Clinical study on using 125i seeds articles combined with biliary stent implantation in the treatment of malignant obstructive jaundice

Abstract

Aim: To study the feasibility and curative effect of 125I seeds articles combined with biliary stent implantation in the treatment of malignant obstructive jaundice. Patients and Methods: Fifty patients with malignant obstructive jaundice were included. Twenty-four were treated by biliary stent implantation combined with intraluminal brachytherapy by 125I seeds articles as the experimental group, while the remaining 26 were treated by biliary stent implantation only as the control group. The goal of this study was to evaluate total bilirubin, direct bilirubin and tumor markers (cancer antigen (CA)-199, CA-242 and carcinoembryonic antigen (CEA)), as well as biliary stent patency status and survival time before and after surgery. Results: Jaundice improved greatly in both groups. The decreases of CA-199 and CA-242 had statistical significance (p=0.003 and p=0.004) in the experimental group. The ratio of biliary stent patency was 83.3% (20/24) in the experimental group and 57.7% (15/26) in the control group (p=0.048). The biliary stent patency time in the experimental group was 1~15.5 (mean=9.84) months. The biliary stent patency time in the control group was 0.8~9 (mean=5.57) months, which was statistically significant (p=0.018). The median survival time was 10.2 months in the experimental group, while 5.4 months in control group (p<0.05). Conclusion: 125I seeds articles combined with biliary stent implantation significantly prolongs biliary stent patency time and survival time for patients with malignant obstructive jaundice possibly by inhibiting the proliferation of vascular endothelial cells and the growth of tumor. Malignant obstructive jaundice refers to the bile duct obstruction caused by a variety of malignant lesions, most of which will not be diagnosed until reaching an advanced stage. Unfortunately, only 7% of patients with this condition have the opportunity of radical surgery (1, 2). Biliary stent implantation technique can restore the physiological drainage of bile (3, 4). 125I seeds articles combined with biliary stent implantation technique has been demonstrated in the past as a potential approach that can ease the jaundice recurrence due to the stent blockage; it also has therapeutic effects on the primary tumor via the radiation effects (5, 6). We have been evaluating this technique in the clinical condition. From September 2010 to February 2013, we applied 125I seeds articles combined with biliary stent implantation treatment to 24 patients with malignant obstructive jaundice, together with a control group. Here, we report the efficacy and clinical outcome of the findings.