Radium-223 (Xofigo®) Therapy for Bone Metastases
Radium-223 (Xofigo®) therapy is used to treat advanced prostate cancer patients where the cancer has gone to the bone as well. It is a palliative therapy used to help relieve bone pain caused by the bone metastases, but in clinical trials it has also been shown to extend life expectancy by an average of a few months.
As bones grow and repair, they use calcium. As bone metastases grow, they also use calcium. In fact, they take up a lot more calcium than normal bone does. Xofigo® is a calcium analogue and as such is taken up into the bone like calcium in food is absorbed. However, since it is radioactive it can destroy bone metastases. The normal bone is not destroyed, because although it also absorbs Xofigo®, this is in much lower quantities than the concentration in the metastases and the radiation dose is very localised to the metastases.
This treatment is carried out on an outpatient basis in the Nuclear Medicine Department of the Royal Surrey County Hospital. All patients have a pre-therapy appointment in Nuclear Medicine. This is at least one week before the planned date for the first therapy cycle. This involves a blood test and possibly a Nuclear Medicine bone scan as well. A doctor and a Medical Physicist discuss all aspects of the therapy and are able to answer any questions. The doctor determines whether they think the therapy is suitable after the blood test results have come back and they have reported the bone scan, if a bone scan was required at this appointment.
Patients receive six injections of Xofigo®, four weeks apart. All patients are required to see their Oncologist the week before each planned therapy cycle to ensure that they are still fit for therapy. They also have a blood test at this point.
Each therapy appointment lasts approximately 30 minutes, with a 30 minute wait beforehand while the injection is prepared. The injection is given by a doctor or a radiographer. During this appointment a radiation protection advice card will be issued by a Medical Physicist. Some basic hygiene precautions need to be followed for one week following each injection, because all bodily fluids will be a little bit radioactive during this time. However, the precautions required are usually minimal since the radioiosotope has only a very short range.
More detailed information can be found in the Patient Information Leaflet.