Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2021; 9(4): 792-800
Published online Feb 6, 2021. doi: 10.12998/wjcc.v9.i4.792
Radioactive 125I seed implantation for pancreatic cancer with unexpected liver metastasis: A preliminary experience with 26 patients
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, Zhou ZP, and Jia YZ analyzed and interpreted the data and wrote the article; Jia YZ, Tan XL, and Song YY drafted the work and collected the data; Li CG designed the study and revised the article for important intellectual content.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Chinese PLA General Hospital (No. 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: November 16, 2020
Peer-review started: November 16, 2020
First decision: November 29, 2020
Revised: December 3, 2020
Accepted: December 11, 2020
Article in press: December 11, 2020
Published online: February 6, 2021
Abstract
BACKGROUND

Preoperative diagnosis rate of pancreatic cancer has increased year by year. The prognosis of pancreatic cancer patients with unexpected liver metastasis found by intraoperative exploration is very poor, and there is no effective and unified treatment strategy.

AIM

To evaluate the therapeutic effect of radioactive 125I seed implantation for pancreatic cancer patients with unexpected liver metastasis.

METHODS

The demographics and perioperative outcomes of patients who underwent 125I seed implantation to treat pancreatic cancer with unexpected liver metastasis between January 1, 2017 and June 1, 2019 were retrospectively analyzed. During the operation, 125I seeds were implanted into the pancreatic 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

Preoperative imaging evaluation of all patients in this study showed that the tumor was resectable without liver metastasis. There were 26 patients in this study, including 18 males and 8 females, aged 60.5 ± 9.7 years. The most common tumor site was the pancreatic head (17, 65.4%), followed by the pancreatic neck and body (6, 23.2%) and pancreatic tail (3, 11.4%). Fourteen patients (53.8%) underwent palliative surgery and postoperative pain relief occurred in 22 patients (84.6%). The estimated blood loss in operation was 148.3 ± 282.1 mL and one patient received blood transfusion. The postoperative hospital stay was 7.6 ± 2.8 d. One patient had biliary fistula, one had pancreatic fistula, and all recovered after conservative treatment. After operation, 7 patients received chemotherapy and 19 did not. The 1-year survival rate was significantly higher in patients who received chemotherapy than in those who did not (68.6% vs 15.8%, P = 0.012). The mean overall survival of patients in the chemotherapy group and non-chemotherapy group was 16.3 mo and 10 mo, respectively (χ2 = 7.083, P = 0.008).

CONCLUSION

Radioactive 125I seed implantation combined with postoperative chemotherapy can prolong the survival time and relieve pain of pancreatic cancer patients with unexpected liver metastasis.

Keywords: Pancreatic cancer, Liver metastases, Radioactive 125I seeds, Radiotherapy, Permanent implantation, Therapeutic effect

Core Tip: To evaluate the therapeutic effect of radioactive 125I seed implantation for pancreatic cancer patients with unexpected liver metastasis. We found that it can prolong the survival time and relieve pain of pancreatic cancer patients with unexpected liver metastasis.