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BMC Cancer

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Open Access 01-12-2023 | Brachytherapy | Research

Biliary drainage combined with simultaneous ¹²⁵I seed strand brachytherapy for the treatment of hilar cholangiocarcinoma

Authors: Chengzhi Zhang, Mengyao Song, Zhanguo Sun, Yi Fang, Yiming Liu, Kaihao Xu, Xinwei Han, Dechao Jiao

Published in: BMC Cancer | Issue 1/2023

Abstract

Background

To evaluate the clinical efficacy of percutaneous biliary drainage (PBD) combined with ¹²⁵I seed strand brachytherapy (ISSB) for the treatment of hilar cholangiocarcinoma (HCCA).

Methods

The clinical data of 64 patients with HCCA (median age 62.5, male 29, female 35) treated in our department from April 2017 to April 2021 were retrospectively analyzed. Thirty-four patients in the experimental group (EG) were treated with PBD combined with ISSB, while 30 patients in the control group (CG) were treated with PBD alone. The primary study endpoints were technical success, clinical success and the 2-month local tumor control (LTC) rate. Secondary endpoints were early/late complications, median progression-free survival (mPFS) and overall survival (mOS).

Results

The technical and clinical success in the EG and CG showed no significant differences (100 vs. 100%, 94.1 vs. 93.3%, P > 0.05). Both early and late complications showed no significant differences between the two groups (P > 0.05). The 2-month LTC rates were significantly better in the EG versus the CG (94.1% vs. 26.7%, 157.7 ± 115.3 vs. 478.1 ± 235.3 U/ml), respectively (P < 0.05). The mPFS and mOS were 4.3 (95% CI 3.9–4.7) months and 2.8 (95% CI 2.5–3.1) months and 13.5 (95% CI 10.7–16.3) months and 8.8 (95% CI 7.8–9.8) months, respectively, with significant differences (P < 0.05).

Conclusion

PBD combined with ISSB is a safe and effective treatment for HCCA that can inhibit local tumors and prolong PFS and OS.

Soares KC, Jarnagin WR. The landmark series: hilar cholangiocarcinoma. Ann Surg Oncol. 2021;28(8):4158–70. https://doi.org/10.1245/s10434-021-09871-6.CrossRefPubMedPubMedCentral

Anderson B, Doyle MBM. Surgical considerations of hilar cholangiocarcinoma. Surg Oncol Clin N Am. 2019;28(4):601–17. https://doi.org/10.1016/j.soc.2019.06.003.CrossRefPubMed

Chen Y, Xu Y, Zhang Y. Current status of laparoscopic radical hilar cholangiocarcinoma in Mainland China. Biosci Trends. 2020;14(3):168–73. https://doi.org/10.5582/bst.2020.03010.CrossRefPubMed

Blechacz B. Cholangiocarcinoma: current knowledge and new developments. Gut Liver. 2017;11(1):13–26. https://doi.org/10.5009/gnl15568.CrossRefPubMed

Zhou X, Zhang W, Dou M, et al. ¹²⁵I seeds inhibit proliferation and promote apoptosis in cholangiocarcinoma cells by regulating the AGR2-mediated p38 MAPK pathway. Cancer Lett. 2022;524:29–41.CrossRefPubMed

Jiao D, Zhou X, Li Z, et al. A newly designed biliary brachytherapy drainage catheter for patients with malignant biliary obstruction: a pilot study. J Cancer Res Ther. 2020;16(2):286–91. https://doi.org/10.4103/jcrt.JCRT_804_19.CrossRefPubMed

Yuan D, Gao Z, Zhao J, et al. ¹²⁵I seed implantation for hepatocellular carcinoma with portal vein tumor thrombus: a systematic review and meta-analysis. Brachytherapy. 2019;18(4):521–9. https://doi.org/10.1016/j.brachy.2019.01.014.CrossRefPubMed

Chen Y, Wang XL, Yan ZP, et al. HDR-192Ir intraluminal brachytherapy in treatment of malignant obstructive jaundice. World J Gastroenterol. 2004;10(23):3506–10. https://doi.org/10.3748/wjg.v10.i23.3506.CrossRefPubMedPubMedCentral

Jiao D, Wu G, Ren J, et al. Study of self-expandable metallic stent placement intraluminal 125I seed strands brachytherapy of malignant biliary obstruction. Surg Endosc. 2017;31(12):4996–5005. https://doi.org/10.1007/s00464-017-5481-5.CrossRefPubMed

10.

Duan F, Cui L, Bai Y, et al. Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis. Cancer Imaging. 2017;17(1):27. https://doi.org/10.1186/s40644-017-0129-1.CrossRefPubMedPubMedCentral

11.

Cardella JF, Kundu S, Miller DL, et al. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 2009;20(7 Suppl):S189-91. https://doi.org/10.1016/j.jvir.2009.04.035.CrossRefPubMed

12.

Waseem D, Tushar P. Intrahepatic, perihilar and distal cholangiocarcinoma: management and outcomes. Ann Hepatol. 2017;16(1):133–9. https://doi.org/10.5604/16652681.1226927.CrossRefPubMed

13.

Lee TH, Moon JH, Park SH. Biliary stenting for hilar malignant biliary obstruction. Dig Endosc. 2020;32(2):275–86. https://doi.org/10.1111/den.13549.CrossRefPubMed

14.

Cambridge WA, Fairfield C, Powell JJ, et al. Meta-analysis and meta-regression of survival after liver transplantation for unresectable perihilar cholangiocarcinoma. Ann Surg. 2021;273(2):240–50. https://doi.org/10.1097/SLA.0000000000003801.CrossRefPubMed

15.

Sapisochin G, Ivanics T, Subramanian V, et al. Multidisciplinary treatment for hilar and intrahepatic cholangiocarcinoma: a review of the general principles. Int J Surg. 2020;82S:77–81. https://doi.org/10.1016/j.ijsu.2020.04.067.CrossRefPubMed

16.

Olthof PB, Aldrighetti L, Alikhanov R, et al. Portal Vein embolization is associated with reduced liver failure and mortality in high-risk resections for perihilar cholangiocarcinoma. Ann Surg Oncol. 2020;27(7):2311–8. https://doi.org/10.1245/s10434-020-08258-3.CrossRefPubMedPubMedCentral

17.

Yoshizawa T, Hong SM, Jung D, et al. Three-dimensional analysis of extrahepatic cholangiocarcinoma and tumor budding. J Pathol. 2020;251(4):400–10. https://doi.org/10.1002/path.5474.CrossRefPubMedPubMedCentral

18.

Lauterio A, De Carlis R, Centonze L, et al. Current surgical management of Peri-hilar and intra-hepatic cholangiocarcinoma. Cancers (Basel). 2021;13(15):3657. https://doi.org/10.3390/cancers13153657.CrossRefPubMed

19.

Cillo U, D’Amico FE, Furlanetto A, et al. Robotic hepatectomy and biliary reconstruction for perihilar cholangiocarcinoma: a pioneer western case series. Updates Surg. 2021;73(3):999–1006. https://doi.org/10.1007/s13304-021-01041-3.CrossRefPubMedPubMedCentral

20.

Wang M, Chen Z, Guo P, et al. Therapy for advanced cholangiocarcinoma: current knowledge and future potential. J Cell Mol Med. 2021;25(2):618–28. https://doi.org/10.1111/jcmm.16151.CrossRefPubMed

21.

Chen P, Yang T, Shi P, et al. Benefits and safety of photodynamic therapy in patients with hilar cholangiocarcinoma: a meta-analysis. Photodiagnosis Photodyn Ther. 2022;37:102712. https://doi.org/10.1016/j.pdpdt.2022.102712.CrossRefPubMed

22.

Simmons DT, Baron TH, Petersen BT, et al. A novel endoscopic approach to brachytherapy in the management of Hilar cholangiocarcinoma. Am J Gastroenterol. 2006;101(8):1792–6. https://doi.org/10.1111/j.1572-0241.2006.00700.x.CrossRefPubMed

23.

Yoshioka Y. Current status and perspectives of brachytherapy for prostate cancer. Int J Clin Oncol. 2009;14(1):31–6. https://doi.org/10.1007/s10147-008-0866-z.CrossRefPubMed

24.

Feng Y, Yang B, Li X. Clinical analysis of 125I seed implantation combined with Apatinib in the treatment of locally advanced lung cancer: a case series. J Pak Med Assoc. 2021;71(3):1025–7. https://doi.org/10.47391/JPMA.1442.CrossRefPubMed

25.

Gai B, Zhang F. Chinese expert consensus on radioactive 125I seeds interstitial implantation brachytherapy for pancreatic cancer. J Cancer Res Ther. 2018;14(7):1455–62. https://doi.org/10.4103/jcrt.JCRT_96_18.CrossRefPubMed

26.

Jiao D, Yao Y, Xu K, et al. Investigation of a novel brachytherapy ureteral stent: trial studies on normal beagle dogs. J Cancer Res Clin Oncol. 2021;147(4):1115–23. https://doi.org/10.1007/s00432-021-03513-w.CrossRefPubMed

27.

Mocan T, Horhat A, Mois E, et al. Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: when and how? World J Gastrointest Oncol. 2021;13(12):2050–63. https://doi.org/10.4251/wjgo.v13.i12.2050.CrossRefPubMedPubMedCentral

28.

Mattiucci GC, Autorino R, Tringali A, et al. A Phase I study of high-dose-rate intraluminal brachytherapy as palliative treatment in extrahepatic biliary tract cancer. Brachytherapy. 2015;14(3):401–4. https://doi.org/10.1016/j.brachy.2014.12.002.CrossRefPubMed

29.

Lamarca A, Hubner RA, David Ryder W, et al. Second-line chemotherapy in advanced biliary cancer: a systematic review. Ann Oncol. 2014;25:2328–38. https://doi.org/10.1093/annonc/mdu162.CrossRefPubMed

30.

Abou-Alfa GK, Macarulla T, Javle MM, et al. Ivosidenib in IDH1-mutant, chemotherapy-refractory cholangiocarcinoma (ClarIDHy): a multicentre, randomised, double-blind, placebo-controlled, phase 3 study. Lancet Oncol. 2020;21(6):796–807. https://doi.org/10.1016/S1470-2045(20)30157-1.CrossRefPubMedPubMedCentral

31.

Liu Y, Lu Z, Zou DW, et al. Intraluminal implantation of radioactive stents for treatment of primary carcinomas of the peripancreatic-head region: a pilot study. Gastrointest Endosc. 2009;69:1067–73. https://doi.org/10.1016/j.gie.2008.08.033.CrossRefPubMed

32.

Chen Y, Wang XL, Yan ZP. Damage to pig bile duct caused by intraluminal brachytherapy using a 125I ribbon. Acta radiol. 2013;54:272–7. https://doi.org/10.1258/ar.2012.120214.CrossRefPubMed

33.

Chen Y, Wang XL, Yan ZP. The use of 125I seed strands for intraluminal brachytherapy of malignant obstructive jaundice. Cancer Biother Radiopharm. 2013;27:317–23. https://doi.org/10.1089/cbr.2011.0999.CrossRef

34.

Li ZM, Jiao DC, Han XW, et al. Preliminary application of brachytherapy with double-strand 125I seeds and biliary drainage for malignant obstructive jaundice. Surg Endosc. 2022;36(7):4932–8. https://doi.org/10.1007/s00464-021-08848-6.CrossRefPubMed

35.

Jiao D, Xu K, Mukhiya G, et al. Brachytherapy drainage catheter and chemotherapy for unresectable pancreatic carcinoma combined with obstructive Jaundice. Front Oncol. 2022;12:941336. https://doi.org/10.3389/fonc.2022.941336.CrossRefPubMedPubMedCentral

36.

Yao Y, Jiao D, Lei Q, et al. Managing occluded stents in biliary obstruction using radiofrequency ablation combined with 125I-strand brachytherapy. Diagn Interv Radiol. 2021;27(1):79–84. https://doi.org/10.5152/dir.2020.2014.CrossRefPubMed

37.

Wang HW, Li XJ, Li SJ, et al. Biliary stent combined with iodine-125 seed strand implantation in malignant obstructive jaundice. World J Clin Cases. 2021;9(4):801–11. https://doi.org/10.12998/wjcc.v9.i4.801.CrossRefPubMedPubMedCentral

38.

Li S, Li B, Li L, et al. The efficacy of the combination of percutaneous transhepatic biliary drainage and 125I stranded seeds for malignant bile duct obstruction treatment. J Contemp Brachytherapy. 2020;12(3):225–32. https://doi.org/10.5114/jcb.2020.96862.CrossRefPubMedPubMedCentral

39.

Cao J, Wang Z, Cai H, et al. Effect of PTCD-based biliary stent placement combined with 125I particle intracavitary irradiation in treating pancreatic head cancer. J BUON. 2020;25(2):1056–62.PubMed

40.

Pan T, Li MA, Mu LW, et al. Stent placement with iodine-125 seeds strand effectively extends the duration of stent patency and survival in patients with unresectable malignant obstructive jaundice. Scand J Gastroenterol. 2020;55(1):123–8. https://doi.org/10.1080/00365521.2019.1707275.CrossRefPubMed

41.

Zhou C, Li H, Huang Q, et al. Biliary self-expandable metallic stent combined with Iodine-125 seeds strand in the treatment of hilar malignant biliary obstruction. J Int Med Res. 2020;48(4):300060519887843. https://doi.org/10.1177/0300060519887843.CrossRefPubMed

42.

Pang Q, Zhou L, Hu XS, et al. Sci Rep. 2019;9(1):11348. https://doi.org/10.1038/s41598-019-47791-4.CrossRefPubMedPubMedCentral

43.

Zhou WZ, Fu YM, Yang ZQ, et al. Study of percutaneous stent placement with iodine-125 seed strand for malignant biliary obstruction. Cardiovasc Intervent Radiol. 2019;42(2):268–75. https://doi.org/10.1007/s00270-018-2117-7.CrossRefPubMed

44.

Tjong MC, Malik NH, Chen H, et al. Stereotactic ablative radiotherapy for malignant mediastinal and hilar lymphadenopathy: a systematic review. J Thorac Dis. 2020;12(5):2280–7. https://doi.org/10.21037/jtd.2020.03.112.CrossRefPubMedPubMedCentral

Title: Biliary drainage combined with simultaneous 125I seed strand brachytherapy for the treatment of hilar cholangiocarcinoma
Authors: Chengzhi Zhang
Mengyao Song
Zhanguo Sun
Yi Fang
Yiming Liu
Kaihao Xu
Xinwei Han
Dechao Jiao
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Brachytherapy
Cholangiocarcinoma
Cholangiocarcinoma
Published in: BMC Cancer / Issue 1/2023
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-023-10868-5

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Abstract

Background

Methods

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