Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2020; 8(17): 3743-3750
Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3743
Radioactive 125I seed implantation for locally advanced pancreatic cancer: A retrospective analysis of 50 cases
Cheng-Gang Li, Zhi-Peng Zhou, Yu-Ze Jia, Xiang-Long Tan, Yu-Yao Song
Cheng-Gang Li, Zhi-Peng Zhou, Yu-Ze Jia, Xiang-Long Tan, Yu-Yao Song, Second Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Li CG and Zhou ZP contributed equally to this work and should be considered as co-first authors; Li CG and Zhou ZP analyzed and interpreted the data and wrote the article; Tan XL, Jia YZ, and Song YY drafted the work and collected the data; Li CG designed the study and revised the manuscript for important intellectual content.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Chinese PLA General Hospital (S2016-098-02).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Cheng-Gang Li, MD, PhD, Associate Professor, Second Department of Hepatobiliary Surgery, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China. lcgang301@126.com
Received: April 14, 2020
Peer-review started: April 14, 2020
First decision: May 15, 2020
Revised: May 25, 2020
Accepted: August 12, 2020
Article in press: August 12, 2020
Published online: September 6, 2020
Processing time: 142 Days and 22.4 Hours
Abstract
BACKGROUND

Pancreatic cancer is one of the common malignant tumors of the digestive system, and radical resection is the first choice of treatment for pancreatic cancer. If patients with locally advanced pancreatic cancer cannot be treated in time and effectively, their disease often develops rapidly and their survival period is very short.

AIM

To evaluate the therapeutic effect of 125I seed implantation in patients with locally advanced pancreatic cancer.

METHODS

The demographics and perioperative outcomes of a consecutive series of patients who underwent 125I seed implantation to treat locally advanced pancreatic cancer between January 1, 2017 and June 30, 2019 were retrospectively analyzed. According to the results of preoperative computed tomography or magnetic resonance imaging, the treatment planning system was used to determine the area and number of 125I seeds implanted. During the operation, 125I seeds were implanted into the tumor under the guidance of intraoperative ultrasound, with a spacing of 1.5 cm and a row spacing of 1.5 cm. For patients with obstructive jaundice and digestive tract obstruction, choledochojejunostomy and gastroenterostomy were performed simultaneously. After operation, the patients were divided into a non-chemotherapy group and a chemotherapy group that received gemcitabine combined with albumin-bound paclitaxel treatment.

RESULTS

Among the 50 patients, there were 29 males and 21 females, with a mean age of 56.9 ± 9.8 years. The main reason for the failure of radical resection was superior mesenteric artery invasion (37, 74%), followed by superior mesenteric vein invasion (33, 66%). Twenty-one (62%) patients underwent palliative surgery and postoperative pain relief occurred in 40 (80%) patients. The estimated blood loss in operation was 107.4 ± 115.3 mL and none of the patient received blood transfusion. The postoperative hospital stay was 7.5 ± 4.2 d; one patient had biliary fistula and three had pancreatic fistula, all of whom recovered after conservative treatment. After operation, 26 patients received chemotherapy and 24 did not. The 1-year survival rate was significantly higher in patients who received chemotherapy than in those who did not (60.7% vs 35.9%, P = 0.034). The mean overall survival of patients of the chemotherapy group and non-chemotherapy group was 14 and 11 mo, respectively (χ2 = 3.970, P = 0.046).

CONCLUSION

Radioactive 125I seed implantation combined with postoperative chemotherapy can prolong the survival time, relieve pain, and improve the quality of life of patients with locally advanced pancreatic cancer.

Keywords: Pancreatic cancer; Radioactive 125I seeds; Radiotherapy; Permanent implantation

Core tip: The survival period of patients with locally advanced pancreatic cancer is very short. Radioactive 125I seed implantation can prolong the survival time, relieve pain, and improve the quality of life of patients with locally advanced pancreatic cancer.