Radium 223 audit in Southend Hospital from the implementation of treatment in January 2018

ABSTRACT

Category Prostate Background to the audit On top of conventional chemotherapy and hormonal manipulation, radium 223 treatment, which is given over six cycles, has been shown to improve symptoms and survival for castration-resistant metastatic prostate cancer in a previous alpharadin in symptomatic prostate cancer (ALSYMPCA) study. Standard Inclusion and exclusion criteria were set out as per the original study. Indicator The indication of this audit is to compare the safety and efficacy of our Mid and South Essex patients who received radium 223 treatment since the implementation of treatment in our trust in January 2018. Target All the patients who received radium 223 treatment between January 2018 and November 2021 were included. Methodology: It was a retrospective cohort study. Results of first audit round Our audit had fewer patients (n=36) compared with the original study (n=614). It demonstrated comparable inclusion and exclusion criteria for the treatment. However, we had lower overall survival of 13.5 months for the patients who completed six cycles of radium 223 compared with 14.9 months in the ALSYMPCA study. Being a single-centre audit, having older patients with poorer performance status, less bisphosphonate use and the global COVID pandemic during the time of our audit could have affected the survival outcome. However, when we compared our results with another UK study done in Mount Vernon and Lister Hospitals, they had comparable overall survival (13.1 months) for patients who completed all six doses of radium 223. First action plan To continue current practice of careful patient selection for radium 223 treatment. To encourage use of bisphosphonate to help improve bony pain. References 1. Parker C, Nilsson S, Heinrich D et al. Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med 2013;369(3) 213-223. 2. Dadhania S, Alonzi R, Douglas S et al. Single-centre experience of use of radium 223 with clinical outcomes based on number of cycles and bone marrow toxicity. Anticancer Res 2018;38(9) 5423-5427. 3. Saad F, Sternberg CN, Mulders PF, Niepel D, Tombal BF. The role of bisphosphonates or denosumab in light of the availability of new therapies for prostate cancer. Cancer Treat Rev 2018;68 25-37. Copyright © 2022