Department of Interventional Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Bei yuan road, Jinan, 250033, China.
Interventional Oncology Institute of Shandong University, Jinan, China.
Eur Radiol. 2021 Sep;31(9):6500-6510. doi: 10.1007/s00330-021-07764-6. Epub 2021 Feb 25.
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.
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.
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.
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.
• 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.
评估经皮胆道支架置入联合 CT 引导下碘 125 粒子植入序贯治疗合并梗阻性黄疸的局部进展期胰腺癌的作用。
回顾性纳入 2016 年 1 月至 2018 年 12 月诊断为合并梗阻性黄疸的局部进展期胰腺癌患者 42 例。所有患者均行经皮经肝胆道引流（PTBD）胆道支架置入以缓解梗阻性黄疸。此后，22 例患者接受 CT 引导下碘 125 粒子植入（治疗组），20 例患者未接受（对照组）。治疗组的规定剂量为 110-130Gy。评估临床资料、胆道支架通畅时间和总生存期（OS）。
总体而言，经皮胆道支架置入术后 1 个月，总胆红素水平从 275.89±115.44μmol/L 降至 43.08±43.35μmol/L（p<0.001）。在治疗组中，术后中位剂量覆盖 90%靶体积为 129.71Gy。与对照组相比，治疗组的胆道支架通畅时间和中位 OS 较长（11.42 个月比 8.57 个月，p<0.01；11.67 个月比 9.40 个月，p<0.01）。治疗后 6 个月，治疗组和对照组的总体阳性反应率分别为 72.7%（16/22）和 30%（6/20）。随访期间未观察到 3 级以上不良事件。
经皮胆道支架置入联合 CT 引导下碘 125 粒子植入序贯治疗合并梗阻性黄疸的局部进展期胰腺癌是一种有效且安全的治疗选择，值得临床应用。
所有患者胆道支架置入后黄疸均得到缓解，总胆红素水平降低。
治疗组治疗后 6 个月的总体阳性反应率高于对照组，随访期间未观察到 3 级以上不良事件。
经皮胆道支架置入联合 CT 引导下碘 125 粒子植入序贯治疗可延长胆道支架通畅时间并改善生存。
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