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Iodine-125 Brachytherapy Combined with Biliary Stenting in Advanced Pancreatic Cancer: A Clinical Application Study
Huiyi Sun1, Yirou Zhou1, Guoping Li1
1Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China (H.S., Y.Z., G.L., F.W., Z.H., J.S., Z.Y., L.L., Y.H.); Shanghai Institute of Medical Imaging, Shanghai 200032, China (H.S., Y.Z., G.L., F.W., Z.H., J.S., Z.Y., L.L., Y.H.); National Clinical Research Center for Interventional Medicine, Shanghai 200032, China (H.S., Y.Z., G.L., F.W., Z.H., J.S., Z.Y., L.L., Y.H.).
Rationale And Objectives:
This study aims to investigate the impact of iodine-125 intraluminal brachytherapy on stent patency time (SPT) and overall survival (OS) in patients with advanced pancreatic cancer complicated by obstructive jaundice, which may provide evidence for optimizing multimodal interventional strategies for patients with pancreatic cancer.
Methods:
This retrospective study enrolled 262 patients with advanced pancreatic cancer complicated by obstructive jaundice who had underwent metallic biliary stent implantation. Patients were stratified into the 125I group and the control group. A 1:1 propensity score matching (PSM) was performed using a caliper width of 0.2 standard deviations of the propensity score.
Results:
After 1 month of biliary stent implantation, significant reductions of serum bilirubin, transaminases, and CA19-9 levels compared to predrainage were observed in this study. A median SPT of 7.63 months (95% CI 7.10-8.16), a stent restenosis rate of 36.2%, and a median OS of 9.40 months (95% CI 9.11-9.69) was demonstrated in the entire cohort demonstrated. After 1:1 PSM (62 patients per group), the 125 I group showed a significantly longer median SPT (9.44 months vs. 6.21 months, P < 0.001) and lower stent restenosis rate (17.7% vs. 43.5%, P = 0.002) compared to the control group. However, no significant OS difference was observed between groups (10.59 months vs. 9.07 months, P = 0.248). Cox analysis suggested that intratumoral brachytherapy (HR 0.382, P < 0.001) was an independent protective factor for SPT; post-stent Eastern Cooperative Oncology Group (ECOG) 2 score (HR 1.572, P = 0.019) was an independent risk factor for SPT. The independent risk factors for OS included post-stent ECOG 2 score (HR 1.469, P = 0.042) and post-stent CA19-9≥500 ku/L (HR 1.322, P = 0.046).
Conclusion:
Biliary stent combined with iodine-125 intraluminal brachytherapy significantly prolonged SPT compared to stent-alone in patients with advanced pancreatic cancer complicated by obstructive jaundice, although it did not significantly improve survival outcomes. Higher ECOG performance score and higher CA19-9 level after jaundice reduce were associated with poor prognosis.
