title: Haematopoietic toxicity of radium-223 in patients with high skeletal tumour burden.
abstract: In patients with metastasized, castration resistant prostate cancer (mCRPC) treatment with radium-223 (Xofigo) is an attractive therapeutic option. In particular, patients with high tumour load seem to profit from this treatment in regard of survival and quality of live. Aim of this study was to stratify mCRPC patients according to a quantitative imaging marker derived from routine bone scans (EXINI bone) and analyze haematopoietic toxicity of Xofigo in these patients.
  
  
  METHODS
  Toxicity and oncologic outcome were investigated in a cohort of 14 patients with high tumour load. Additionally, based on a web survey, experience of toxicity in 41 high tumour load patients in Germany in 2014 was collected.
  
  
  RESULTS
  In patients with a bone scan index (BSI) greater than 5, significant toxicity occurred in more patients than expected from the ALSYMPCA trial. This was associated with application of fewer cycles. Similar experiences have been made in other centers in Germany. Approximately 7% of these patients will need very long time or will not recover from grade ≥ 3 toxicity.
  
  
  CONCLUSIONS
  Close follow-up of haematopoietic indices and, in case of toxicity, early termination of therapy is in particular necessary in late stage disease where limited bone marrow reserve is likely.
authors.affiliation: Priv.-Doz. Dr. Matthias Miederer, Department of Nuclear Medicine, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany, Matthias.miederer@unimedizin-mainz.de.
authors.forename: M
authors.initials: M
authors.lastname: Miederer
authors.forename: C
authors.initials: C
authors.lastname: Thomas
authors.forename: J
authors.initials: J
authors.lastname: Beck
authors.forename: C
authors.initials: C
authors.lastname: Hampel
authors.forename: C
authors.initials: C
authors.lastname: Krieger
authors.forename: P E
authors.initials: PE
authors.lastname: Baqué
authors.forename: A
authors.initials: A
authors.lastname: Helisch
authors.forename: M
authors.initials: M
authors.lastname: Schreckenberger
mesh_terms: D001855:Bone Marrow Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D001859:Bone Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D011832:Radiation Injuries / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D011868:Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use; D011883:Radium / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D011868:Radioisotopes; D019275:Radiopharmaceuticals; C581106:radium Ra 223 dichloride; D011883:Radium
keywords: Radium-223; Xofigo; bone scan index; haematopoietic toxicity; high tumour load