Full Text | PDF

J Cancer 2021; 12(5):1334-1342. doi:10.7150/jca.49663 This issue Cite

Research Paper

Iodine-125 Seeds Combined With Biliary Stent Placement Versus Stent Placement Alone For Unresectable Malignant Biliary Obstruction: A Meta-Analysis Of Randomized Controlled Trials

Yucheng Xiang^1,2, Sinan Lu^1,2, Yufeng Li^1,2, Zhenghao Liu^1,2, Weilin Wang^{1,2,3,4 ✉}

1. Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009.
2. Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang 310009.
3. Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou, Zhejiang 310009.
4. Clinical Research Center of Hepatobiliary and Pancreatic diseases of Zhejiang Province, Hangzhou, Zhejiang 310009.

✉ Corresponding author: Weilin Wang, Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang, China, 310009.

Abstract

Background and Aims: Malignant biliary obstruction is always caused by tumors which are unresectable so that palliative stent placement is conducted for drainage of bile duct tree. Recently, irradiation stent with ¹²⁵I seeds has been used to improve the stent patency and survival time of patients. We conducted this meta-analysis to evaluate the therapeutic efficacy and safety of biliary stent placement with ¹²⁵I seeds compared with stent placement alone in patients with malignant biliary obstruction.

Methods: We searched Pubmed, Web of Science, ClinicalTrials.gov, Cochrane Library, Embase and CNKI databases for all relevant studies up to 1 May 2020. Patient survival, stent patency, and adverse events were the primary outcome measured. Also, Review Manager 5.3 and Stata/SE15.0 were used to perform the analysis.

Results: Eleven randomized controlled trials with a total of 767 patients were included for meta-analysis. Stent combined with ¹²⁵I seeds showed lower risk of stent occlusion at 3 month (Odds Ratios(OR) = 0.15; 95%CI: 0.05-0.49, P =0.002), 6 month (OR = 0.18; 95%CI: 0.08-0.44, P = 0.0001), 9 month (OR = 0.10; 95%CI: 0.05-0.20, P < 0.00001) and 1 year (OR = 0.15; 95%CI: 0.07-0.31, P < 0.00001) and better mean survival (MD = 125days; 95% CI 91-159 days; P < 0.00001) compared with stent placement alone. Also, reconstructed Kaplan-Meier data demonstrated improved survival in patients treated with stent plus ¹²⁵I seeds (hazard ratio(HR)= 1.886; 95% CI: 1.609 to 2.210; P < 0.0001) Moreover, our analysis did not show significant difference between the two groups about the risk of adverse events including abdominal pain, hemobilia, pancreatitis, cholangitis and cholecystitis.

Conclusion: ¹²⁵I seeds combined with stent demonstrated superior stent patency and improved survival time compared to stent alone with acceptable complications.

Keywords: malignant biliary obstruction, ¹²⁵I seed, biliary stent, stent patency, survival.

Citation styles

©2024 Ivyspring International Publisher. Terms of use