Radium-223 (Xofigo®) Therapy for Bone Metastases

Radium-223 Dichloride (Xofigo®) therapy is used to treat prostate cancer patients whose cancer has spread to the bones (metastases). 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. This is also true of bone metastases; in fact, they take up a lot more calcium than normal bone. Xofigo® is a calcium analogue, and as such it accumulates in the bones. The radiation that Radium-223 emits is very short-range alpha particles, which destroy cells in a very localised way. Because much more Xofigo® accumulates in the bone metastases than in normal bone, it destroys the cancer cells whilst sparing those in the normal bone.  In some cases, the bone marrow can be affected leading to a reduced blood cell count.  This is monitored by the doctors and can be treated if it happens.

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 the therapy is suitable based on the blood test and scan results.

Patients receive six injections of Xofigo®, four weeks apart. All patients are required to have a blood test the week before each planned therapy cycle to ensure that they are still fit for therapy.


Each therapy appointment lasts approximately 30 minutes, with a 30 minute wait beforehand while the injection is prepared. This is because the injection is based on your weight, and we use your weight on the day of treatment to prepare each injection individually.  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 four weeks following each injection, because body fluids will be slightly radioactive during this time. However, there are no restrictions on close contact as the radiation has only a very short range.

More detailed information on this therapy can be found in the Patient Information Leaflet: https://www.royalsurrey.nhs.uk/wp-content/uploads/2018/02/PIN1443_Xofigo_Therapy_w.pdf

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