Endovascular implantation of iodine-125 seed strand combined and stent placement for locally advanced pancreatic ductal adenocarcinoma with vascular invasion: a prospective single-arm pilot study

Abstract

Purpose To investigate the safety and feasibility of endovascular brachytherapy using iodine-125 ( 125 I) seed strand for locally advanced pancreatic ductal adenocarcinoma (PDAC) with vascular invasion. Material and methods From January 2010 to January 2015, 12 patients diagnosed with locally advanced, inoperable PDAC with splenic or superior mesenteric vein invasion were enrolled in the present study and received endovascular brachytherapy combined with regional intra-arterial infusion chemotherapy. Standardized software was used for dose calculation. Procedure-related and radiation complications were documented and assessed. Overall survival was calculated with the Kaplan-Meier approach. Results The technical success rate of 125 I seed strand implantation and stent placement was 100%. During follow-up with a mean duration of 17.00 ±6.07 months (range, 6~24 months), the mean and median survival times were 12.0 ±2.4 months (95% CI: 7.4~16.6 months) and 10.7 ±1.4 months (95% CI: 8.0~13.5 months), respectively. One month after the treatment, the disease control and objective rates were 83.8% and 58.3%, respectively. The 6-, 12-, and 15-month cumulative survival rates were 66.7%, 47.6%, and 9.5%, respectively. Conclusions Endovascular brachytherapy using 125 I seed strand and stent placement may be a safe and effective treatment option for locally advanced pancreatic duct adenocarcinoma with vascular invasion.

CT-guided trans-sternal 125I seeds implantation for masses in the anterior or middle mediastinum

“…In recent years, CT-guided 125 I seeds implantation has been used to treat various malignant solid tumors, including primary metastatic lung cancer, pancreatic, primary or metastatic liver cancer, prostate cancer, and soft-tissue sarcoma as well as salvage therapy for cervical lymph node recurrence after external beam radiation of esophageal squamous cell carcinoma. This approach offers many advantages, such as a high local control rate and good therapeutic effect with minimal injury to normal tissue, with precise anatomical location and shorter hospital stay compared to routine radiotherapy [14][15][16][17][18][19][20][21][22][23]. But there are limits for a successful treatment of mediastinal masses because of the complex anatomical structure involved: 1.…”

Pancreatic Cancer: Challenges and Opportunities in Locoregional Therapies

“…In an attempt to investigate the clinical outcome of combining IAI with other interventions, Timmer et al evaluated the efficacy and safety of endovascular seed implant of iodine-125 (125I) and stent placement in patients with LAPC receiving a regional intra-arterial infusion of chemotherapy. This treatment regimen demonstrated a 100% success rate, a median survival rate of 10.7 months, and 83% disease control [ 218 ]. As mentioned in Section 2.4 ., Glypican 1 (GPC1) is being investigated as an extracellular vesicular biomarker for the early detection of PDAC.…”