Endovascular Treatment of Cancer-Associated Venous Obstruction: Comparison of Efficacy Between Stent Alone and Stent Combined With Linear Radioactive Seeds Strand

Abstract

Objectives: To investigate the safety and efficacy of a stent combined with a linear strand of 125I seeds to treat malignant cancer–associated venous obstruction. Methods: We retrospectively analyzed the data of 57 patients with malignant cancer–associated venous obstruction. Nineteen patients underwent the placement of a stent combined with a linear strand of 125I seeds (group A), and 38 patients underwent the placement of a bare stent (group B). The following parameters were compared between the 2 groups of patients: symptom relief rate, duration of venous patency, survival time, quality of life, and adverse events. Results: A total of 34 stents and 527 seeds were implanted in group A, while a total of 57 stents were implanted in group B. The surgery success rate was 96.5%, and no serious complication related to the surgery was reported. Symptoms of venous obstruction improved significantly after surgery. The score of group A decreased from 14.74 ± 0.562 points before surgery to 2.79 ± 1.357 points after surgery( P < .001), and the score of group B decreased from 13.79 ± 1.398 points before surgery to 5.55 ± 3.674 points after surgery ( P < .001). The patency rate of group A was significantly higher than that of group B at 1 to 6 months after surgery (100%, 84.2%, 68.4%, 63.2%, 36.8%, 21.1% vs 68.4%, 23.7%, 18.4%, 7.9%, 5.3%, 2.6%, respectively; P < .05). Before treatment, there was no statistically significant difference in the Karnofsky Performance Status (KPS) score between the groups ( P = .791). After 1 to 6 months of treatment, the KPS score was significantly higher in group A than in group B ( P = .013). The median patency duration in groups A and B was 125 days (95% CI: 80.018-169.982) and 35 days (95% CI: 20.501-49.499), respectively ( P < .001). The median survival time of group A was 155 days (95% CI: 110.406-199.594), and that of group B was 98 days (95% CI: 55.712-140.288; P = .325). Multivariate analysis showed that the implantation of a stent combined with a linear strand of 125I seeds and the KPS score (≥80 points) were independent factors of long-term patency after stent placement. Conclusions: The placement of a stent combined with a linear strand of 125I seeds is a safe and effective treatment for venous obstruction caused by malignant tumors. This treatment provides prolonged patency compared with the placement of bare stent, and while it does not significantly improve the survival time of patients, it can improve their quality of life.

Radioactive Seed Strand Efficacy in Superior Vena Cava Stenting Due to Non-small-cell Lung Cancer Obstruction

“…This could be due to the RSS's ability to suppress tumor cell multiplication, induce tumor cell death, and diminish vascular intimal hyperplasia, all of which help to reduce the risk of re-stenosis following stent implantation. 10 The median OS in the stent with RSS group in this study was 229 days, which was significantly longer than the 178 days in the stent-alone group (P = .026). However, multivariate analysis showed many other factors (including use of post-operative chemotherapy and lower tumor stage) were also associated with the longer OS.…”

“…12,13 I-125 seeds have been widely used during brachytherapy procedures because they have a long half-life, a narrow irradiation range, and a high radiobiological effect. 9-11 Stent with RSS insertion has been used for patients with malignant biliary obstruction, portal venous tumor thrombus, and cancer-associated venous obstruction. 9,10,14 The RSSs were effective in suppressing tumor growth and ensuring long-term patency.…”

“…This could be due to the RSS’s ability to suppress tumor cell multiplication, induce tumor cell death, and diminish vascular intimal hyperplasia, all of which help to reduce the risk of re-stenosis following stent implantation. 10…”

“…[9][10][11] Stent with RSS insertion has been used for patients with malignant biliary obstruction, portal venous tumor thrombus, and cancer-associated venous obstruction. 9,10,14 The RSSs were effective in suppressing tumor growth and ensuring longterm patency.…”

“…8 Many researchers inserted a radioactive seed strand (RSS) beside the stent to provide brachytherapy effectiveness and prevent stent re-stenosis in patients with malignant luminal obstructions. [9][10][11] However, this technique has not been used for patients with malignant SVCO. In addition, previous research studies also did not focus on patients with SVCO caused by a specific cancer type.…”