A novel combination of percutaneous stenting with iodine-125 seed implantation and chemotherapy for the treatment of pancreatic head cancer with obstructive jaundice

Abstract

Insertion of radioactive strips through the biliary stent has been reported to offer longer survival and patency than an uncovered conventional self-expanding metal stent in patients with unresectable malignant biliary obstruction. The aim of this study was to investigate the safety and effectiveness of intraluminal brachytherapy combined with 125 I seed implantation and transarterial infusion chemotherapy for the treatment of pancreatic head cancer with obstructive jaundice. METHOD: From October 2012 to January 2018, 21 consecutive patients diagnosed with biliary obstruction caused by locally advanced, nonmetastatic pancreatic cancer with cytologically or histologically confirmed by biopsy were enrolled and receive treatment with intraluminal brachytherapy using 125 I seed strand and CT-guided percutaneous radioactive seed implantation therapy. The procedure-related and radiation complications were assessed. The outcomes were measured in terms of stent patency, patient survival, complications related to the procedure. RESULT: One of the 22 patients (4.5%, 1/22) with pancreatic head cancer failed to perform the above procedure because the guidewire was unable to pass through the obstruction segment. The remaining 21 patients (95.5%, 21/22) with pancreatic head cancer with obstructive jaundice were successfully placed with biliary stents and radioactive strips through drainage tubes. The median number of 125 I seeds loaded was 15, ranging from 12 to 17. After the chemotherapy with gemcitabine and cisplatin, no adverse reaction of Grade III~Ⅳ occurred in all cases. Median stent patency was 12.50 months (95% CI: 10.26, 14.74). By May 2019, all 21 patients had died, with overall survival of 5.2e23.3 months, with a median survival of 13.20 months (95% CI: 10.96, 15.44). CONCLUSION: Percutaneous 125 I seed implantation combined with insertion of radioactive strips through the biliary stent has the characteristics of less trauma, fewer complications, simple operation, and so on. These procedures bring remission of obstructive jaundice combined with the increased survival for the treatment of obstructive jaundice caused by unresectable pancreatic head cancer if follow-up chemotherapy is carried out. The long-term efficacy of this treatment combination needs to be confirmed by further multicenter, large sample size prospective randomized controlled studies.

Efficacy and safety of 3D printing coplanar template-assisted iodine-125 seed implantation as palliative treatment for inoperable pancreatic cancer

“…In addition, the combination of percutaneous stenting with 125 I seed implantation and chemotherapy may bring remission of obstructive jaundice combined with an increased survival for obstructive jaundice treatment caused by unresectable pancreatic head cancer [ 25 ]. However, long-term efficacy of this treatment needs to be confirmed with further prospective studies [ 25 ]. CT-guided radioactive 125 I seeds implantation was the most reported.…”

The efficacy and safety of biliary stenting alone versus stenting combined with iodine-125 seed strand implantation for the treatment of cholangiocarcinoma with malignant obstructive jaundice: a prospective, nonrandomized, controlled clinical study

“…However, repair of the damaged epithelium was completed in approximately 60 days, and no significant radiological damage to the surrounding tissue was detected (15). Therefore, biliary intraparticle radiotherapy is safe and feasible, and many clinical studies have also confirmed its safety (6,8,14,16,17). Common adverse reactions of biliary seed implantation include biliary tract infection, pancreatitis, puncture tract bleeding, bile leakage, ascites leakage, and seed strand displacement, but few serious lifethreatening complications occur.…”

Percutaneous transhepatic cholangial drainage combined with intra-tumoral iodine-125 seeds implantation and chemotherapy for locally progressive pancreatic head cancer with obstructive jaundice

“…Li et al [19] investigated 50 patients with incurable pancreatic cancer subjected to intra-operative ultrasound-guided particle implantation, 26 of whom received GEM + albumin after particle and GEM + albumin paclitaxel chemotherapy again, with mOS of 14 and 11 months for patients who received and did not receive chemotherapy, respectively (p = 0.046). Chi et al [20] selected 21 patients with pancreatic head cancer accompanied by obstructive jaundice, all of whom underwent biliary stenting with 125 I particles combined with chemotherapy. The overall survival of these 21 patients was 5.2-23.3 months, which was similar to that of the present study.…”

“…Chi et al . [ 20 ] selected 21 patients with pancreatic head cancer accompanied by obstructive jaundice, all of whom underwent biliary stenting with 125 I particles combined with chemotherapy. The overall survival of these 21 patients was 5.2-23.3 months, which was similar to that of the present study.…”