125I Intracavitary Irradiation Combined with 125I Seeds Implantation for Treatment of Locally Advanced Pancreatic Head Cancer: A Retrospective Analysis of 67 Cases

Abstract

Background Pancreatic cancer is an aggressive malignant tumor of the digestive system and the fourth leading cause of tumor-related death. Intracavitary 125 I seed irradiation has been recently developed as a therapy for locally advanced pancreatic head carcinoma. However, there are still many limitations, and more investigations are needed in order to optimize this new treatment method. Methods Sixty-seven patients were included in our study; 41 cases treated by SEMS-CL- 125 I intracavular irradiation (SEMS-CL- 125 I group) and 26 cases treated by SEMS-CL- 125 I intracavular irradiation combined with 125 I particle implantation in the tumor body (the combined group). Among the 67 patients, 43 were males and 24 were females, with an average age of 69.64±8.84 years. Tumor site size was determined based on the MRI or CT imaging scans, and the number and radius of 125 I particle placement were calculated according to a specific formula. 125 I particles were inserted into the tumor with a radius of 1.5 cm and a row spacing of 1 cm. The main postoperative biochemical indexes, imaging analysis, postoperative analgesia degree, median survival time and rate of complications were compared between the two groups. Results Jaundice and liver function improved in both groups after treatment for 6 months. The combined group did better. Kaplan–Meier analysis showed that patients in the combined group had a significantly better overall survival than those in the SEMS-CL- 125 I group. Patients in the combined group had less complications than those in the SEMS-CL- 125 I group (23.1% vs 34.1%), and the postoperative pain status of the combined group was improved (26.8% vs 53.8%). Conclusion Compared with the SEMS-CL- 125 I intracavular irradiation alone, the combination of 125 I seed implantation with solid tumor 125 I seed implantation had a better therapeutic effect in LAPHC patients, with improved biochemical indicators, survival prognosis, pain relief, and fewer complications.

Intratumoral injection therapies for locally advanced pancreatic cancer: systematic review

“…For the application method, 14 studies (542 patients) implanted the seeds intraoperatively in an open approach using X-ray, CT, or ultrasonography guidance 27 , 28 , 30 , 34–36 , 38 , 40 , 44 , 46 , 48 , 50 , 51 , 54 . Twelve studies (401 patients) used percutaneous implantation guided by ultrasonography or CT 25 , 26 , 31 , 32 , 39 , 43 , 45 , 49 , 52 , 53 , 55 , 56 . Since 2006, four studies (179 patients) implemented endoscopic ultrasonography (EUS) to deliver the radioactive seeds to the tumour with a transgastric or transduodenal injection 37 , 41 , 42 , 47 .…”