A Comparative Study of Self-Expandable Metallic Stent Combined with Double 125I Seeds Strands or Single 125I Seeds Strand in the Treatment of Advanced Perihilar Cholangiocarcinoma with Malignant Obstructive Jaundice

Abstract

The purpose of this study was to compare the safety and effectiveness of a selfexpandable metallic stent (SEMs) with a novel brachytherapy biliary drainage catheter (BBDC, double 125 I seeds strands) or a single 125 I seeds strand in the treatment of advanced perihilar cholangiocarcinoma (pCCA) with malignant obstructive jaundice (MOJ). Methods: From September 2016 to December 2018, we retrospectively enrolled patients with biliary stent implantation after receiving either BBDC loaded with 125 I seeds (doublestrands irradiation group) or an 125 I seed strand treatment (single-strand irradiation group, control group). The outcomes were analyzed regarding the relief of obstructive jaundice, and interventional-related complications. Moreover, the Kaplan-Meier method was used to analyze stent patency and survival. Results: The success rate of interventional therapy in both groups was 100%, and all patients with MOJ were alleviated. According to the Common Terminology Criteria for Adverse Events (CTCAE 4.02), the grade 3 or 4 complications in the BBDC group and in the control group were 6/34 (17.65%) and 7/39 (17.95%), respectively (P > 0.05). The median and mean overall stent patency of the BBDC group and the control group were 207 days versus 180 days, 204.212 days versus 186.278 days (P = 0.043). The median and mean overall survivals in the BBDC group were higher than those in the control group (245 days versus 212 days, 244.883 days versus 221.844 days, P = 0.030). Conclusion:This interim analysis showed that BBDC (double-stranded irradiation) can prolong the stent patency time compared with 125 I seed strand treatment (single-stranded irradiation) and had the advantage of reducing jaundice, which seemed to extend the survival period of advanced pCCA.

Correlation between functional drainage and survival in malignant biliary obstruction after percutaneous biliary drainage

“…The results of our multivariate analysis showed that functionally success drainage and antitumor treatment were independent factors of better survival and improved patient outcomes in these patients with advanced tumors. The median OS in this study was 135 days, which was slightly greater than the intervals of 79–104 days reported in previous studies [ 16 , [18] , [19] , [20] ]. What is important is that the median survival time of 8.4 months in the patients with functionally successful drainage was significantly greater than in the non-functionally successful group (3.2 months).…”

Safety and efficacy of self-expandable metallic stent combined with 125I brachytherapy for the treatment of malignant obstructive jaundice

“…Technical success was classified as satisfactory placement of the stent through the stricture with the seed strand or seeds in the appropriate position and brisk flow of contrast through the stent into the intestine. Clinical success was defined as the serum total bilirubin level dropped by 75% of the preoperative value within 4 weeks [ 15 ]. The duration of stent patency was defined as the interval between stent deployment and stent restenosis.…”

A Review of Direct Endobiliary Techniques for the Management of Biliary Conditions

“…[52][53][54] ILBT, using 192 Ir or 125 I seed strands, can be used with SEMSs to improve their patency rates and present a viable option for the management of patients with MOJ. 55,56 Interventional Technique for ILBT Treatment of Bile Duct Cancers Brachytherapy in patients with biliary tract cancers is delivered through a percutaneous transhepatic biliary drainage (PTBD) catheter, placed under fluoroscopic guidance, or through catheters placed in the tumor bed during surgery. The percutaneous transhepatic or transduodenal techniques can be used for biliary drainage and device catheter placement.…”

“…52 53 54 ILBT, using 192 Ir or 125 I seed strands, can be used with SEMSs to improve their patency rates and present a viable option for the management of patients with MOJ. 55 56…”