Name of the Procedure:

Radium Ra-223 Dichloride Therapy
Common name(s): Xofigo Treatment
Technical/medical term: Radium Ra-223 Dichloride, therapeutic, per microcurie (HCPCS Code: A9606)

Summary

Radium Ra-223 Dichloride Therapy is a form of radiation treatment that involves injecting a radioactive substance into the bloodstream to target and kill cancer cells in the bones. It is often used to treat metastatic prostate cancer that has spread to the bones and is resistant to other treatments.

Purpose

Radium Ra-223 Dichloride Therapy is primarily used to treat prostate cancer that has spread to the bones. The goals are to reduce bone pain, slow the progression of the disease, and improve quality of life.

Indications

This treatment is indicated for patients with:

• Metastatic prostate cancer that has spread to the bones.
• Cancer that does not respond to hormone therapy or surgical treatment.
• Significant bone pain due to metastases.

Preparation

• Patients may need to undergo blood tests to check bone marrow function.
• Inform your healthcare provider about all medications and supplements you are taking.
• Fasting is generally not required.
• No specific diagnostic tests beyond the regular monitoring of cancer progression.

Procedure Description

1. The patient receives an intravenous injection of Radium Ra-223 Dichloride.
2. The injection is usually administered over a few minutes.
3. The procedure is typically done in an outpatient setting.
4. No anesthesia is required.
5. The radioactive substance targets bone metastases and emits alpha particles that destroy cancer cells while minimizing damage to surrounding healthy tissue.

Duration

The injection itself takes only a few minutes, but the entire appointment may last around 30-60 minutes.

Setting

This procedure is typically performed in an outpatient clinic or a specialized treatment center.

Personnel

• Medical oncologist
• Oncology nurse specialized in radiopharmaceutical treatments

Risks and Complications

• Common risks: Mild nausea, diarrhea, swelling in the legs or feet, and temporary low blood cell counts.
• Rare risks: Severe bone marrow suppression, severe infections, and secondary malignancies.
• Management: Immediate medical attention for severe side effects, regular monitoring of blood counts.

Benefits

• Expected benefits include reduced bone pain and delayed progression of cancer in the bones.
• Patients may start to see benefits within a few weeks after the first injection.

Recovery

• Post-procedure care involves regular blood tests to monitor blood cell counts.
• No significant recovery time is required, and patients can usually resume normal activities almost immediately.
• Follow-up injections are typically given every 4 weeks for a total of 6 injections.

Alternatives

• Chemotherapy: May have more systemic side effects compared to focused bone treatment.
• Hormone therapy: Effective for some but not all metastatic prostate cancers, particularly those resistant to hormone treatment.
• External beam radiation: Targets specific bone pain areas but does not treat widespread bone metastases as effectively.

Patient Experience

• The injection is usually well-tolerated with minimal pain.
• Common side effects include mild nausea and diarrhea which can be managed with medications.
• Continuous monitoring and supportive care can help manage side effects and improve the overall experience. Pain management strategies may involve medications prescribed by the healthcare provider.