Radium-223 Dichloride Therapy (NR223)

Please ensure you have your next appointment booked before leaving.

Introduction

You are receiving this information leaflet because you have been referred to have a procedure called a Radium-223-dichorlide therapy. This leaflet aims to provide an overview of your test and answer general questions. A member of our team will explain the procedure in detail when you arrive. If you have any concerns beforehand, please feel free to contact us using the details on this leaflet

What is ‘nuclear medicine’?

Nuclear medicine is the medical use of radioactive substances for diagnosis and treatment of diseases. Your doctor will discuss your treatment with you, and will consider its benefits before sending us your referral.

What is Radium-223 Dichloride therapy?

Radium-223 dichloride mimics the calcium found in bones. It is injected into a patient, to reach the bone the cancer has spread to. There it emits short-range radiation (alpha particles) which kills the surrounding tumour cells.

This is used to treat adults with prostate cancer, a cancer of a gland of the male reproductive system that does not respond to treatment to reduce male hormones. It is only used when the disease has spread to the bone but is not known to have spread to other internal organs, and is causing symptoms (pain).

The recommended dosing schedule is one injection every four weeks for six months, for a total of six injections. The use of Radium-223 dichloride beyond six injections has not been studied.

How is the treatment carried out?

• On your first appointment you will be seen by a doctor and the treatment will be explained.
• After seeing the doctor, and on subsequent appointments, a nurse will give you a radioactive injection into vein, usually in your arm (similar to a blood test).
• The dose you receive depends on your body weight. The recommended dose of Radium-223 dichloride is 55 kBq* per kilogram body weight. Therefore, if your weight changes by more than 10% please inform the department.

* a kiloBecquerel is a unit of radioactivity.

Do I need to prepare for the treatment?

Yes. You can eat and drink as usual.

Make sure you keep your blood cell count monitoring appointments and tell your doctor about any symptoms or signs of low blood cell counts such as shortness of breath, tiredness, bleeding (such as bruising), or infection (such as fever).

There will be a small amount of radioactive material in your blood, urine and faeces after each radium injection. To protect other staff from the radiation, please ensure blood tests and medical examinations (e.g. colonoscopy, biopsies, surgery) are booked before each cycle of treatment. You can contact Nuclear Medicine for advice on the telephone number below.

How long will the test take?

The treatment takes about 30 minutes.

Will it hurt?

The injection is no worse than a blood test.

Side effects

Very common (more than 1 in 10 people):

• Diarrhoea (2-4 days)
• Nausea (1-2 days)
• Vomiting
• Thrombocytopenia (decrease in the number of blood platelets).
• Bone fracture

Common (Less than 1 in 10 people):

• Decrease in the number of white blood cells (leukopenia)
• Decrease in the number of neutrophils, a type of white blood cell (neutropenia), which may lead to an increased risk of infection)
• Decrease in the number of red and white blood cells and blood platelets (pancytopenia)
• Injection site reactions (such as redness of the skin, pain and swelling)

Uncommon (may affect up to 1 in 100 people):

• Decrease in the number of lymphocytes, a type of white blood cell (lymphopenia)

What are the risks?

The scan involves an injection of a small amount of a radioactive tracer which will remain in your body for a few hours. This radiation can cause cell damage that can, after many years or decades, contribute to the development of cancerous cells. This procedure carries only a very small chance of this happening to you.

What happens after the test?

This is an out-patient procedure, so you will go home after the treatment.

There are no restriction regarding contact with other people after your radium injection.

Follow good hygiene practices for at least one week after you injections to minimise radiation exposure from bodily fluids to household members and caregivers.

We advise that you sit on the toilet when urinating to minimise splashes, and to flush twice after each use.

Any linens soiled with patient urine or faeces should be washed promptly and separately from other laundry.

Caregivers should use standard hygiene precautions to avoid small amounts of radioactive contamination from bodily fluids, e.g. wear gloves and aprons.

Are there any restrictions on travel after treatment?

You can drive as usual after the treatment.

There are no restrictions on overseas travel following radium treatment. However, most border controls (air, sea, rail) have sensitive radiation monitor that may detect small amounts of radium after treatment. We advise that you keep this letter or the written radiation safety advice given on a yellow card at your first treatment when travelling abroad.

Accessibility requirements

If you require support for your appointment, e.g. if you find it hard to hear, see or be understood by others, please let the receptionist or healthcare professional know on arrival or contact us - email: cuh.accessibility@nhs.net or telephone: 01223 256998.

Can I bring someone with me?

Those accompanying you may be required to stay out of the treatment room during the procedure and remain in the waiting area.

Childcare whilst in department

Staff are unable to look after or supervise children whilst your procedure/examination is taking place. Please make alternative arrangements for the care of your children whilst you attend for your procedure/examination. If you attend an appointment with children with no one to look after them whilst you have your examination/procedure, then your appointment will unfortunately have to be cancelled and rescheduled.

Contacts/ Further information

Nuclear Medicine 01223 217145

Facilities available

Toilets, disabled toilets, changing rooms, baby changing facilities, waiting room.

Require leaflet in a different format or language

The Recite Me toolbar makes our website digitally inclusive by allowing you to customise the contents so that it works best for you. It features an accessibility tools bar positioned at the top of webpage:

Key functions:

• Screen reader – option for all information on the website to be read aloud
• Translation – option to translate all information into over 100 different languages
• Styling and customisation – option to change the text, font style, size, colour and spacing so that the information is easier to read.
• Reading aids – including a screen mask (tint) and magnifier to help make the information more accessible for all.

Directions to the department

Please report to the nuclear medicine reception which is located on level 3 in the Outpatients end of the hospital. The closest car park is car park 1.

Question, concern or complaint

Firstly speak to your nurse, doctor or other staff member as soon as you can so they can do their best to put things right straightaway.

If you don’t feel able to speak directly to the people caring for you, contact the patient advice and liaison service (PALS). Please call 01223 216756 9am to 4pm Monday to Friday, or email at CUH PALS, or via a form available via link on the CUH PALS webpage.

PALS is open every weekday, and you can leave a message in the evenings and weekends.

My Chart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on the My Chart section on our website.