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CC BY-NC-ND 4.0 · World J Nucl Med 2019; 18(03): 307-309
DOI: 10.4103/wjnm.WJNM_7_19
Case Report

Can radium 223 be a conservative non-surgical management of medication-related osteonecrosis of the jaw?

Renato Patrizio Costa
1   Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo, Italy
,
Vincenzo Tripoli
1   Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo, Italy
,
Alessandro Princiotta
1   Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo, Italy
,
Alessandra Murabito
1   Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo, Italy
,
Maria Licari
1   Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo, Italy
,
Rodolfo Mauceri
2   Clinical Sector of Oral Medicine, Department of Surgical, Oncological and Oral, University of Palermo, Italy
,
Giuseppina Campisi
2   Clinical Sector of Oral Medicine, Department of Surgical, Oncological and Oral, University of Palermo, Italy
,
Antonio Pinto
3   Internal Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo, Italy
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Abstract

Osteonecrosis of the jaw (ONJ) is a rare and severe necrotic bone disease reflecting a compromise in the body's osseous healing mechanisms and unique to the craniofacial region. Radium 223 dichloride (Ra223) is the only targeted alpha therapy able to extend survival in patients with bone metastases from prostate cancer. Mechanism of action and data currently available focused mainly on osteoblastic metastases from prostate cancer. In 2018, a Caucasian 54-year-old woman presented to our institution for a breast cancer with bone metastases. Since the patient refused any treatment and taking into account the bone disease, our multidisciplinary team evaluated a supplementary strategy with radium 223. A total of six treatments were planned with a dose of 50 KBq/kg every 4 weeks according to Phase 2 data. Four days after the second cycle administration, the patient presented for examination with a self-extracted necrotic bone fragment. Oroantral communication remained in the absence of algic symptomatology or suppuration. The multidisciplinary approach between oncologists, nuclear physicians, and dental health teams is crucial throughout the treatment process to avoid unnecessary suffering in patients at risk. More prospective studies are needed; however, considering the limitation of the present case, radio 223 may play an adjuvant role in the medical treatment of cancer patients with active ONJ.

Keywords

Bone metastases - breast cancer - osteonecrosis of the jaw - radium 223

Financial support and sponsorship

Nil.




Publikationsverlauf

Eingereicht: 18. Januar 2019

Angenommen: 04. März 2019

Artikel online veröffentlicht:
22. April 2022

© 2019. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Chang J, Hakam AE, McCauley LK. Current understanding of the pathophysiology of osteonecrosis of the jaw. Curr Osteoporos Rep 2018;16:584-95.
  • 2 Carroll PR, Parsons JK, Andriole G, Bahnson RR, Castle EP, Catalona WJ, et al. NCCN guidelines insights: Prostate cancer early detection, version 2.2016. J Natl Compr Canc Netw 2016;14:509-19.
  • 3 AIOM 2016 – Prostate Cancer Guidelines; 2017. Available from: http://www.aiom.it/C_Common/Download.asp?fi le=/$Site$/fi les/doc/LG/2017_LGAIOM_Prostata.pdf. [Last accessed on 2018 Dec 10].
  • 4 Parker C, Sartor O. Radium-223 in prostate cancer. N Engl J Med 2013;369:1659-60.
  • 5 Carrasquillo JA, O'Donoghue JA, Pandit-Taskar N, Humm JL, Rathkopf DE, Slovin SF, et al. Phase I pharmacokinetic and biodistribution study with escalating doses of 223Ra-dichloride in men with castration-resistant metastatic prostate cancer. Eur J Nucl Med Mol Imaging 2013;40:1384-93.
  • 6 Hindorf C, Chittenden S, Aksnes AK, Parker C, Flux GD. Quantitative imaging of 223Ra-chloride (Alpharadin) for targeted alpha-emitting radionuclide therapy of bone metastases. Nucl Med Commun 2012;33:726-32.
  • 7 Nilsson S, Larsen RH, Fosså SD, Balteskard L, Borch KW, Westlin JE, et al. First clinical experience with alpha-emitting radium-223 in the treatment of skeletal metastases. Clin Cancer Res 2005;11:4451-9.
  • 8 Coleman R, Aksnes AK, Naume B, Garcia C, Jerusalem G, Piccart M, et al. Aphase IIa, nonrandomized study of radium-223 dichloride in advanced breast cancer patients with bone-dominant disease. Breast Cancer Res Treat 2014;145:411-8.
  • 9 Nguyen NC, Shah M, Appleman LJ, Parikh R, Mountz JM. Radium-223 therapy for patients with metastatic castrate-resistant prostate cancer: An update on literature with case presentation. Int J Mol Imaging 2016;2016:2568031.