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BioMed Research International
Volume 2017, Article ID 3905216, 10 pages
Research Article

Tumor Burden and Intraosseous Metabolic Activity as Predictors of Bone Marrow Failure during Radioisotope Therapy in Metastasized Prostate Cancer Patients

1Nuclear Medicine Unit, Department of Radiology, University of Tübingen, Tübingen, Germany
2Department of Internal Medicine, University of Genoa, Genova, Italy
3Nuclear Medicine Unit, “Henri Mondor” University Hospital, Paris, France
4National Council of Research-SPIN, Section of Genoa, Genova, Italy
5National Council of Research-IBFM, Section of Genoa, Genova, Italy
6Department of Mathematics, University of Genoa, Genova, Italy
7Nuclear Medicine Unit, Department of Health Sciences, University of Genoa, Genova, Italy

Correspondence should be addressed to Francesco Fiz; moc.liamg@mn.zif.ocsecnarf

Received 7 August 2017; Accepted 6 December 2017; Published 25 December 2017

Academic Editor: Kazuma Ogawa

Copyright © 2017 Francesco Fiz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Rationale. Radium-223-Dichloride (Ra-223) is an alpha-emitter, used to treat bone metastases. Patients with high metastatic burden and/or with increased trabecular bone uptake could present a higher incidence of hematologic toxicity. We hypothesized that these two factors are predictors of bone marrow failure. Material and Methods. A computer algorithm discriminated between trabecular bone () and tumor metastases () within pretherapeutic whole-body skeletal SPECT/CT (). The program calculated the metastatic invasion percent (INV%) as the ) ratio and extracted the mean counts. counts were correlated to % drop of hemoglobin (Hb), leukocytes (WBC), and platelets (PLT) after 3/6 Ra-223 cycles. Patient-specific and computational-derived parameters were tested as predictors of hematologic toxicity with MANOVA. Results. counts correlated with drop of Hb ( = 0,65, ) and PLT ( = 0,45, ). Appendicular counts showed a better correlation (, , and for Hb, WBC, and PLT, resp.). INV% directly correlated with counts ( = 0.68, ). At MANOVA, grade III/IV toxicity was predicted by INV% (), by long-bone invasion (), and by counts (). Conclusions. In patients with significant bone tumor burden, degree of bone invasion and trabecular bone uptake are predictors of subsequent bone marrow failure.