A National Multicenter Study on overall survival in elderly metastatic castrate-resistant prostate cancer patients treated with Radium-223

Abstract

Background Radium-223 prolongs overall survival (OS) and delays time to the first symptomatic skeletal events in patients with symptomatic metastatic castration-resistant prostate cancer (mCRPC). There is a lack of evidence on the safety and efficacy of Radium-223 treatment in the very elderly population. Aims Aim of this multicentre study is to analyze mCRPC patients treated with Radium-223 in terms of OS and to assess whether there are differences between young and elderly, as well as to verify efficacy and safety in patients ≥ 75 years of age. Methods 430 mCRPC patients of six Italian Centres were analyzed in this multicenter retrospective study. At baseline and after each cycle were collected clinical and diagnostic patients' parameters. The whole cohort was divided into two groups based on the age of the patients (< 75 years old and ≥ 75 years old). Results 47% of the patients were < 75 years old and 53% were ≥ 75 years old. The primary outcome, OS, does not show significant differences between the two subgroups if other basal parameters are considered. Considering clinical covariates in univariate models (p < 0.05) several clinical aspects have an impact on OS, except for age (p = 0.072). Age continues to have no significant impact on the OS (p = 0.274) even in multivariate models in the two groups. The toxic effects are similar in the two groups. Conclusions Radium-223 prolongs survival in both younger and older patients at the same baseline condition and is a good option in the symptomatic mCRPC setting compared to other agents.

Behavior of total alkaline phosphatase after radium-233 therapy in metastatic castration-resistant prostate cancer: a single-center, real-world retrospective study

“…Some of the baseline characteristics known to be potential keys to radium-233 treatment success are PSA, ECOG performance status, pain status, baseline tALP, and Hb ( 9 , 18 , 25 ) . Frantellizzi et al ( 26 ) found no differences between responders and nonresponders in terms of age and baseline characteristics, although they found that a three-variable score could be a useful predictor of treatment success. They showed that patients with an ECOG performance status of 0 or 1, PSA < 20 ng/mL, and Hb > 12 g/dL were likely to show a better response.…”

“…Regardless of other characteristics, a greater number of cycles of treatment is consider one of the main predictors of prolonged OS (18,(25)(26)(27)(28) . In the present study, OS was significantly longer among the patients receiving five or six cycles of radium-223 therapy than among those receiving fewer cycles.…”

Validation of the 3-variable prognostic score (3-PS) in mCRPC patients treated with 223Radium-dichloride: a national multicenter study

“…The cited work was obtained on the same population sample of this study, however the purpose and results obtained are totally different and have not been duplicated in any way. In fact, while the manuscript presented (3-PS) focuses on the statistical validation of a multidimensional system that allows the better selection of patients who can benefit from 223 Ra in terms of OS, the previous article published in a geriatric journal, analyzed the population based on age and therefore took into account efficacy, toxicity profiles and survival in elderly patients [20].…”

Internal fixation of acetabular quadrilateral plate fractures in elderly patients: Could the fracture reduction quality affect their functional recovery?

“…It is important to note that osteoporotic acetabular fractures might be managed following different surgical principles, compared to the high-energy fractures observed in young patients. Moreover, it could be difficult to achieve the anatomical reduction and stable fixation of osteoporotic QP fractures, because of the QP location in the true pelvis and juxta-articular position, the frequent fracture comminution and the poor bone quality [ 18 , 19 ].…”