{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T01:40:17Z","timestamp":1768873217874,"version":"3.49.0"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,1,18]],"date-time":"2023-01-18T00:00:00Z","timestamp":1674000000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001320","name":"Roswell Park Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001320","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30CA016056"],"award-info":[{"award-number":["P30CA016056"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Radium-223 dichloride (Ra-223) is now frequently used to treat prostate cancer that has metastasized to bone, although patient selection continues to be suboptimal for determining who will benefit most from this novel treatment modality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Seventy-nine patients with metastatic castration-resistant prostate cancer (mCRPC) were treated with Ra-223 from 2012 to 2016. The burden of skeletal metastasis was determined for each using the Bone Scan Index (BSI) as a ratio of diseased to normal bone. Clinical, laboratory, and survival data were collected and examined for associations with BSI, and treatment tolerability was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Chemotherapy-na\u00efve patients were significantly more likely to complete the full course of treatment. Median follow-up was 31 months (range 0.7-38.8 months) and median overall survival was 15.4 months (range 9.5-20.6 months). Overall survival was significantly associated with findings on bone scans (P &amp;lt; .05). Patients with higher BSI tended toward poorer outcomes. Nearly half the patients with low baseline BSI survived 3 years or more following Ra-223 treatment. By contrast, only 20% of the patients with high baseline BSI lived for 1 year, and none lived for an additional 3. Baseline BSI was significantly associated with decreased hemoglobin, higher serum PSA and alkaline phosphatase levels, and treatment-associated reductions in platelet and absolute neutrophil counts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our results suggest better outcomes to Ra-223 therapy for patients who are chemotherapy-na\u00efve and who undergo treatment earlier in the course of their disease as reflected by low BSI and concordant laboratory parameters.<\/jats:p><\/jats:sec>","DOI":"10.1093\/oncolo\/oyac245","type":"journal-article","created":{"date-parts":[[2023,1,18]],"date-time":"2023-01-18T14:50:11Z","timestamp":1674053411000},"page":"246-251","source":"Crossref","is-referenced-by-count":4,"title":["Optimization of Radium-223 Treatment of Castration-resistant Prostate Cancer Based on the Burden of Skeletal Metastasis and Clinical Parameters"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2397-6914","authenticated-orcid":false,"given":"Ahmad","family":"Shariftabrizi","sequence":"first","affiliation":[{"name":"Division of Nuclear Medicine, Department of Radiology, University of Iowa Carver College of Medicine , Iowa City, IA , USA"},{"name":"Division of Nuclear Medicine, Department of Radiology, Roswell Park Comprehensive Cancer Center , Buffalo, NY , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9268-0354","authenticated-orcid":false,"given":"Shalin","family":"Kothari","sequence":"additional","affiliation":[{"name":"Department of Medicine, Roswell Park Comprehensive Cancer Center , Buffalo, NY , USA"},{"name":"Department of Internal Medicine, Section of Hematology, Yale University School of Medicine , New Haven, CT , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saby","family":"George","sequence":"additional","affiliation":[{"name":"Department of Medicine, Roswell Park Comprehensive Cancer Center , Buffalo, NY , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristopher","family":"Attwood","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Informatics, Roswell Park Comprehensive Cancer Center , Buffalo, NY , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellis","family":"Levine","sequence":"additional","affiliation":[{"name":"Department of Medicine, Roswell Park Comprehensive Cancer Center , Buffalo, NY , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3219-1916","authenticated-orcid":false,"given":"Dominick","family":"Lamonica","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Radiology, Roswell Park Comprehensive Cancer Center , Buffalo, NY , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,1,18]]},"reference":[{"issue":"3","key":"2023041012091247600_","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1038\/s41391-018-0121-2","article-title":"Impact of new systemic therapies on overall survival of patients with metastatic castration-resistant prostate cancer in a hospital-based registry","volume":"22","author":"Francini","year":"2019","journal-title":"Prostate Cancer Prostatic Dis"},{"issue":"5","key":"2023041012091247600_","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1002\/pros.23286","article-title":"Clinical correlates of benefit from radium-223 therapy in metastatic castration resistant prostate 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castration-resistant prostate cancer patients candidates to 223RaCl treatment","volume":"54","author":"Frantellizzi","year":"2019","journal-title":"Radiol Oncol"},{"issue":"5","key":"2023041012091247600_","doi-asserted-by":"crossref","first-page":"671","DOI":"10.2967\/jnumed.119.231100","article-title":"Assessing radiographic response to 223Ra with an automated bone scan index in metastatic castration-resistant prostate cancer patients","volume":"61","author":"Anand","year":"2020","journal-title":"J Nucl Med"},{"issue":"11","key":"2023041012091247600_","doi-asserted-by":"crossref","first-page":"1728","DOI":"10.1093\/annonc\/mdz270","article-title":"Advances in targeted alpha therapy for prostate cancer","volume":"30","author":"De Vincentis","year":"2019","journal-title":"Ann Oncol"},{"key":"2023041012091247600_","author":"National Comprehensive Cancer Network (NCCN 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