Clinical value of CT-guided radioactive 125 I particle implantation combined with 89 SrCl 2 for pain relief after failed external irradiation in patients with prostate cancer bone metastases
Authors: JI Liqiu , HAO Shanhu , WANG Zhiguo , ZHANG Wenwen , DING Tingting , Zhang Guoxu 
Published: May 2023

Abstract
Objective To evaluate the feasibility and clinical value of CT-guided radioactive 125I particle implantation combined with 89SrCl2 to relieve pain after failed external irradiation in patients with bone metastases from prostate cancer.
Methods Retrospective analysis of clinical data of 48 patients (aged 56-85 years) with prostate cancer bone metastases admitted to the Department of Nuclear Medicine, Northern War Zone General Hospital from January 2019 to January 2022, treated with 125I particle implantation combined with 89SrCl2 (group A) and 89SrCl2 alone (group B), and two independent samples t-test and repeated measures ANOVA were used to evaluate the two groups The differences in pain level (worst pain, least pain, average pain and current pain) scores and bone pain interference scores before and after treatment (before treatment, 3 d, 4 weeks, 8 weeks and 12 weeks after treatment) were evaluated, and the changes in prostate-specific antigen (PSA), free prostate-specific antigen (fPSA) and alkaline phosphatase (ALP) before and 12 weeks after treatment were compared (two independent samples t-test). The factors associated with the relief of bone pain were also analyzed.
Results The most severe pain, mean pain, and current pain scores in group A decreased with time (F value: 22.47, 5.219, 3.707, P value: <0.001, 0.001, 0.007), and by 12 weeks after treatment, the most severe pain, mean pain, and current pain scores in group B decreased. The difference between the most severe pain, mean pain, and current pain scores at 12 weeks compared to before treatment was statistically significant (t-value: 6.137, 3.359, 2.859, P-value: <0.001, 0.002, 0.007), and the most severe pain at 3 days, 4 weeks, 8 weeks, and 12 weeks after treatment compared to before treatment was statistically significant at 3 days after treatment t=2.014, P= 0.0501, and the remaining 4, 8 and 12 weeks were statistically significant (t=7.113, 5.311, 6.137, P<0.0001); the most severe pain, mean pain and current pain scores in group B also differed before and after treatment (F value: 2.523, 2.454, 2.449, P value: 0.044, 0.049, 0.049), with the scores first decreased (by 8 weeks post-treatment, there was a statistically significant difference in the most severe pain, mean pain, and current pain scores compared to pre-treatment t-values: 2.258, 3.238, 2.016, p-values: 0.029, 0.002, 0.049) and then increased, with no statistically significant difference in the four pain level scores compared to pre-treatment at 12 weeks post-treatment (t-values: 1.952, 0.397, 0.676, 0.934, p-value: 0.057, 0.693, 0.502, 0.355). At 12 weeks after treatment, there was a statistically significant difference in the most severe pain, mean pain and current pain scores between the 2 groups (t-value: 2.04 to 3.41, P-value: 0.001 to 0.047). Bone pain interference scores: group A scores were higher than group B in the 2 groups after treatment and the difference was statistically significant (t-value: 2.04 to 3.165, P-value: 0.022 to 0.047). Univariate and multivariate analyses suggested that the preoperative worst pain score and Gleason classification were independently associated factors, with relative risk ratios (OR) of 1.967 (P=0.013),2.273 (P=0.041), respectively; 7 patients with worst pain score and Gleason classification ≥7 and 5 patients with worst pain score and Gleason classification <7 The time to pain recurrence in the patients was 12.5 and 15.2 weeks, respectively (χ2=2.762, P=0.045). Postoperatively, PSA, PSA and ALP were lower in group A than in group B (t-value: 4.38-6.82, P-value: 0.012-0.042).
Conclusion CT-guided radioactive 125I particle implantation combined with 89SrCl2 is a feasible and effective treatment for pain after failed external irradiation in patients with bone metastases from prostate cancer, and it is relatively more effective for fulminant pain and improves the quality of life of patients with painful bone metastases.