Importance of the correct assessment of bone fractures in the clinical management of metastatic castration-resistant prostate cancer treated with radium-223: A case report

Patients who undergo radium-223 treatment for metastatic castration-resistant prostate cancer (mCRPC) generally have a long history of androgen deprivation therapy and/or steroid therapy, which leads to bone loss and causes osteoporosis. Notably, Osteoporosis in combination with metastatic bone disease increases the risk of bone fracture. An 84-year-old man with multi-metastatic bone CRPC underwent six administrations of intravenous radium-223, which induced a good biochemical and clinical response. However, two months following the treatment, the patient reported acute pain localized to the lumbar spine mimicking bone progression disease and presented with stable prostate-specific antigen levels. A prostate-specific membrane antigen-positron emission tomography scan showed no tracer uptake in that site, whereas a magnetic resonance imaging scan and subsequent vertebral biopsy confirmed the absence of cancer progression and showed the presence of vertebral crushing of L4-L5, which was probably due to an osteoporotic process. The patient had never received bisphosphonate therapy and refused it during alpha-emitting therapy with radium-223. The osteoporotic process, in association with metastatic bone disease, more easily leads to bone fractures that have an important impact on performance status, quality of life and prognosis quoad vitam in patients with advanced prostate cancer. Use of bisphosphonates or anti-RANKL antibody appears to be effective in improving bone mineral density. Notably, patients with multi-metastatic bone disease who undergo radium-223 therapy should be treated in conjunction with anti-osteoporotic therapy (bisphosphonates or anti-RANKL antibody) and adequate calcium and vitamin D supplementation. Early recognition and differentiation of osteoporotic processes when determining the progression of cancer-associated bone disease is crucial in evaluating the response to radium-223 therapy and, consequently, for further therapeutic decision making

Use of Radium-223 Dichloride in Patients With Osteonecrosis of the Jaw Induced by Zoledronic Acid: Report of 2 Cases

Bisphosphonates, a group of inorganic pyrophosphate analogues that prevent the loss of bone density, are commonly used in patients with bone metastases; the calcium-mimetic a-emitter radium-223 dichloride (Ra223) is a bone-targeting therapy used in patients with metastatic castration-resistant prostate cancer (mCRPC)-related bone metastases. Both treatments reduce pain and disability; Ra223 is associated with significantly improved overall survival in mCRPC. Patients who receive bisphosphonate therapy are at risk of developing osteonecrosis of the jaw, especially in those who do not undergo an accurate oral evaluation and sanitation before the beginning of therapy, and in patients who present with conditions that facilitate the development of this problem, such as inadequate oral and dental care, lack of prophylactic antimicrobial mouth rinsing, patient comorbidity, or suboptimal suturing after tooth extraction. Although there is possible synergism between bisphosphonates and Ra223 therapy, there is no consensus about the use of Ra223 in patients with previous/current osteonecrosis of the jaw induced by zoledronic acid. However, our experience suggests that Ra223 therapy might not be contraindicated in patients with osteonecrosis of the jaw induced by zoledronic acid if an appropriate multidisciplinary approach is followed, and we report 2 cases of patients with current or previous osteonecrosis of the jaw induced by zoledronic acid, who were treated with Ra223 for mCRPCrelated bone metastases. Multidisciplinary management, including accurate clinical and radiological evaluation before beginning therapy with Ra223, together with oral sanitation and periodic controls during treatment, allowed successful administration of Ra223 while reducing side effects, with absent or minimal worsening of osteonecrosis

Design and prototype results of the FAST detector

A new fiber tracker is being developed for the ASACUSA experiment at the Antiproton Decelerator at CERN. The detector is based on I mm diameter scintillating fibers readout by HAMAMATSU 64 channel multianode photomultipliers (MA-PMTs) connected to a dedicated electronic chain. The paper gives a description of the testing procedures for time resolution, spatial resolution and efficiency measurements performed with standard NIM electronics and a commercial TDC and reports the results for different prototype detectors

A família Rubiaceae na Reserva Biológica Guaribas, Paraíba, Brasil: subfamília Rubioideae The family Rubiaceae in the Guaribas Biological Reserve, Paraíba State, Brazil: subfamily Rubioideae

Este trabalho consiste no levantamento dos representantes de Rubiaceae subfamília Rubioideae na Reserva Biológica Guaribas, Estado da Paraíba, Brasil. Foram realizadas coletas intensivas no período de outubro/2000 a outubro/2001, as quais resultaram em 17 espécies e nove gêneros de Rubioideae. Os gêneros com maior número de espécies foram Psychotria L. (seis) e BorreriaG. Mey. (quatro). Coccocypselum P. Browne, Declieuxia Kunth, Diodia L., Mitracarpus Zucc. ex Roem. & Schult., PalicoureaAubl., RichardiaL. e Staelia Cham. & Schltdl. apresentaram uma única espécie cada. Perama hirsuta Aubl., de posição taxonômica incerta na família, também foi tratada neste trabalho. São apresentados chave, descrições, comentários e ilustrações dos táxons.<br>This paper describes the results of a survey of the Rubiaceae subfamily Rubioideae in the Guaribas Biological Reserve, State of Paraíba, Brazil. Intensive collections were made from October/2000 to October/2001, revealing 17 species and nine genera of Rubioideae. The most diverse genera were Psychotria L. (six species) and Borreria G. Mey. (four species). Coccocypselum P. Browne, Declieuxia Kunth, Diodia L., Mitracarpus Zucc. ex Roem. & Schult., Palicourea Aubl., Richardia L. and Staelia Cham. & Schltdl. were each represented by a single species. Perama hirsuta Aubl., of uncertain position within the family, is also treated in this paper. A key, descriptions, notes, and illustrations of the taxa are provided