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Therapy to skeletal metastases by Xofigo® (Ra-223)

Xofigo® (Ra-223) may prolong survival of patients with prostate cancer and bone metastases with a disease progression under antihormonal therapy. The therapy is approved and will be paid by the health insurance. However, patients must not have any organ metastases or large lymph node metastases.

Mode of action of therapy with Xofigo® (Ra-223)

Radium-223 is a so-called calcium analogon and is built into the hydroxyapatite of newly formed bones like calcium. This inclusion is to an increased level done within bone-forming (osteosclerosis or osteoblastic) metastases which predominate in case of prostate carcinoma. Xofigo® (Ra-223) therein purposefully irradiates adjacent tumor cells by α-radiation and thus a localized cytotoxic effect. Due to the little penetration depth of α particles, the surrounding bone marrow will be spared by radiation with lower bone marrow side-effects compared to other bone-seeking radioligands. Thus, after several cycles, a slowed growth or even reduction of the affected bone can be achieved and patient’s quality of life can be improved (illustration 1).

Therapy procedure

After the indication and feasibility for Radium-223 therapy is clarified, patients will be informed about the procedure and possible side effects in a detailed meeting. The therapy is an out-patient treatment. Xofigo® (Ra-223) will be given 6 times with an interval of one month between each application. Prior to the first and second application, a skeletal scintigraphy will be performed to define uptake and staging prior to the therapy and the response to Radium-223.

Which documents and examination results have to be available prior to the therapy with Xofigo® (Ra-223)?

  • Current doctor’s letter with detailed illustration of the former course and therapy of teh prostate carcinoma
  • Course of PSA values; the most recent PSA value should not be older than 4 weeks.
  • Overview of all drugs taken by patient
  • Current laboratory results (may also be collected at our department)
  • CT or MRI results of thorax/abdomen/pelvis (not older than 8 weeks)
  • No evidence of organ metastases or larger lymph node metastases (>3 cm).
  • Current skeletal scintigraphy (can also be performed at our department)

Inclusion criteria for therapy with Ra-223

Exlusion criteria

  • castration resistant prostate carcinoma with symptomatic bone metastases
  • >18 years of age

  • written approval by patient

  • visceral metastases
  • limited hemogram (neutropenia, thrombopenia or anemia, depending on level)

If Ra-223 therapy is impossible due to e.g. visceral metastases, a therapy with radiolabeled peptides (e.g. Lu-177 PSMA) can be discussed on an individualized basis.


Contact for further questions:

Dr. med. Harun Ilhan

Department of Nuclear Medicine
LMU Muninch Campus Großhadern

Marchioninistr. 15
81377 München

Tel: 089 4400 7 7655

Dr. med. A. Todica

Department of Nuclear Medicine
LMU Muninch Campus Großhadern

81377 München

Tel.: 089 4400 7 4653