Survival of patients with advanced pancreatic cancer after iodine(125) seeds implantation brachytherapy: A meta-analysis

BACKGROUND: Brachytherapy with iodine(125)-labeled seeds ((125)I-seeds) implantation is increasingly being used to treat tumors because of its positional precision, minimal invasion, least damage to noncancerous tissue due to slow and continuous release of radioactivity and facilitation with modern medical imaging technologies. This study evaluates the survival and pain relief outcomes of the (125)I-seeds implantation brachytherapy in advanced pancreatic cancer patients. METHODS: Literature search was carried out in multiple electronic databases (Google Scholar, Embase, Medline/PubMed, and Ovid SP) and studies reporting I(125) seeds implantation brachytherapy in pancreatic cancer patients with unresectable tumor were selected by following predetermined eligibility criteria. Random effects meta-analysis was performed to achieve inverse variance weighted effect size of the overall survival rate after the intervention. Sensitivity and subgroups analyses were also carried out. RESULTS: Twenty-three studies (824 patients’ data) were included in the meta-analysis. (125)I-seeds implantation brachytherapy alone was associated with 8.98 [95% confidence interval (CI): 6.94, 11.03] months (P < 0.00001) overall survival with 1-year survival of 25.7 ± 9.3% (mean ± standard deviation; SD) and 2-year survival was 17.9 ± 8.6% (mean ± SD). In stage IV pancreatic cancer patients, overall survival was 7.13 [95% CI: 4.75, 9.51] months (P < 0.00001). In patients treated with (125)I-seeds implantation along with 1 or more therapies, overall survival was 11.75 [95% CI: 9.84, 13.65] months (P < 0.00001) with 1-year survival of 47.4 ± 22.75% (mean ± SD) and 2-year survival was 16.97 ± 3.1% (mean ± SD). (125)I-seeds brachytherapy was associated with relief of pain in 79.7 ± 9.9% (mean ± SD) of the patients. CONCLUSIONS: Survival of pancreatic cancer patients after (125)I-seeds implantation brachytherapy is found to be 9 months, whereas a combined treatment with (125)I-seeds brachytherapy and other therapies was associated with approximately 12 months’ survival. The majority of patients who underwent (125)I-seeds brachytherapy had their pain relieved.