and Affiliations

  1. Department of Nuclear Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Shohei Fukai, Takuro Umeda, Naoki Shimada, Takashi Terauchi & Mitsuru Koizumi

  2. Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, 323-1 Kamioki-machi, Maebashi, Gunma, 371-0052, Japan

    Shohei Fukai & Hiromitsu Daisaki

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  1. Shohei Fukai
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Contributions

All authors contributed to the study design and data interpretation. SF and HD wrote the article and contributed to the entire study procedure as the principal investigators. TU and NS contributed to image analysis. TT and MK contributed to the radium-223 treatment and obtention of ethical approval for this study.

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Correspondence to Shohei Fukai.

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Hiromitsu Daisaki received a research funding from Nihon Medi-Physics Co., Ltd.

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Fukai, S., Daisaki, H., Umeda, T. et al. Evaluation of two-dimensional total bone uptake (2D-TBU) and bone scan index (BSI) extracted from active bone metastatic burden on the bone scintigraphy in patients with radium-223 treatment. Ann Nucl Med (2024). https://doi.org/10.1007/s12149-024-01918-4

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