Locally advanced pancreatic carcinoma with jaundice: the benefit of a sequential treatment with stenting followed by CT-guided 125I seeds implantation

Abstract

Objectives To evaluate the role of sequential therapy with percutaneous biliary stenting and CT-guided iodine-125 seed implantation for locally advanced pancreatic carcinoma with concomitant obstructive jaundice. Methods Between January 2016 and December 2018, 42 patients diagnosed with locally advanced pancreatic carcinoma with concomitant obstructive jaundice were enrolled retrospectively. All patients received biliary stenting via percutaneous transhepatic biliary drainage (PTBD) to alleviate obstructive jaundice. Thereafter, twenty-two patients underwent CT-guided iodine-125 seed implantation (treatment group), and 20 did not (control group). The prescribed dose in the treatment group was 110–130 Gy. The clinical data, duration of biliary stent patency, and overall survival (OS) were evaluated. Results Overall, the total bilirubin level decreased from 275.89 ± 115.44 to 43.08 ± 43.35 μmol/L (p < 0.001) 1 month after percutaneous biliary stenting. In the treatment group, the postoperative median dose covering 90% of the target volume was 129.71 Gy. Compared with the control group, the treatment group had a long mean duration of biliary stent patency and median OS (11.42 vs. 8.57 months, p < 0.01; 11.67 vs. 9.40 months, p < 0.01, respectively). The overall positive response rates 6 months post-treatment in the treatment and control groups were 72.7% (16/22) and 30% (6/20), respectively. Adverse events of more than grade 3 were not observed during the follow-up. Conclusion Sequential therapy with percutaneous biliary stenting and CT-guided iodine-125 seed implantation is an effective and safe treatment alternative for locally advanced pancreatic carcinoma with concomitant obstructive jaundice, which is worthy of clinical application. Key Points • Obstructive jaundice was alleviated after biliary stent placement in all patients, and the total bilirubin level decreased. • The overall positive response rates at 6 months post-treatment were higher in the treatment group than in the control group, and adverse events of more than grade 3 were not observed during the follow-up period. • Sequential therapy with percutaneous biliary stenting and CT-guided iodine-125 seed implantation can prolong biliary stent patency and improve survival.

Application and Research Status of <sup>125</sup>I Seeds Brachytherapy in Unresectable Pancreatic Cancer

“…All patients underwent percutaneous biliary stent implantation, and the treatment group received CT-guided implantation 125 The results showed that the median OS of the treatment group was 11.67 months, while that of the control group was 9.40 months. The effective rate (complete remission + partial remission) of the treatment group was 72.7%, while that of the control group was only 30% at 6 months follow-up, and no serious complications occurred in all patients [14]. Li Hongwei et al observed 90 cases 125 I No serious complications occurred in the pancreatic cancer patients after particle implantation, including 31 cases with complete remission of cancer pain, 17 cases with partial remission, and 14 cases with ineffective treatment.…”

“…CT should be reexamined immediately after the operation and introduced into the TPS treatment system to observe the distribution of particles and check the number of particles, and evaluate the implementation of the plan. If there is an obvious dose deficiency area, namely the cold area, replantation can be carried out [13][14][15][16]. Multiple center studies showed cT-guided radioactivity 125 I Particle implantation in unresectable pancreatic cancer has a significant short-term efficacy, which can effectively control tumor cell growth, reduce tumor volume, relieve pain and improve quality of life.…”

Percutaneous transhepatic cholangial drainage combined with intra-tumoral iodine-125 seeds implantation and chemotherapy for locally progressive pancreatic head cancer with obstructive jaundice

“…The overall survival of these 21 patients was 5.2-23.3 months, which was similar to that of the present study. Chen et al [21] selected 42 LAPHC patients with obstructive jaundice, and twenty-two patients underwent CT-guided 125 I seed placement after biliary stenting via percutaneous transhepatic biliary drainage (PTBD). The overall positive response rate at 6 months after treatment was 72.7% (16/22) and 30% (6/20) in patients who received and did not receive particle implantation, respectively.…”

Clinical practice guidelines for the interventional treatment of advanced pancreatic cancer (5th edition)

“…If there is still a cold radiant zone in the lesion, stage II 125 I seed implantation can be performed without complications after two weeks. 40 , 41 , 42 Postoperative observation and treatment The patient should fast for 6 ​hours postoperatively. Observe the general vital signs of the patient after the operation, including signs of abdominal pain, abdominal distension, and stool color.…”

“…If there is still a cold radiant zone in the lesion, stage II 125 I seed implantation can be performed without complications after two weeks. 40 , 41 , 42 …”