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Radium 223 therapy (Xofigo)

Radium 223 is a type of internal radiotherapy treatment for cancer that has spread into bones.

What is radium 223?

Radium 223 is a mildly radioactive form of the metal radium. It used to be called Alpharadin and now has the brand name Xofigo (pronounced zoh-fee-go).

Doctors use radium 223 to treat prostate cancers that have spread to the bones. Radium 223 can work well to treat cancers in more than one area of the bone. It can treat those areas and reduce pain.

It is only for men who have had hormone treatment that is no longer working and whose cancer has spread to their bones but not other organs. You can't have it if you are having treatment with abiraterone

You might need to travel to a different hospital to have radium 223 as it's not available in every hospital.

How radium 223 works

Radium is very similar to calcium. And like calcium, active bone cells take up the radium. This makes it a good way of specifically targeting bone cancer cells. Cancer cells are more active than normal bone cells and so are more likely to pick up the radium 223. 

Once the radium is in the bones it releases the radiation. The radiation only travels a short distance, between 2 and 10 cells deep. This is much less than a millimetre.

This means that the cancer cells receive a high dose of radiation and some of them die. And healthy cells receive only a low dose or no radiation. So this treatment causes few side effects.

How you have radium 223

You have radium 223 as an injection into a vein. Usually this is through a thin short tube (cannula) put into a vein in your arm each time you have treatment. The injection takes up to a minute.

The injection is normally repeated every 4 weeks. You may have it up to 6 times. You have the treatment as an outpatient and can go home afterwards.

After radium 223 treatment

After the treatment, some radiation may be present in your urine for a few hours and in your poo (faeces) for up to 7 days. The total amount is extremely small and gets lower each day. 

Your radiotherapy doctor (clinical oncologist) or specialist nurse usually ask you to take the following precautions:

  • drink plenty of fluids for a few days
  • sit down on the toilet when passing urine, instead of standing up or using a urinal for the first few days
  • wash your hands thoroughly every time you use the toilet
  • for 7 days, wipe yourself very carefully after having your bowels open (some hospitals suggest that you use gloves)
  • for 7 days, flush the toilet twice after using it
  • wipe the toilet seat after using it if you share the toilet with other people
  • wash clothing separately if it becomes soiled with urine or faeces

After this treatment, men shouldn't father children for at least 6 months because the treatment can cause sperm damage. Talk to your doctor or nurse about effective contraception before having the treatment.

It might be possible to store sperm before the treatment if you are planning to have children in the future. You can ask your doctor about this. 

Possible side effects of radium 223

The side effects of radium 223 can include diarrhoea and sickness but these are generally mild.

The treatment can also sometimes cause low levels of blood cells after a few weeks. This can lead to an increased risk of infection, anaemia, and bruising more than usual. So you need to have regular blood tests after the treatment.

Rarely, some people have increased pain in the area of cancer in the bone for a few days or weeks after this treatment. Let your doctor or nurse know if you have this. They can give you painkillers. 

Information and help

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