I-125 seed-loaded versus normal stent insertion for obstructive esophageal cancer: a meta-analysis.

Abstract

Introduction: Malignant esophageal obstruction is usually caused by esophageal and other chest cancers. More than 80% of cases of obstructive esophageal cancer (OEC) have lost the chance of curative resection. Stent insertion is a first-line palliative approach used to treat incurable OEC. Aim: To gauge the relative clinical efficacy of I-125 seed-loaded stent (ISS) versus normal stent (NS) insertion as a treatment for OEC. Material and methods: Querying of the PubMed, Embase, and Cochrane Library databases was conducted to find all relevant studies published up to November 2020. The meta-analysis was undertaken using RevMan v5.3. Results: We identified 158 studies initially, eight (4 randomized controlled trials and 4 retrospective studies) of which were used in this meta-analysis. We found that the two groups exhibited the comparable pooled Δdysphagia scores (MD = 0.02; p = 0.80), stent restenosis rates (OR = 0.97; p = 0.89), stent migration rates (OR = 0.81; p = 0.63), severe chest pain rates (OR = 1.05; p = 0.81), hemorrhage rates (OR = 1.53; p = 0.16), aspiration pneumonia rates (OR = 0.72; p = 0.38), and fistula formation rates (OR = 1.47; p = 0.44). The pooled time-to-restenosis and survival were both significantly longer in the ISS group (p = 0.04 and < 0.0001, respectively). Significant heterogeneity was detected in the endpoints of Δdysphagia scores and survival (I 2 = 73% and 86%, respectively). Funnel plot analysis indicated an absence of publication bias related to the selected study endpoints. Conclusions: For patients with OEC, our meta-analysis indicated that ISS insertion could provide longer stent patency and survival than NS insertion.

Anti-reflux versus conventional self-expanding metal stents in the palliation of esophageal cancer: A systematic review and meta-analysis

“…Although both types of SEMS are associated with high rates of dysphagia improvement, recently, a novel radioactive SEMS such as the I-125 seed-loaded stent (ISS) have been developed to potentially improve the benefits. As described in two recent meta-analyses, this novel radioactive ISS provided better dysphagia improvement than conventional SEMS and other therapies 32 33 .…”

CIRSE Standards of Practice on Oesophageal and Gastroduodenal Stenting

“…Reports of radioactive I-125-loaded metallic stents have shown promise in increasing stent patency. In a recent meta-analysis comparing these stents to conventional SEMS, these stents have shown similar dysphagia improvement rates and complication rates but significantly improved stent patency and survival [ 20 ].…”

Why is a very easy, useful, old technique underused? An overview of esophageal brachytherapy – interventional radiotherapy

“…Another technique that should be mentioned is seed coated stents for dysphagia palliation [ 9 - 11 ]. In particular, the results of a meta-analysis by Zhao et al .…”

“…In particular, the results of a meta-analysis by Zhao et al . showed longer stent patency and survival than normal stent insertion [ 9 ].…”

“…Several studies have demonstrated benefits in dysphagia palliation, with good 5-year survival rates in T1-2 cases not suitable for surgery and chemotherapy using EBT with HDR-BT [ 2 , 3 ]. More recently, 125 I seed coated expandable stents have been used in palliative care [ 9 - 11 ]. EBT administers high doses to the endoluminal component of tumor with a rapid fall-off, leading to a lower dose to normal surrounding soft tissues.…”