Effect of PTCD-based Biliary Stent Placement Combined With 125I Particle Intracavitary Irradiation in Treating Pancreatic Head Cancer

J BUON. Mar-Apr 2020;25(2):1056-1062.

Abstract

Purpose: To explore the efficacy and safety of percutaneous transhepatic cholangial drainage (PTCD)-based biliary stent placement combined with iodine-125 (125I) particle intracavitary irradiation versus palliative internal biliary-intestinal drainage in the treatment of pancreatic head cancer-induced obstructive jaundice.

Methods: The clinical data of 110 patients with pancreatic head cancer, who were admitted to and treated in our hospital from July 2013 to July 2016 were registered. Among them, 55 patients underwent PTCD-based biliary metallic stent placement combined with 125I particle intracavitary irradiation (125I group), while the other 55 patients received palliative internal biliary-intestinal drainage (Surgery group). The jaundice index, and liver function parameters before and after treatment, duration of stent patency, tumor growth and incidence of adverse reactions were compared between the two groups of patients, and the patient overall survival (OS) time was followed up and recorded.

Results: The two therapies both effectively alleviated jaundice and improved liver function in patients. There were no statistically significant differences in the preoperative liver function parameters albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and direct bilirubin (DBIL) between the two groups of patients, and the liver function was significantly improved at each period of time after operation, showing a statistically significant difference. At 3 months after operation, 125I group had substantially lower levels of ALT, AST, TBIL and DBIL, but a prominently higher level of ALB than Surgery group. The complications of patients mainly included pancreatitis, recurrent biliary infections and stent blockage, which were resolved after symptomatic treatments. After operation, the maximum diameter of tumors was enlarged in both groups, and the tumor size in Surgery group and 125I group was increased from 3 months after operation to 6 months after operation, with a more obvious increase in Surgery group. The total clinical benefit rate (CBR) was 61.8% (34) and 54.5% (30), and the mean survival time of patients was 13.4±4.9 months and 12.7±4.6 months in 125I group and Surgery group, respectively. Moreover, the OS in 125I group was notably superior to that in Surgery group.

Conclusion: PTCD-based biliary metallic stent placement combined with 125I particle intracavitary irradiation can effectively relieve jaundice, improve liver function, repress tumor growth, prolong survival and produce tolerable adverse reactions in the patients with pancreatic head cancer who lose the opportunity for surgery or are intolerant to surgery.