CT引导下 125I粒子联合 89SrCl_(2)缓解前列腺癌骨转移患者外照射失败后疼痛的临床价值  

Clinical value of CT-guided 125I seeds combining with 89SrCl_(2) in relieving pain of patients with bone metastases from prostate cancer after failure of external irradiation

作　　者：纪立秋 郝珊瑚 王治国 张文文 张国旭 Ji Liqiu;Hao Shanhu;Wang Zhiguo;Zhang Wenwen;Zhang Guoxu(Department of Nuclear Medicine,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院核医学科,沈阳110016

出　　处：《中华核医学与分子影像杂志》2023年第10期604-608,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：辽宁省民生科技计划联合计划(2021JH2/10300098)。

摘　　要：目的:评价CT引导下 125I粒子联合 89SrCl 2缓解前列腺癌骨转移患者外照射失败后疼痛的临床价值。 方法:回顾性分析2019年1月至2021年6月北部战区总医院核医学科收治的48例(年龄56~85岁)前列腺癌骨转移患者的临床资料,分别行 125I粒子植入联合 89SrCl_(2)治疗(A组)和单纯 89SrCl 2治疗(B组),采用两独立样本 t检验及重复测量方差分析评价2组治疗前后(治疗前,治疗后3 d、4周、8周、12周)疼痛程度(最严重疼痛、最轻疼痛、平均疼痛和当前疼痛)评分和骨痛干扰评分的差异,以及治疗后12周2组前列腺特异抗原(PSA)、游离PSA(fPSA)、碱性磷酸酶(ALP)的差异。 结果:A组23例患者39个骨转移灶共植入粒子722颗,植入成功率为97.44%(38/39);B组25例患者。A组最严重疼痛、平均疼痛、当前疼痛评分随时间延长下降( F值:3.71~22.47,均 P<0.05),除治疗后3 d的评分外,余治疗后不同时间的最严重疼痛、平均疼痛、当前疼痛评分与治疗前相比,差异均有统计学意义(均 P<0.05);B组最严重疼痛、平均疼痛、当前疼痛评分治疗前后亦有差异( F值:2.45~2.52, P值:0.044~0.049),评分先下降(至治疗后8周)后回升,治疗后8周评分低于治疗前(均 P<0.05),但治疗后12周4种疼痛程度评分与治疗前相比差异无统计学意义( P值:0.057~0.693)。治疗后12周,2组最严重疼痛、平均疼痛和当前疼痛评分差异有统计学意义( t值:2.04~3.41, P值:0.001~0.047)。治疗后12周A组的骨痛干扰评分高于B组( t值:2.04~3.16, P值:0.022~0.047)。术后A组PSA、fPSA和ALP均低于B组( t值:4.38~6.82, P值:0.012~0.042)。 结论:CT引导下 125I粒子植入联合 89SrCl_(2)治疗前列腺癌骨转移患者外照射失败后骨痛可行有效,尤其对于爆发性疼痛联合治疗有明显优势。ObjectiveTo evaluate the clinical value of CT-guided 125I seeds implantation combining with 89SrCl_(2) to relieve pain after failure of external irradiation in patients with bone metastases from prostate cancer.MethodsClinical data of 48 patients(age 56-85 years)with bone metastases from prostate cancer admitted to General Hospital of the Northern Theater Command from January 2019 to June 2021 were retrospectively analyzed.Patients were treated with 125I seeds implantation combining with 89SrCl_(2)(group A)and 89SrCl_(2) alone(group B),respectively.Independent-sample t test and repeated measures analysis of variance were used to evaluate the differences of pain level(most severe pain,least pain,mean pain and current pain)scores and bone pain interference scores between 2 groups before and after treatment(before treatment,3 d,4 weeks,8 weeks and 12 weeks after treatment).Prostate specific antigen(PSA),free PSA(fPSA)and alkaline phosphatase(ALP)12 weeks after treatment of 2 groups were also compared by using independent-sample t test.ResultsIn group A,a total of 722 seeds were implanted in 39 bone metastases in 23 patients,and the implantation successful rate was 97.44%(38/39).There were 25 patients in group B.In group A,the most severe pain,mean pain and current pain scores decreased with time(F values:3.71-22.47,all P<0.05).Except for the scores at 3 d posttreatment,most severe pain,mean pain,and current pain scores at different times showed significant differences with those before treatment(all P<0.05).There were also differences in the most severe pain,mean pain,and current pain scores in group B before and after treatment(F values:2.45-2.52,P values:0.044-0.049),with scores decreasing first(till 8 weeks after treatment)and increasing later.The most severe pain,mean pain,and current pain scores 8 week after treatment were lower than those before treatment(all P<0.05),but all the four scores at 12 weeks were not significantly different from those before treatment(P values:0.057-0.693).At 12 weeks after treatmen

关 键 词：前列腺肿瘤 肿瘤转移 骨骼 近距离放射疗法 碘放射性同位素 放射疗法 锶放射性同位素 

分 类 号：R737.25[医药卫生—肿瘤]