Published online Oct 28, 2016. doi: 10.4329/wjr.v8.i10.816
Peer-review started: May 3, 2016
First decision: July 6, 2016
Revised: August 4, 2016
Accepted: August 27, 2016
Article in press: August 29, 2016
Published online: October 28, 2016
Processing time: 180 Days and 9.1 Hours
After being approved by the National Drug Agency in several countries, Radium-223 (Ra-223) is gaining wide acceptance in the treatment of bone metastatic castration resistant prostate cancer. The exact mechanism of action remain unclear: The established model of direct alpha-particle irradiation from the remodelling bone surface, where Ra-223 accumulates, surrounding the tumor foci can explain a lethal effect only on metastatic microdeposits, but not on higher tumor burden. According to the “pre-metastatic niche model”, it is likely that Ra-223 targets several non-tumoral cell types of the tumor microenvironment involved in the complex mechanism of cancer bone homing and colonization. A deeper insight into this hypothetical mechanism will lead to a more accurate dosimetric approach and to find optimal sequencing and/or combination with the other therapeutic options.
Core tip: Radium-223, possible perspectives for a more effective use in bone metastatic castration resistant prostate cancer.