自膨式金属支架联合碘 125 粒子近距离放疗治疗恶性梗阻性黄疸的安全性和有效性。
Safety and efficacy of self-expandable metallic stent combined with I brachytherapy for the treatment of malignant obstructive jaundice.
机构信息
Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
Department of Interventional Radiology, The Third Affiliated Hospital of Soochow University and The First People's Hospital of Changzhou, Changzhou, Jiangsu, China.
出版信息
Cancer Imaging. 2023 Apr 4;23(1):33. doi: 10.1186/s40644-023-00551-0.
BACKGROUND
Several previous studies demonstrated that the combination of self-expandable metallic stents (SEMS) and I seed implantation might prolong stent patency and obtain survival benefits for malignant obstructive jaundice (MOJ) patients. However, these studies rarely mentioned a comparison between CT-guided intratumoral I seed implantation and intraluminal I seed strand insertion combined with stenting for the management of MOJ. This study aimed to further evaluate the safety and efficacy of SEMS combined with I brachytherapy in the management of unresectable MOJ.
METHODS
Fifty-nine patients with unresectable MOJ were retrospectively included from March 2018 to June 2021. The main therapeutic outcomes were evaluated in terms of stent patency, and overall survival. Cumulative stent patency and overall survival rates were calculated by Kaplan-Meier survival analysis. Both clinical and treatment factors associated with survival were analyzed.
RESULTS
Technical success was achieved in all patients. The clinical success rate was 94% (32/34) in the seeds group and 92% (23/25) in the control group, no significant difference was found (p =1.000). The median duration of stent patency was significantly longer in the I brachytherapy group compared with the control group (289 days vs. 88 days, respectively, p =0.001). The I brachytherapy group demonstrated a significantly better median overall survival rate than the control group (221 days vs. 78 days, respectively, p =0.001). In multivariate analysis, stents with I brachytherapy (p =0.004) was a significant favorable prognostic factor that affected patient survival. No significant difference was observed between CT-guided I seed implantation and I seed strand insertion in stent patency (p =0.268), and overall survival (p =0.483).
CONCLUSION
SEMS combined with I brachytherapy is safe and effective for treating MOJ. I brachytherapy may help to maintain stent patency and prolong overall survival. There was no significant difference between CT-guided I seed implantation with SEMS and I seed strand insertion with SEMS in stent patency and overall survival.
背景
几项先前的研究表明，自膨式金属支架（SEMS）联合碘 125 放射性粒子植入可能延长支架通畅时间，并为恶性梗阻性黄疸（MOJ）患者带来生存获益。然而，这些研究很少提及 CT 引导下肿瘤内碘 125 放射性粒子植入与腔内碘 125 放射性粒子条置入联合支架治疗 MOJ 的比较。本研究旨在进一步评估 SEMS 联合碘 125 放射性粒子近距离治疗在不可切除性 MOJ 治疗中的安全性和有效性。
方法
回顾性纳入 2018 年 3 月至 2021 年 6 月期间 59 例不可切除性 MOJ 患者。主要治疗结局评估包括支架通畅率和总生存率。通过 Kaplan-Meier 生存分析计算累积支架通畅率和总生存率。分析与生存相关的临床和治疗因素。
结果
所有患者均达到技术成功。碘 125 放射性粒子组的临床成功率为 94%（32/34），对照组为 92%（23/25），差异无统计学意义（p=1.000）。碘 125 放射性粒子组的支架通畅时间中位数明显长于对照组（分别为 289 天和 88 天，p=0.001）。碘 125 放射性粒子组的中位总生存率明显优于对照组（分别为 221 天和 78 天，p=0.001）。多因素分析显示，带碘 125 放射性粒子的支架（p=0.004）是影响患者生存的显著有利预后因素。CT 引导下碘 125 放射性粒子植入与 SEMS 联合和碘 125 放射性粒子条置入与 SEMS 联合在支架通畅率（p=0.268）和总生存率（p=0.483）方面无显著差异。
结论
SEMS 联合碘 125 放射性粒子近距离治疗 MOJ 安全有效。碘 125 放射性粒子治疗可能有助于维持支架通畅，延长总生存期。CT 引导下碘 125 放射性粒子植入与 SEMS 联合和碘 125 放射性粒子条置入与 SEMS 联合在支架通畅率和总生存率方面无显著差异。
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