DOI: 10.1007/s00259-017-3900-4Pages: 824-845

EANM guideline for radionuclide therapy with radium-223 of metastatic castration-resistant prostate cancer

1. University Hospital Essen, Department of Nuclear Medicine

2. Centre of Oncology - MSC Institute, Department of Nuclear Medicine and Endocrine Oncology

3. University Hospital Dresden, Department of Nuclear Medicine

4. Academic Teaching Hospital Feldkirch, Department of Nuclear Medicine

5. Hospital Lippe, Department of Nuclear Medicine

6. Hannover Medical School, Department of Medical Physics and Radiation Protection

7. University Hospital Aachen, Department of Nuclear Medicine

8. Rostock University Medical Centre, Department of Nuclear Medicine

9. Inselspital, University Hospital Bern, Department of Nuclear Medicine

10. Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy

11. Ludwig Boltzmann Institute for Applied Diagnostics

12. Memorial Sloan Kettering Cancer Center, Department of Radiology

13. University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Department of Diagnostic Imaging (Radiology) and Nuclear Medicine

14. Kepler University Hospital, Institute of Nuclear Medicine and Endocrinology

15. Medical University of Innsbruck, University Clinic of Nuclear Medicine

Correspondence to:
Michael Gabriel
Tel: +43 (0)5 7680 83



Radium Ra-223 dichloride (radium-223, Xofigo®) is a targeted alpha therapy approved for the treatment of castration-resistant prostate cancer (CRPC) with symptomatic bone metastases and no known visceral metastatic disease. Radium-223 is the first targeted alpha therapy in this indication providing a new treatment option, with evidence of a significant survival benefit, both in overall survival and in the time to the first symptomatic skeletal-related event. The skeleton is the most common metastatic site in patients with advanced prostate cancer. Bone metastases are a clinically significant cause of morbidity and mortality, often resulting in bone pain, pathologic fracture, or spinal cord compression necessitating treatment. Radium-223 is selectively accumulated in the bone, specifically in areas of high bone turnover, by forming complexes with the mineral hydroxyapatite (the inorganic matrix of the bone). The alpha radiation generated during the radioactive decay of radium-223 produces a palliative anti-tumour effect on the bone metastases. The purpose of this guideline is to assist nuclear medicine specialists in evaluating patients who might be candidates for treatment using radium-223, planning and performing this treatment, understanding and evaluating its consequences, and improving patient management during therapy and follow-up.

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  • Accepted: Nov 23, 2017
  • Online: Dec 12, 2017

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