DOI: 10.1007/s00259-017-3756-7Pages: 1671-1678

Practical recommendations for radium-223 treatment of metastatic castration-resistant prostate cancer

1. The Royal Marsden NHS Foundation Trust, Department of Nuclear Medicine & PET/CT

2. Hospital Sant Pau

3. Policlinico Umberto I University Hospital Rome

4. University Hospital Bologna

5. Ludwig-Maximilians-University Hospital

6. Praxis für diagnostische und therapeutische Nuklearmedizin Berlin

7. Canton Hospital Aarau

8. University Hospital Southampton NHS Foundation Trust

9. The Netherlands Cancer Institute

10. The Institute of Cancer Research

11. Guy’s and St Thomas’ NHS Foundation Trust

Correspondence to:
Yong Du
Tel: +44 (0)20 8661 3827




Radium Ra 223 dichloride (radium-223, Xofigo®) is the first targeted alpha therapy for patients with castration-resistant prostate cancer and symptomatic bone metastases. Radium-223 provides a new treatment option for this setting, but also necessitates a new treatment management approach. We provide straightforward and practical recommendations for European nuclear medicine centres to optimize radium-223 service provision.


An independent research consultancy agency observed radium-223 procedures and conducted interviews with all key staff members involved in radium-223 treatment delivery in 11 nuclear medicine centres across six countries (Germany, Italy, the Netherlands, Spain, Switzerland and the UK) experienced in administering radium-223. The findings were collated and discussed at a meeting of experts from these centres, during which key consensus recommendations were defined.


The recommendations cover centre organization and preparation; patient referral; radium-223 ordering, preparation and disposal; radium-223 treatment delivery/administration; and patient experience. Guidance includes structured coordination and communication within centres and multidisciplinary teams, focusing on sharing best practice to provide high-quality, patient-centred care throughout the treatment pathway.


These expert recommendations are intended to complement existing management guidelines. Sharing best practice and experience will help nuclear medicine centres to optimize radium-223 service provision and improve patient care.

This article is freely available, click here to access the full text/PDF

  • Accepted: Jun 7, 2017
  • Online: Jun 19, 2017

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