Fatal Pancytopenia Associated with Radium-223 Dichloride in a Patient with Castration-Resistant Prostate Cancer and Multiple Bone Metastases

  • Yukihiro Hama Department of Radiology, Edogawa Hospital, Tokyo, Japan
  • shoji koga Department of Urology, Edogawa Hospital, Tokyo, Japan
Keywords: Radionuclide, Hematology, Radiation effects

Abstract

Radium-223 dichloride (Ra-223) is an alpha-emitting radioisotope that targets osteoblastic metastasis of prostate cancer. For Ra-223, a favorable safety profile has been described. However, here we report a case of a fatal hematologic toxicity following the administration of Ra-223 observed at our hospital. An 80-year-old man with castration-resistant prostate cancer (CRPC) and multiple metastatic bone lesions was treated with Ra-223. He was complicated with systemic edema, constipation, and decline of renal function. One week later, he developed pancytopenia which deteriorated gradually, and died with severe prolonged pancytopenia and pneumonia 4 weeks after administration of Ra-223. Our report demonstrates the risk of fatal hematologic toxicity of Ra-223 even though pretreatment clinical and laboratory findings fulfill the selection criteria. Caution should be paid when prescribing Ra-223 to a patient with systemic edema, constipation, and decline of renal function.

Author Biography

Yukihiro Hama, Department of Radiology, Edogawa Hospital, Tokyo, Japan
Director

References

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Parker C, Nilsson S, Heinrich D, Helle SI, O'Sullivan JM, Fossa SD, et al. Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med 2013; 369(3): 213-23.

Hoskin P, Sartor O, O'Sullivan JM, Johannessen DC, Helle SI, Logue J, et al. Efficacy and safety of radium-223 dichloride in patients with castration-resistant prostate cancer and symptomatic bone metastases, with or without previous docetaxel use: A prespecified subgroup analysis from the randomised, doubleblind, phase 3 ALSYMPCA trial. Lancet Oncol 2014; 15(12): 1397-406.

Miederer M, Thomas C, Beck J, Hampel C, Krieger C, Baque PE, et al. Haematopoietic toxicity of radium-223 in patients with high skeletal tumour burden. Nuklearmedizin 2015; 54(5): 197-203.

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Published
2018-02-17
How to Cite
1.
Hama Y, koga shoji. Fatal Pancytopenia Associated with Radium-223 Dichloride in a Patient with Castration-Resistant Prostate Cancer and Multiple Bone Metastases. CRCP. 2(3):63-6.
Section
Case Report(s)