A single-center, multidisciplinary experience with radium-223 dichloride in men with metastatic castrate-resistant prostate cancer


  • Cédric Charrois-Durand
  • Fred Saad
  • Maroie Barkati
  • Jean-Baptiste Lattouf
  • Paul Perrotte
  • Pierre I. Karakiewicz
  • Denis Soulières
  • Normand Blais
  • Zineb Hamilou
  • Daniel Juneau
  • Nicolas Plouznikoff
  • Daniel Taussky Département de Radio-Oncologie, Centre Hospitalier de l’Université de Montréal (CHUM) - Hôpital Notre-Dame, Montréal, Québec, Canada
  • Guila Delouya




radium-223; metastatic castrate-resistant prostate cancer; overall survival


Introduction: We aimed to investigate several clinical and biochemical parameters, including palliative external beam radiation therapy (EBRT) to predict survival in patients with metastatic castrate-resistant prostate cancer (mCRPC) treated with radium-223 (223Ra).

Methods: We tested known and possible prognostic parameters, including palliative EBRT, both prior and concurrent to 223Ra. Log rank test (Kaplan-Meier method) and Cox regression analysis were used to predict overall survival (OS).

Results: A total of 133 patients were treated with 223Ra; median age was 72 years. Median OS was 9.0 (95% confidence interval [CI] 7.4–10.6) months. By univariate analysis (log-rank test), baseline Eastern Cooperative Oncology Group performance status (ECOG PS) 0–1 (p=0.001), ≥5 cycles of 223Ra (p<0.001), baseline hemoglobin (Hb) ≥120 g/L (p <0.001), baseline total alkaline phosphatase (tALP) <110 U/L (p=0.001), and any prostate-specific antigen (PSA) decline at week 12 (p=0.013) were associated with increased OS. EBRT prior and/or concurrent to 223Ra showed a trend (p=0.051) towards inferior OS by univariate analysis only. By multivariate analysis, significant factors were PS 0–1 (hazard ratio [HR] 1.94, 95% CI 1.3–2.9, p=0.001), Hb ≥120 g/L (HR 0.5, 95% CI 0.3–0.9, p=0.011), and absence of docetaxel use prior to 223Ra (HR 1.86, 95% CI 1.08–3.22, p=0.026). With baseline Hb, tALP, and ECOG PS, we were able to divide patients into three groups with different median OS (months): 23.0 (95% CI 12.8–33.2), 8.0 (95% CI 6.7–9.3), and 5.0 (95% CI 3.1–6.9) for low-, intermediate-, and high-risk, respectively (p<0.001).

Conclusions: We found that 223Ra therapy can result in an OS of close to two years in carefully selected patients. Earlier administration of 223Ra therapy to fitter patients with mCRPC should be tested.


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How to Cite

Charrois-Durand, C. ., Saad, F., Barkati, M. . ., Lattouf , J.-B. ., Perrotte, P. ., Karakiewicz, P. I. ., Soulières , D. ., Blais, N. ., Hamilou , Z. ., Juneau, D. ., Plouznikoff, N. ., Taussky, D., & Delouya, G. . (2022). A single-center, multidisciplinary experience with radium-223 dichloride in men with metastatic castrate-resistant prostate cancer. Canadian Urological Association Journal, 16(6), 199–205. https://doi.org/10.5489/cuaj.7591



Original Research