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Radium-223 in a Community Setting for Castration Resistant Prostate Cancer

机译：在去势抵抗性前列腺癌的社区环境中使用Radium-223

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Purpose: To evaluate the toxicity, palliative benefit, and survival benefit of Radium-223 (Ra-223) in a community setting.Introduction: The ALSYMCA (Alpharadin in Symptomatic Prostate Cancer) trial demonstrated improved survival for men with painful bone metastasis from castration resistant prostate cancer who were treated with Ra-223. The median survival was 14.9 months for the Ra-223 patients compared to 11.3 months for patients treated with a placebo.Methods: We identified through the nuclear medicine records 11 patients who started Ra-223 between March 15, 2013 and December 10, 2015. The Wilcoxon signed rank test was used to compare the published results of the ALSYMPCA patients with those from our institution.Results: The Hodges-Lehman estimate of the median survival of our patients from the date of the first Ra-223 infusion was 7.8 months. The 95% confidence interval (CI) was (2.8, 14.7; p=0.0122) indicating our patients had a significantly shorter survival than the Ra-223 ALSYMPCA patients.Our patients did not have a statistically significant worse rate of anemia, neutropenia, or thrombocytopenia. We used 3 measures of treatment effectiveness: 1) reduction in the pain scores, 2) reduction in the serum PSA, and 3) reduction in the alkaline phosphatase from baseline, but the reductions were not statistically significant.Conclusions: This small study is not meant to challenge the results of the ALSYMPCA international trial. It is intended only as a caution that prior lines of therapy, especially with newer agents such as abiraterone and enzalutamide, may attenuate the benefit from this treatment, particularly in elderly patients.Radium-223 in a Community Setting for Castration Resistant Prostate Cancer
机译：目的：在社区环境中评估Radium-223（Ra-223）的毒性，姑息性和生存获益。简介：ALSYMCA（有症状前列腺癌中的Alpharadin）试验表明，去势痛苦的骨转移患者的生存期得到了改善。 Ra-223治疗的耐药性前列腺癌。 Ra-223病患的中位生存期为14.9个月，而安慰剂治疗组的中位生存期为11.3个月。使用Wilcoxon符号秩和检验比较ALSYMPCA患者和我们机构的已公布结果。结果：从首次Ra-223输注之日起，Hodges-Lehman估计我们患者的中位生存期为7.8个月。 95％的置信区间（CI）为（2.8，14.7; p = 0.0122），表明我们的患者比Ra-223 ALSYMPCA患者的生存期短得多。我们的患者的贫血，中性粒细胞减少或血小板减少症。我们使用了3种治疗效果度量标准：1）疼痛评分降低，2）血清PSA降低，3）碱性磷酸酶从基线水平降低，但这种降低没有统计学意义。旨在挑战ALSYMPCA国际试验的结果。仅在警告时，以前的疗法，特别是使用较新的药物如阿比特龙和恩杂鲁胺可能会减弱这种疗法的益处，尤其是在老年患者中。Radum-223在去势抵抗性前列腺癌的社区环境中

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