Clinical Study on Using 125I Seeds Articles Combined with Biliary Stent Implantation in the Treatment of Malignant Obstructive Jaundice

Abstract

Aim: To study the feasibility and curative effect of 125 I seeds articles combined with biliary stent implantation in the treatment of malignant obstructive jaundice. Patients and Methods: Fifty patients with malignant obstructive jaundice were included. Twenty-four were treated by biliary stent implantation combined with intraluminal brachytherapy by 125 I seeds articles as the experimental group, while the remaining 26 were treated by biliary stent implantation only as the control group. The goal of this study was to evaluate total bilirubin, direct bilirubin and tumor markers (cancer antigen (CA)-199, CA-242 and carcinoembryonic antigen (CEA)), as well as biliary stent patency status and survival time before and after surgery. Results: Jaundice improved greatly in both groups. The decreases of CA-199 and CA-242 had statistical significance (p=0.003 and p=0.004) in the experimental group. The ratio of biliary stent patency was 83.3% (20/24) in the experimental group and 57.7% (15/26) in the control group (p=0.048). The biliary stent patency time in the experimental group was 1~15.5 (mean=9.84) months. The biliary stent patency time in the control group was 0.8~9 (mean=5.57) months, which was statistically significant (p=0.018). The median survival time was 10.2 months in the experimental group, while 5.4 months in control group (p<0.05). Conclusion: 125 I seeds articles combined with biliary stent implantation significantly prolongs biliary stent patency time and survival time for patients with malignant obstructive jaundice possibly by inhibiting the proliferation of vascular endothelial cells and the growth of tumor.

The efficacy of the combination of percutaneous transhepatic biliary drainage and 125I stranded seeds for malignant bile duct obstruction treatment

“…Iodine-125 is a synthetic radioisotope of iodine allowing for the delivery of γ-ray radiation using radioactive seeds. Through γ-ray-mediated induction of tumor cell cycle arrest and inhibition of tumor angiogenesis, the goal of suppressing bile duct endothelial hyperplasia and disrupting the growth of cancerous cells are possible to achieve [ 33 , 34 , 35 , 36 ]. In addition, 125 I seeds deliver sustained irradiation to the tumor and can further oxygenize hypoxic cells, causing the tumor to become more sensitive to intracavitary brachytherapy, thus enhancing treatment efficacy [ 14 ].…”

Nutritional prognostic scores in patients with hilar cholangiocarcinoma treated by percutaneous transhepatic biliary stenting combined with 125I seed intracavitary irradiation

“…[22,23] Moreover, compared with biliary stent alone, the combination of biliary stenting with 125 I seed intracavitary irradiation significantly prolongs stent patency time and improves prognosis in patients with unresectable HCCA. [7,24–26] The implanted 125 I seed has a direct effect on the local lesion, and the radioactivity inside the tumor is much higher than the surrounding normal tissues. Therefore, radiation-induced complications, such as gastrointestinal ulcer, hemorrhage, and enteritis, significantly decreased compared with external irradiation.…”

“…[4,5] However, as the ingrowth of tumor, the biliary stent alone is associated with a high risk of biliary reobstruction and a poor survival. [6] In contrast, the PTBS combined with 125 I seed intracavitary irradiation shows a longer stent patency time and a better survival for patients with HCCA, [7,8] while further research is still needed to determine the efficacy of this technique and factors associated with outcome.…”

Biliary Self-expandable Metallic Stent Combined with Iodine-125 Seeds&nbsp;in the Treatment of Malignant Biliary Obstruction (Bismuth&nbsp;type I or II)

“…Due to the poor basic condition of the patient, the sensitivity of surrounding organs to radiotherapy, the limitation of the primary tumor type and the cumbersome surgical operation, etc., it cannot be widely used in clinical applications. SEMS combined with 125 I seed implantation and intracavitary irradiation has been used to treat malignant biliary obstruction [18,19], and certain clinical effects have been achieved.…”