Рентгенология & Радиология, 2018, LVII 125-138

The hybrid imaging modalities – 68Ga PSMA PET/ CT AND 99mTc MDP SPECT/CT for the theurapetic management of patients with prostate carcinoma treated with Radium 223 in Bulgaria

  1. Hadzhiyska, M. Ilcheva, P. NIkolova, St. Veneva, B. Mladenov, Sv. Dineva, M. Nedevska, Y. Asenov, Zh. Panayotova


More than 90% of patients with mCRPC present with radiologically proven bone metastases, which are the main cause of death and poor quality of life. Available osteotropic agents have not shown improvement in survival in these patients. Radium-223 dichloride (Radium-223) is the first osteotrophic therapeutic agent that significantly extends the overall survival of patients with CRPC and metastatic bone disease. The aim of this study is to present our first impressions of the use of Радий-223 in patients with symptomatic bone metastases of mCRPC, as well as the application of various hybrid imaging methods for staging and evaluation of the therapeutic effect. For a period of 18 months, four patients with bone lesions from CRPC were treated with Radium-223 dichloride at the Clinic of Nuclear Medicine at the University Hospital “Alexandrovska”. The therapeutic response evaluation is based on all clinical and imaging data, including the use of the prostate total score and the EuroQoL 5D utility. All patients received an incomplete course of treatment with four to five intravenous Radium-223. After restaging, one of the patients had a complete metabolic and morphologic response, two оf them – partial therapeutic effect, and one – radiological progression. Two of the treated patients developed II gr. anemia and III gr. thrombocytopenia as an undesirable side effect. All patients reported an improvement in the pain symptoms. Regardless of the small number of patients and the nonlinear results of Radium-223 application in Bulgaria, the latter offer hope for its effective application after fulfillment of complete or partial morphological response in three of the treated patients, as well as a complete improvement in symptoms and quality of life for all treated patients.