Safety and efficacy of self-expandable metallic stent combined with (125)I brachytherapy for the treatment of malignant obstructive jaundice

BACKGROUND: Several previous studies demonstrated that the combination of self-expandable metallic stents (SEMS) and (125)I seed implantation might prolong stent patency and obtain survival benefits for malignant obstructive jaundice (MOJ) patients. However, these studies rarely mentioned a comparison between CT-guided intratumoral (125)I seed implantation and intraluminal (125)I seed strand insertion combined with stenting for the management of MOJ. This study aimed to further evaluate the safety and efficacy of SEMS combined with (125)I brachytherapy in the management of unresectable MOJ. METHODS: Fifty-nine patients with unresectable MOJ were retrospectively included from March 2018 to June 2021. The main therapeutic outcomes were evaluated in terms of stent patency, and overall survival. Cumulative stent patency and overall survival rates were calculated by Kaplan–Meier survival analysis. Both clinical and treatment factors associated with survival were analyzed. RESULTS: Technical success was achieved in all patients. The clinical success rate was 94% (32/34) in the seeds group and 92% (23/25) in the control group, no significant difference was found (p =1.000). The median duration of stent patency was significantly longer in the (125)I brachytherapy group compared with the control group (289 days vs. 88 days, respectively, p =0.001). The (125)I brachytherapy group demonstrated a significantly better median overall survival rate than the control group (221 days vs. 78 days, respectively, p =0.001). In multivariate analysis, stents with (125)I brachytherapy (p =0.004) was a significant favorable prognostic factor that affected patient survival. No significant difference was observed between CT-guided (125)I seed implantation and (125)I seed strand insertion in stent patency (p =0.268), and overall survival (p =0.483). CONCLUSION: SEMS combined with (125)I brachytherapy is safe and effective for treating MOJ. (125)I brachytherapy may help to maintain stent patency and prolong overall survival. There was no significant difference between CT-guided (125)I seed implantation with SEMS and (125)I seed strand insertion with SEMS in stent patency and overall survival.