Brachytherapy Drainage Catheter and Chemotherapy for Unresectable Pancreatic Carcinoma Combined with Obstructive Jaundice

Abstract

BackgroundMost patients with advanced pancreatic cancer do not have the chance to undergo surgery or chemotherapy because of their poor conditions. Biliary drainage is a palliative treatment to restore liver function and alleviate jaundice, but most patients still face the risk of biliary obstruction in the short term after operation. The purpose of this study is to evaluate the efficacy and safety of brachytherapy drainage catheter (BDC)-combined chemotherapy in the treatment of pancreatic cancer complicated with obstructive jaundice.Patients and MethodsFrom November 2017 and May 2019, 48 patients underwent the BDC or conventional drainage catheter (CDC) intervention with chemotherapy. The outcomes/endpoints analyzed were technical and clinical success, early complications, stent patency period, and survival.ResultsThe technical and clinical success rates in both groups were 100%, and the early complication rates were not significantly different (P = 0.43). The median stent patency in the BDC group was significantly longer than that in the CDC group (7.8 ± 1.5 vs. 5.7 ± 0.7 months, P = 0.001), and the median overall survival period in the BDC group was prone to significant difference than that in the CDC group (9.4 ± 4.0 vs. 8.2 ± 0.3 months, P = 0.089).ConclusionThe findings of this study show that BDC with chemotherapy was associated with better stent patency and survival. However, since the sample size was very small, large randomized controlled multicenter studies are needed to further evaluate the long-term survival effects of BDC in patients with advanced pancreatic carcinoma combined with obstructive jaundice.

Biliary metallic stent combined with radioactive 125I seeds strands for malignant hilar obstruction

“…[16] had been carried out, tumor recurrence still exceeded 50% yielding a 5-year OS below 20%. For unresectable tumors, palliative care involved endoscopic or transhepatic interventions with BMS placement which can decrease biliary hypertension, leading to liver function recovery and improvement of quality of life for patients [17]. Although BMS placement is a minimally invasive intervention with e cient biliary drainage, stent occlusion by tumor overgrowth, tissue reactive hyperplasia and debris can occur resulting in hyperbilirubinemia again.…”

Clinical application of the retrograde track method in reopening dysfunctional biliary stents

“…When biliary duct obstruction reoccurs, patients may experience clinical symptoms such as obstructive jaundice, fever, and pain. It remains unclear if dysfunctional biliary stent can be resolved by reopening of the dysfunctional occluded duct and completing advanced antitumor treatment, such as biliary radiofrequency ablation ( 6 ), photodynamic therapy ( 7 ), iodione-125 ( 125 I) seed strand brachytherapy ( 8 ), or reimplantation of a second stent ( 9 ). The first step is to pass the catheter guide wire through the dysfunctional biliary stent in anterograde fashion and reopen the lumen, but the bile duct above the obstruction may be severely dilated, thus making it too difficult for the catheter and guide wire to be manipulated into the dysfunctional stent through the port of the stent under two-dimensional fluoroscopy.…”

CT-guided radioactive 125I seeds brachytherapy for lung oligometastases from colorectal cancer: initial results

“…This highly conformal brachytherapy can ensure accurate attack on the tumor while simultaneously protecting the surrounding normal tissues and organs at risk (OAR) to the greatest extent. RISB has been widely used in the local treatment of prostate cancer [ 8 ], lung cancer [ 9 ], pancreatic cancer [ 10 ], esophageal cancer [ 11 ], biliary cancer [ 12 ] and so on. What’s more, RISB for prostate cancer and brachytherapy stent loaded with 125 I seeds for malignant esophageal obstruction is recommended by some guidelines from the European Endoscopic Society and the Chinese Society for Esophageal Cancer Radiotherapy [ 13 , 14 ].…”