Practical recommendations for radium-223 treatment of metastatic castration-resistant prostate cancer Academic Article uri icon

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  • PURPOSE: Radium Ra 223 dichloride (radium-223, Xofigo┬«) is the first targeted alpha therapy for patients with castration-resistant prostate cancer and symptomatic bone metastases. Radium-223 provides a new treatment option for this setting, but also necessitates a new treatment management approach. We provide straightforward and practical recommendations for European nuclear medicine centres to optimize radium-223 service provision. METHODS: An independent research consultancy agency observed radium-223 procedures and conducted interviews with all key staff members involved in radium-223 treatment delivery in 11 nuclear medicine centres across six countries (Germany, Italy, the Netherlands, Spain, Switzerland and the UK) experienced in administering radium-223. The findings were collated and discussed at a meeting of experts from these centres, during which key consensus recommendations were defined. RESULTS: The recommendations cover centre organization and preparation; patient referral; radium-223 ordering, preparation and disposal; radium-223 treatment delivery/administration; and patient experience. Guidance includes structured coordination and communication within centres and multidisciplinary teams, focusing on sharing best practice to provide high-quality, patient-centred care throughout the treatment pathway. CONCLUSIONS: These expert recommendations are intended to complement existing management guidelines. Sharing best practice and experience will help nuclear medicine centres to optimize radium-223 service provision and improve patient care.


  • Du, Yong
  • Carrio, Ignasi
  • De Vincentis, Giuseppe
  • Fanti, Stefano
  • Ilhan, Harun
  • Mommsen, Caroline
  • Nitzsche, Egbert
  • Sundram, Francis
  • Vogel, Wouter
  • Oyen, Wim
  • Lewington, Val

publication date

  • September 2017