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Rationale   Radium-223-Dichloride (Ra-223) is an alpha-emitter, used to treat bone metastases. Patients with high metastatic burden and/or with increased trabecular bone uptake could present a higher incidence of hematologic toxicity. We hypothesized that these two factors are predictors of bone marrow failure.Material and Methods   A computer algorithm discriminated between trabecular bone ( B  Vol ) and tumor metastases ( M  Vol ) within pretherapeutic whole-body skeletal SPECT/CT ( N  = 47). The program calculated the metastatic invasion percent (INV%) as the  M  Vol /( M  Vol  +  B  Vol ) ratio and extracted the  B  Vol  mean counts.  B  Vol  counts were correlated to % drop of hemoglobin (Hb), leukocytes (WBC), and platelets (PLT) after 3/6 Ra-223 cycles. Patient-specific and computational-derived parameters were tested as predictors of hematologic toxicity with MANOVA.Results    B   Vol  counts correlated with drop of Hb ( R  = 0,65,  p  < 0.01) and PLT ( R  = 0,45,  p  < 0.01). Appendicular  B  Vol  counts showed a better correlation ( p  < 0.05,  p  < 0.01, and  p  < 0.001 for Hb, WBC, and PLT, resp.). INV% directly correlated with  B  Vol  counts ( R  = 0.68,  p  < 0.001). At MANOVA, grade III/IV toxicity was predicted by INV% ( p  < 0.01), by long-bone invasion ( p  < 0.005), and by  B  Vol  counts ( p  < 0.05).Conclusions   In patients with significant bone tumor burden, degree of bone invasion and trabecular bone uptake are predictors of subsequent bone marrow failure.

biomed research international

Tumor Burden and Intraosseous Metabolic Activity as Predictors of Bone Marrow Failure during Radioisotope Therapy in Metastasized Prostate Cancer Patients