The role of seed implantation in patients with unresectable pancreatic carcinoma after relief of obstructive jaundice using ERCP

Li, Wen; Wang, Xiangdong; Wang, Zikai; Zhang, Tiantian; Cai, Fang; Tang, Peng; Meng, Jiangyun; Du, Hong; Wang, Hongbin; Li, Mingyang; Li, Shuling

doi:10.1016/j.brachy.2019.08.010

Cited by 12 publications

(20 citation statements)

References 32 publications

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“…125 I seed has a short half-life, fewer post-operative complications, and is easy to protect. Also, it has an additional importance that daily visits to the hospital are not needed, which improves patient quality of life [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Feasibility and efficacy of endoscopic ultrasound-guided iodine-125 seed implantation in inoperable ampullary carcinoma: initial clinical experience

Cui¹,

Han²,

Xiao³

et al. 2022

jcb

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Purpose The objectives of the present study were to evaluate the feasibility, safety, and efficacy of endoscopic ultrasound (EUS)-guided iodine-125 ( 125 I) seed implantation in ampullary carcinoma (AC). Material and methods From January 2011 to June 2020, 13 patients were selected for this retrospective study. Thirteen tumors (27.46 ±12.07 mm) were treated with EUS-guided 125 I seed implantation in 29 sessions. We evaluated the therapeutic efficacy, adverse effects, and overall survival (OS) time. Results Complete response (CR) was observed in one tumor in 6 months. Partial response (PR) was detected in two target tumors in 3 months, seven in 6 months, seven in 9 months, and six in 12 months. Good periods of survival were observed. The median OS was 35 months, 95% confidence interval (95% CI) was 8.97 to 61.03 months. The 1-, 2-, and 5-year OS rates were 100%, 67.5%, and 11.3%, respectively. There were no procedure-related deaths or serious adverse events. Transient abdominal pain (5 cases, 17.2%), abdominal distension and loss of appetite (3 cases, 10.3%), and seed migration (1 case, 3.4%) were observed, respectively. Conclusions In selected patients with inoperable AC, EUS-guided 125 I seed implantation is feasible and safe with favorable local control efficacy and OS.

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Section: Discussionmentioning

confidence: 99%

Feasibility and efficacy of endoscopic ultrasound-guided iodine-125 seed implantation in inoperable ampullary carcinoma: initial clinical experience

Cui¹,

Han²,

Xiao³

et al. 2022

jcb

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“…In most cases, patients with newly diagnosed pancreatic cancer are eligible for a potentially curative surgical resection due to distant metastasis or local invasion. Although the surgical resection rate of malignant obstructive jaundice has been greatly improved, it is still only about 20% (20). Up to now, chemotherapy and radiotherapy are still the main conservative treatments for pancreatic cancer (21).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…A special EUS treatment planning system software may play a role in EUS-guided brachytherapy in patients with unresectable cancer, as it demonstrated a rate of partial remission of up to 80% in patients whose minimal peripheral dose was larger than 90 Gy, with a median survival time of 9 mo[ 35 ]. In addition to survival benefits, iodine-125 seed implantation placed percutaneously or via EUS after relief of obstructive jaundice via ERCP can improve biliary stent patency, time to development of gastric outlet obstruction, and improve quality of life by pain relief[ 36 ]. More recently, EUS guided placement of phosphorus-32 microparticles alone or with gemcitabine with or without nab-paclitaxel in unresectable locally advanced pancreatic cancer has been reported as alternative brachytherapy options[ 37 , 38 ].…”

Section: Eus-guided Brachytherapymentioning

confidence: 99%

Endoscopic ultrasound guided interventions in the management of pancreatic cancer

Kerdsirichairat¹,

Shin²

2022

WJGE

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There has been a growing interest in developing endoscopic ultrasound (EUS)-guided interventions for pancreatic cancer, some of which have become standard of care. There are two main factors that drive these advancements to facilitate treatment of patients with pancreatic cancer, ranging from direct locoregional therapy to palliation of symptoms related to inoperable pancreatic cancer. Firstly, an upper EUS has the capability to access the entire pancreas–lesions in the pancreatic head and uncinate process can be accessed from the duodenum, and lesions in the pancreatic body and tail can be accessed from the stomach. Secondly, there has been a robust development of devices that allow through-the-needle interventions, such as placement of fiducial markers, brachytherapy, intratumoral injection, gastroenterostomy creation, and ablation. While these techniques are rapidly emerging, data from a multicenter randomized controlled trial for some procedures are awaited prior to their adoption in clinical settings.

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The role of seed implantation in patients with unresectable pancreatic carcinoma after relief of obstructive jaundice using ERCP

Cited by 12 publications

References 32 publications

Feasibility and efficacy of endoscopic ultrasound-guided iodine-125 seed implantation in inoperable ampullary carcinoma: initial clinical experience

Feasibility and efficacy of endoscopic ultrasound-guided iodine-125 seed implantation in inoperable ampullary carcinoma: initial clinical experience

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

Endoscopic ultrasound guided interventions in the management of pancreatic cancer

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