The role of EUS-guided iodine-125 seed implantation in patients with unresectable ampullary cancer after relief of obstructive jaundice

IF 1.1 4区医学 Q4 ONCOLOGY

Journal of Contemporary Brachytherapy Pub Date : 2024-04-30 DOI:10.5114/jcb.2024.139279

Ting-ting Cui, Xin-xiang Guo, Bai-rong Li, Zi-Kai Wang, Nian-Jun Xiao, Fang Liu, Xiang-Dong Wang, Wen Li

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引用次数: 0

Abstract

Purpose:
Few studies have focused on the management of inoperable ampullary carcinoma (AC), and patients with jaundice suffer from biliary stents replacement frequently. Iodine-125 (¹²⁵I) brachytherapy has been used in the treatment of malignant tumors owing to its curative effect, minimal surgical trauma, and tolerable complications. The aim of the study was to investigate the role of ¹²⁵I seed implantation in patients with unresectable ampullary carcinoma after relief of obstructive jaundice.

Material and methods:
A total of 44 patients with obstructive jaundice resulting from unresectable ampullary carcinoma from January 1, 2010 to October 31, 2020 were enrolled in the study. Eleven patients underwent implantation of ¹²⁵I seeds under endoscopic ultrasound (EUS) after receiving biliary stent placement via endoscopic retrograde cholangiopancreatography (ERCP) (treatment group), and 33 patients received a stent alone via ERCP (control group). Cox regression model was applied in this single-center retrospective comparison study.

Results:
The median maximum intervention interval for biliary obstruction was 381 days (interquartile range [IQR]: 204-419 days) in the treatment group and 175 days (IQR: 126-274 days) in the control group (p < 0.05). Stent occlusion rates at 90 and 180 days in the control group were 12.9% and 51.6%, respectively. No stent occlusion occurred in the treatment group. Patients in the treatment group obtained longer survival time (median, 26 vs. 13 months; p < 0.01) and prolonged duodenal obstruction (median, 20.5 vs. 11 months; p < 0.05). No brachytherapy-related grade 3 or 4 adverse events were observed.

Conclusions:
Longer intervention interval for biliary obstruction and survival as well as better stent patency and prolonged time to duodenal obstruction could be achieved by implanting ¹²⁵I seeds combined with biliary stent in patients with unresectable ampullary cancer.

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在梗阻性黄疸缓解后，在 EUS 引导下将碘-125 种子植入无法切除的胰腺癌患者体内的作用

目的：很少有研究关注无法手术的膀胱癌（AC）的治疗，黄疸患者经常需要更换胆道支架。碘-125（125I）近距离放射治疗因其疗效好、手术创伤小、并发症少而被用于恶性肿瘤的治疗。材料与方法：2010年1月1日至2020年10月31日期间，共有44例因不可切除的胰门癌导致梗阻性黄疸的患者被纳入研究。11名患者通过内镜逆行胰胆管造影术（ERCP）植入胆道支架后，在内镜超声（EUS）下植入125I粒子（治疗组），33名患者通过ERCP单独植入支架（对照组）。结果：治疗组胆道梗阻的中位最长干预间隔为 381 天（四分位间距 [IQR]：204-419 天），对照组为 175 天（IQR：126-274 天）（P < 0.05）。对照组 90 天和 180 天的支架闭塞率分别为 12.9% 和 51.6%。治疗组未发生支架闭塞。治疗组患者的存活时间更长（中位 26 个月对 13 个月；p < 0.01），十二指肠梗阻时间更长（中位 20.5 个月对 11 个月；p < 0.05）。结论：在无法切除的膀胱癌患者中，通过植入125I粒子和胆道支架，可以延长胆道梗阻的干预间隔和生存期，并提高支架的通畅性和延长十二指肠梗阻的时间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Contemporary Brachytherapy ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

2.40

自引率

14.30%

发文量

审稿时长

16 weeks

期刊介绍： The “Journal of Contemporary Brachytherapy” is an international and multidisciplinary journal that will publish papers of original research as well as reviews of articles. Main subjects of the journal include: clinical brachytherapy, combined modality treatment, advances in radiobiology, hyperthermia and tumour biology, as well as physical aspects relevant to brachytherapy, particularly in the field of imaging, dosimetry and radiation therapy planning. Original contributions will include experimental studies of combined modality treatment, tumor sensitization and normal tissue protection, molecular radiation biology, and clinical investigations of cancer treatment in brachytherapy. Another field of interest will be the educational part of the journal.