fatal pancytopenia associated with radium-223 dichloride in a patient with castration-resistant prostate cancer and multiple bone metastases

Radium-223 dichloride (ra-223) is an alpha-emitting radioisotope that targets osteoblastic metastasis of prostate cancer. for ra-223, a favorable safety profile has been described. however, here we report a case of a fatal hematologic toxicity following the administration of ra-223 observed at our hospital. an 80-year-old man with castration-resistant prostate cancer (crpc) and multiple metastatic bone lesions was treated with ra-223. he was complicated with systemic edema, constipation, and decline of renal function. one week later, he developed pancytopenia which deteriorated gradually, and died with severe prolonged pancytopenia and pneumonia 4 weeks after administration of ra-223. our report demonstrates the risk of fatal hematologic toxicity of ra-223 even though pretreatment clinical and laboratory findings fulfill the selection criteria. caution should be paid when prescribing ra-223 to a patient with systemic edema, constipation, and decline of renal function.