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Alpharadin Radium-223 (Xofigo), a radiopharmaceutical drug which is used to treat pain when the cancer has metastasized into the bones. The drug is given intravenously and “seeks” cancerous cells and emits radiation that kills some of the cells.

Adverse effects from Xofigo result from radiation that goes into the bones and can cause bone marrow suppression with anemia(red blood cells), neutropenia(white blood cells), thrombocytopenia(platelets).

FDA approved to treat symptomatic bone metastases without visceral metastases. Hematologic evaluation should be performed according to the FDA label before treatment initiation and before each subsequent dose. Radium-223 can be used with denosumab or zoledronic acid.

The use of systemic radiotherapy occasionally benefits patients with widely metastatic, painful, skeletal involvement that is not responding to palliative chemotherapy or systemic analgesia and who are not candidates for localized EBRT.

The risk of bone marrow suppression, which might influence the ability to provide additional systemic chemotherapy, should be considered before this therapy is initiated.

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