Radiofrequency ablation versus (125)I-seed brachytherapy for painful metastases involving the bone

This retrospective study aimed to demonstrate and compare the safety and effectiveness of computed tomography-guided radiofrequency ablation (RFA) and (125)I-seed brachytherapy for painful bone metastases after failure of external beam radiotherapy (EBRT). From June 2013 to October 2015, 79 patients with moderate-to-severe pain caused by metastatic bone lesions who underwent either RFA (n = 41) or (125)I-seed brachytherapy (n = 38) were enrolled. Pain in patients was measured using the brief pain inventory (BPI) before treatment, 1 week after treatment, and 3 months after treatment. Response rates were assessed by measuring the changes in pain and incorporation of changes in the analgesic requirements. At baseline, 1 week, and 3 months, the mean worst pain scores of BPI were 7.8, 5.4, and 2.7, respectively, for the RFA group and 7.7, 6.1, and 2.8, respectively, for the brachytherapy group. At 1 week, the complete and partial response rates were 12% and 59%, respectively, in the RFA group compared with 3% and 45%, respectively, in the brachytherapy group. At 3 months, the complete and partial response rates were 23% and 58%, respectively, in the RFA group compared with 24% and 52% in the brachytherapy group (p = 0.95). The response rates in the RFA group were significantly higher than those in the brachytherapy group at 1 week (p = 0.32), but comparable at 3 weeks (p = 0.95). Both groups had low rates of complications and no treatment-related mortality. In conclusion, the short-term curative efficiency of RFA was better than that of brachytherapy, but the log-term efficiency of both treatments was equal.