Preliminary clinical application of integrated 125I seeds stents in the therapy of malignant lower biliary tract obstruction

Chen, Wei; Fang, Xiangming; Wang, Xuan; Sudarshan, Sanjeev Kumar Pitla; Hu, Xiaoyun; Chen, Hongwei

doi:10.3233/xst-180403

Cited by 15 publications

(27 citation statements)

References 32 publications

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“…Secondly, patients who underwent percutaneous puncture operations were at higher risk. Thirdly, due to operator experience and skills limitations, only interstitial brachytherapy was performed in some centers [13,21,22]. However, intracavitary radiotherapy was feasible due to its minimally invasive technology and ease of manipulation [23].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

jcb

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Purpose: To investigate the efficacy of percutaneous transhepatic biliary drainage (PTBD) combined with iodine-125 (125 I) stranded seeds for the treatment of malignant bile duct obstruction (MBO). Material and methods: A retrospective study was performed on 58 consecutive MBO patients. Twenty patients underwent PTBD combined with 125 I stranded seeds (group A). Thirty-eight patients underwent percutaneous trans-hepatic biliary drainage (group B). Total bilirubin, direct bilirubin, and indirect bilirubin levels were compared preoperatively, 1-week, 1-month, and 3-months post-operatively. Carbohydrate antigen 19-9 (CA19-9), cancer antigen 125 (CA125), and carcino-embryonic antigen (CEA) levels were compared at preoperative and 3-month post-operative stages. The time free from biliary obstruction and survival times were compared. Results: The differences in total bilirubin, direct bilirubin, and indirect bilirubin levels between the two groups were not significant preoperatively (p = 0.857, p = 0.719, and p = 0.870), and 1-week post-operatively (p = 0.259, p = 0.395, and p = 0.145). However, 1-month (p = 0.012, p = 0.005, and p = 0.049) and 3-months post-operatively (p < 0.001, p = 0.001, and p = 0.001), group A was lower than group B. Differences in CA19-9, CA125, and CEA levels between the two groups were not significant preoperatively (p = 0.229, p = 0.116, and p = 0.273) and 3-months post-operatively (p = 0.159, p = 0.342, and p = 0.306). The median biliary obstruction free time was 7.0 months for group A and 5.0 months for group B (p < 0.001). The median survival time was 9.0 months for group A and 6.0 months for group B (p = 0.001). Conclusions: PTBD combined with 125 I stranded seeds seem to reduce bilirubin levels and prevents biliary obstruction, promoting survival.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

jcb

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“…The PRISMA flow diagram for the selection process is presented in Figure 1 . The initial database search yielded 244 potentially relevant studies, ten of which were included in this meta-analysis[ 13 - 15 , 20 - 26 ]. Of these studies, four were retrospective cohort studies and six were RCTs published between 2012 and 2018[ 13 , 14 , 20 , 21 , 25 , 26 ].…”

Section: Resultsmentioning

confidence: 99%

“…The initial database search yielded 244 potentially relevant studies, ten of which were included in this meta-analysis[ 13 - 15 , 20 - 26 ]. Of these studies, four were retrospective cohort studies and six were RCTs published between 2012 and 2018[ 13 , 14 , 20 , 21 , 25 , 26 ]. Five of these RCTs were single-center studies, while one was a multicenter study performed at 20 centers in China[ 21 ].…”

Section: Resultsmentioning

confidence: 99%

“…Percutaneous transhepatic biliary drainage was performed before stent placement in all cases. Three studies used type I stents[ 14 , 24 , 25 ], three used type II[ 20 , 21 , 26 ], and four used type III[ 13 , 15 , 22 , 23 ]. The target population was patients with unresectable MOJ, and the majority of them had cholangiocarcinoma ( n = 331, 37.83%) and pancreatic carcinoma ( n = 177, 20.23%).…”

Section: Resultsmentioning

confidence: 99%

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Percutaneous biliary stent combined with brachytherapy using ¹²⁵I seeds for treatment of unresectable malignant obstructive jaundice: A meta-analysis

Chen¹,

Kong²,

Meng³

et al. 2021

WJCC

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BACKGROUND Malignant obstructive jaundice (MOJ) is a common pathologic manifestation of malignant biliary obstruction. Recently, several clinical trials have explored the clinical effectiveness of intraluminal 125 I seed-based brachytherapy for MOJ patients, and various outcomes have been reported. AIM To assess the efficacy and safety of percutaneous biliary stents with 125 I seeds compared to conventional metal stents in patients with unresectable MOJ. METHODS A systematic search of English-language databases (PubMed, Embase, Cochrane Library, and Web of Science) was performed to identify studies published prior to June 2020 that compared stents with or without 125 I seeds in the treatment of unresectable MOJ. The outcomes analyzed included primary outcomes (stent patency and overall survival) and secondary outcomes (complications and liver function parameters). RESULTS Six randomized controlled trials and four retrospective studies involving 875 patients were eligible for the analysis. Of the 875 included patients, 404 were treated with 125 I seed stents, while 471 were treated with conventional stents. Unadjusted pooled analysis demonstrated that compared to conventional stents, 125 I seed stents extended the stent patency time [hazard ratio (HR) = 0.36, 95% confidence interval (CI) = 0.28-0.45, P < 0.0001] and overall survival period (HR = 0.52, 95%CI = 0.42–0.64, P < 0.00001). Subgroup analyses based on the type of 125 I seed stent and type of study design showed consistent results. However, there were no significant differences in the occurrence of total complications [odds ratio (OR) = 1.12, 95%CI = 0.75-1.67, P = 0.57], hemobilia (OR = 1.02, 95%CI = 0.45-2.3, P = 0.96), pancreatitis (OR = 1.79, 95%CI = 0.42-7.53, P = 0.43), cholangitis (OR = 1.13, 95%CI = 0.60-2.13, P = 0.71), or pain (OR = 0.67, 95%CI = 0.22-2, P = 0.47). In addition, there were no reductions in the levels of serum indices, including total bilirubin [mean difference (MD) = 10.96, 95%CI = -3.56-25.49, P = 0.14], direct bilirubin (MD = 7.37, 95%CI = -9.76-24.5, P = 0.4), alanine aminotransferase (MD = 7.52, 95%CI = -0.71-15.74, P = 0.07), and aspartate aminotransferase (MD = -4.77, 95%CI = -19.98-10.44, P = 0.54), after treatment. Publication bias was detected regarding the outcome overall survival; however, the conclusions were not changed after the adjustment. CONCLUSION Placement of stents combined with brachytherapy using 125 I...

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“…Compared with external irradiation, brachytherapy delivers a higher effective therapeutic dose to carcinomas and a limited dose to adjacent normal organs and tissues (31). Several studies have demonstrated that 125 I brachytherapy combined with stents achieves technical success, and this approach represents an effective therapy in MOJ patients, manifesting as extended stent patency time, better malignancy control, and consequently prolonged survival (8,9,32,33). Consistent with these studies, our results showed that the median survival was 169 days, and the median stent patency was 120 days.…”

Section: Discussionmentioning

confidence: 99%

Self-expandable metallic stent with 125I seed strand in malignant biliary obstruction: a self-made delivery system and novel implantation method

An¹,

Hu²,

Yu³

et al. 2021

Ann Transl Med

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Background: Malignant obstructive jaundice (MOJ) has a low immediate surgery rate (10-20%) and a poor post-resection survival rate. Although several clinical results have demonstrated the safety and efficacy of stent placement combined with radioactive seeds, the existing implantation methods are time consuming and prone to error. In this study, we introduced a self-made delivery system and novel implantation method for a self-expandable metallic stent (SEMS) with 125 I seed strand and evaluated its feasibility and efficacy in MOJ patients.Methods: Our self-made delivery system was applied to 61 patients (39 males and 22 females, mean age 66.36±10.73 years) from October 2018 to June 2020 in our center with a novel implantation method. The preparation and manipulation processes were described in detail. Technical and clinical successes were recorded, and stent patency and overall survival (OS) were assessed. A P value of less than 0.05 indicated a significant difference.Results: Stents with 125 I seed strands were successfully placed in all 61 participants with our novel implantation method. The clinical success rate was 96.7%, and no severe procedure-related complications were found except bile leakage through puncture in 1 participant. The median duration of primary stent patency was 120 (37, 233.5) days, and the median OS was 169 (41, 270) days.Conclusions: Our self-made delivery system with a novel SEMS implantation method with 125 I seed strand was feasible and effective for MOJ patients and significantly simplified the current implantation approach.

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Preliminary clinical application of integrated 125I seeds stents in the therapy of malignant lower biliary tract obstruction

Cited by 15 publications

References 32 publications

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

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

Percutaneous biliary stent combined with brachytherapy using ¹²⁵I seeds for treatment of unresectable malignant obstructive jaundice: A meta-analysis

Self-expandable metallic stent with 125I seed strand in malignant biliary obstruction: a self-made delivery system and novel implantation method

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Preliminary clinical application of integrated 125I seeds stents in the therapy of malignant lower biliary tract obstruction

Cited by 15 publications

References 32 publications

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

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

Percutaneous biliary stent combined with brachytherapy using 125I seeds for treatment of unresectable malignant obstructive jaundice: A meta-analysis

Self-expandable metallic stent with 125I seed strand in malignant biliary obstruction: a self-made delivery system and novel implantation method

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Percutaneous biliary stent combined with brachytherapy using ¹²⁵I seeds for treatment of unresectable malignant obstructive jaundice: A meta-analysis