BACKGROUND Malignant obstructive jaundice(MOJ)is a common pathologic manifestation of malignant biliary obstruction.Recently,several clinical trials have explored the clinical effectiveness of intraluminal^(125)I seed...BACKGROUND Malignant obstructive jaundice(MOJ)is a common pathologic manifestation of malignant biliary obstruction.Recently,several clinical trials have explored the clinical effectiveness of intraluminal^(125)I seed-based brachytherapy for MOJ patients,and various outcomes have been reported.AIM To assess the efficacy and safety of percutaneous biliary stents with^(125)I seeds compared to conventional metal stents in patients with unresectable MOJ.METHODS A systematic search of English-language databases(PubMed,Embase,Cochrane Library,and Web of Science)was performed to identify studies published prior to June 2020 that compared stents with or without^(125)I seeds in the treatment of unresectable MOJ.The outcomes analyzed included primary outcomes(stent patency and overall survival)and secondary outcomes(complications and liver function parameters).RESULTS Six randomized controlled trials and four retrospective studies involving 875 patients were eligible for the analysis.Of the 875 included patients,404 were treated with^(125)I seed stents,while 471 were treated with conventional stents.Unadjusted pooled analysis demonstrated that compared to conventional stents,^(125)I seed stents extended the stent patency time[hazard ratio(HR)=0.36,95%confidence interval(CI)=0.28-0.45,P<0.0001]and overall survival period(HR=0.52,95%CI=0.42–0.64,P<0.00001).Subgroup analyses based on the type of^(125)I seed stent and type of study design showed consistent results.However,there were no significant differences in the occurrence of total complications[odds ratio(OR)=1.12,95%CI=0.75-1.67,P=0.57],hemobilia(OR=1.02,95%CI=0.45-2.3,P=0.96),pancreatitis(OR=1.79,95%CI=0.42-7.53,P=0.43),cholangitis(OR=1.13,95%CI=0.60-2.13,P=0.71),or pain(OR=0.67,95%CI=0.22-2,P=0.47).In addition,there were no reductions in the levels of serum indices,including total bilirubin[mean difference(MD)=10.96,95%CI=-3.56-25.49,P=0.14],direct bilirubin(MD=7.37,95%CI=-9.76-24.5,P=0.4),alanine aminotransferase(MD=7.52,95%CI=-0.71-15.74,P=0.07),and aspartate aminotransferase(MD=-4.77,95%CI=-19.98-10.44,P=0.54),after treatment.Publication bias was detected regarding the outcome overall survival;however,the conclusions were not changed after the adjustment.CONCLUSION Placement of stents combined with brachytherapy using^(125)I seeds contributes to a longer stent patency and higher overall survival than placement of conventional stents without extra complications or severe liver damage.Thus,it can be considered an effective and safe treatment for unresectable MOJ.展开更多
Malignant tumors are major causes of morbidity and mortality in China.Despite advances in surgical,radiological,chemotherapeutic,molecular targeting,and immunotherapeutic treatments,patients with malignant tumors stil...Malignant tumors are major causes of morbidity and mortality in China.Despite advances in surgical,radiological,chemotherapeutic,molecular targeting,and immunotherapeutic treatments,patients with malignant tumors still have poor prognoses.Low-dose-rate brachytherapy,specifically 125I seed implantation,is beneficial because of its high local delivery dose and minimal damage to surrounding tissues.Consequently,it has gained increasing acceptance as a treatment modality for various malignant tumors.In this study,we explored the fundamental principles,clinical applications,and new technologies associated with 125I radioactive seed implantation.展开更多
BACKGROUND Oral cancer(OC)is the most common malignant tumor in the oral cavity,and is mainly seen in middle-aged and elderly men.At present,OC is mainly treated clinically by surgery or combined with radiotherapy and...BACKGROUND Oral cancer(OC)is the most common malignant tumor in the oral cavity,and is mainly seen in middle-aged and elderly men.At present,OC is mainly treated clinically by surgery or combined with radiotherapy and chemotherapy;but recently,more and more studies have shown that the stress trauma caused by surgery and the side effects of radiotherapy and chemotherapy seriously affect the prognosis of patients.AIM To determine the significance of 125I radioactive seed implantation on growth differentiation factor 11(GDF11)and programmed death receptor-1(PD-1)during treatment of OC.METHODS A total of 184 OC patients admitted to The Second Affiliated Hospital of Jiamusi University from May 2015 to May 2017 were selected as the research subjects for prospective analysis.Of these patients,89 who received 125I radioactive seed implantation therapy were regarded as the research group(RG)and 95 patients who received surgical treatment were regarded as the control group(CG).The clinical efficacy,incidence of adverse reactions and changes in GDF11 and PD-1 before treatment(T0),2 wk after treatment(T1),4 wk after treatment(T2)and 6 wk after treatment(T3)were compared between the two groups.RESULTS The efficacy and recurrence rate in the RG were better than those in the CG(P<0.05),while the incidence of adverse reactions and survival rate were not different.There was no difference in GDF11 and PD-1 between the two groups at T0 and T1,but these factors were lower in the RG than in the CG at T2 and T3(P<0.05).Using receiver operating characteristic(ROC)curve analysis,GDF11 and PD-1 had good predictive value for efficacy and recurrence(P<0.001).CONCLUSION 125I radioactive seed implantation has clinical efficacy and can reduce the recurrence rate in patients with OC.This therapy has marked potential in clinical application.The detection of GDF11 and PD-1 in patients during treatment showed good predictive value for treatment efficacy and recurrence in OC patients,and may be potential targets for future OC treatment.展开更多
目的探讨开放式磁共振(MR)引导125I放射性粒子植入治疗脑胶质瘤及转移瘤的可行性及有效性。方法回顾性分析34例临床确诊的脑胶质瘤及转移瘤患者资料,包括初治脑胶质瘤6例,复发性恶性脑胶质瘤14例,脑转移瘤14例(乳腺癌脑转移6例,肺癌脑转...目的探讨开放式磁共振(MR)引导125I放射性粒子植入治疗脑胶质瘤及转移瘤的可行性及有效性。方法回顾性分析34例临床确诊的脑胶质瘤及转移瘤患者资料,包括初治脑胶质瘤6例,复发性恶性脑胶质瘤14例,脑转移瘤14例(乳腺癌脑转移6例,肺癌脑转移6例,结肠癌脑转移2例)。全部患者均采取了开放式MR引导下125I放射性粒子植入治疗。术前行治疗计划系统(TPS)确定125I放射性粒子的数量及空间分布,术中应用1.0 T开放式MR透视实时引导技术引导,术后24 h CT扫描并行剂量验证。定期随访观察术后疗效及并发症。结果根据WHO疗效评价标准,全组病例1、3和6个月有效率分别为47.1%、70.5%和80.1%;全组病例1年生存率为64.7%。并发症包括术中针道少量出血1例,癫痫发作1例,术后3个月出现认知功能障碍1例,术后8个月认知功能恢复正常。无治疗相关死亡病例。结论开放式磁共振引导125I放射性粒子植入治疗脑胶质瘤及转移瘤安全、可行、有效;MR透视实时引导技术操作简便、导引精确,可有效降低并发症发生率。展开更多
基金the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2020KY1086 and No.2020KY1087.
文摘BACKGROUND Malignant obstructive jaundice(MOJ)is a common pathologic manifestation of malignant biliary obstruction.Recently,several clinical trials have explored the clinical effectiveness of intraluminal^(125)I seed-based brachytherapy for MOJ patients,and various outcomes have been reported.AIM To assess the efficacy and safety of percutaneous biliary stents with^(125)I seeds compared to conventional metal stents in patients with unresectable MOJ.METHODS A systematic search of English-language databases(PubMed,Embase,Cochrane Library,and Web of Science)was performed to identify studies published prior to June 2020 that compared stents with or without^(125)I seeds in the treatment of unresectable MOJ.The outcomes analyzed included primary outcomes(stent patency and overall survival)and secondary outcomes(complications and liver function parameters).RESULTS Six randomized controlled trials and four retrospective studies involving 875 patients were eligible for the analysis.Of the 875 included patients,404 were treated with^(125)I seed stents,while 471 were treated with conventional stents.Unadjusted pooled analysis demonstrated that compared to conventional stents,^(125)I seed stents extended the stent patency time[hazard ratio(HR)=0.36,95%confidence interval(CI)=0.28-0.45,P<0.0001]and overall survival period(HR=0.52,95%CI=0.42–0.64,P<0.00001).Subgroup analyses based on the type of^(125)I seed stent and type of study design showed consistent results.However,there were no significant differences in the occurrence of total complications[odds ratio(OR)=1.12,95%CI=0.75-1.67,P=0.57],hemobilia(OR=1.02,95%CI=0.45-2.3,P=0.96),pancreatitis(OR=1.79,95%CI=0.42-7.53,P=0.43),cholangitis(OR=1.13,95%CI=0.60-2.13,P=0.71),or pain(OR=0.67,95%CI=0.22-2,P=0.47).In addition,there were no reductions in the levels of serum indices,including total bilirubin[mean difference(MD)=10.96,95%CI=-3.56-25.49,P=0.14],direct bilirubin(MD=7.37,95%CI=-9.76-24.5,P=0.4),alanine aminotransferase(MD=7.52,95%CI=-0.71-15.74,P=0.07),and aspartate aminotransferase(MD=-4.77,95%CI=-19.98-10.44,P=0.54),after treatment.Publication bias was detected regarding the outcome overall survival;however,the conclusions were not changed after the adjustment.CONCLUSION Placement of stents combined with brachytherapy using^(125)I seeds contributes to a longer stent patency and higher overall survival than placement of conventional stents without extra complications or severe liver damage.Thus,it can be considered an effective and safe treatment for unresectable MOJ.
文摘Malignant tumors are major causes of morbidity and mortality in China.Despite advances in surgical,radiological,chemotherapeutic,molecular targeting,and immunotherapeutic treatments,patients with malignant tumors still have poor prognoses.Low-dose-rate brachytherapy,specifically 125I seed implantation,is beneficial because of its high local delivery dose and minimal damage to surrounding tissues.Consequently,it has gained increasing acceptance as a treatment modality for various malignant tumors.In this study,we explored the fundamental principles,clinical applications,and new technologies associated with 125I radioactive seed implantation.
基金Supported by Heilongjiang Provincial Health and Family Planning Commission Research Project,No.2017-413
文摘BACKGROUND Oral cancer(OC)is the most common malignant tumor in the oral cavity,and is mainly seen in middle-aged and elderly men.At present,OC is mainly treated clinically by surgery or combined with radiotherapy and chemotherapy;but recently,more and more studies have shown that the stress trauma caused by surgery and the side effects of radiotherapy and chemotherapy seriously affect the prognosis of patients.AIM To determine the significance of 125I radioactive seed implantation on growth differentiation factor 11(GDF11)and programmed death receptor-1(PD-1)during treatment of OC.METHODS A total of 184 OC patients admitted to The Second Affiliated Hospital of Jiamusi University from May 2015 to May 2017 were selected as the research subjects for prospective analysis.Of these patients,89 who received 125I radioactive seed implantation therapy were regarded as the research group(RG)and 95 patients who received surgical treatment were regarded as the control group(CG).The clinical efficacy,incidence of adverse reactions and changes in GDF11 and PD-1 before treatment(T0),2 wk after treatment(T1),4 wk after treatment(T2)and 6 wk after treatment(T3)were compared between the two groups.RESULTS The efficacy and recurrence rate in the RG were better than those in the CG(P<0.05),while the incidence of adverse reactions and survival rate were not different.There was no difference in GDF11 and PD-1 between the two groups at T0 and T1,but these factors were lower in the RG than in the CG at T2 and T3(P<0.05).Using receiver operating characteristic(ROC)curve analysis,GDF11 and PD-1 had good predictive value for efficacy and recurrence(P<0.001).CONCLUSION 125I radioactive seed implantation has clinical efficacy and can reduce the recurrence rate in patients with OC.This therapy has marked potential in clinical application.The detection of GDF11 and PD-1 in patients during treatment showed good predictive value for treatment efficacy and recurrence in OC patients,and may be potential targets for future OC treatment.
文摘目的探讨开放式磁共振(MR)引导125I放射性粒子植入治疗脑胶质瘤及转移瘤的可行性及有效性。方法回顾性分析34例临床确诊的脑胶质瘤及转移瘤患者资料,包括初治脑胶质瘤6例,复发性恶性脑胶质瘤14例,脑转移瘤14例(乳腺癌脑转移6例,肺癌脑转移6例,结肠癌脑转移2例)。全部患者均采取了开放式MR引导下125I放射性粒子植入治疗。术前行治疗计划系统(TPS)确定125I放射性粒子的数量及空间分布,术中应用1.0 T开放式MR透视实时引导技术引导,术后24 h CT扫描并行剂量验证。定期随访观察术后疗效及并发症。结果根据WHO疗效评价标准,全组病例1、3和6个月有效率分别为47.1%、70.5%和80.1%;全组病例1年生存率为64.7%。并发症包括术中针道少量出血1例,癫痫发作1例,术后3个月出现认知功能障碍1例,术后8个月认知功能恢复正常。无治疗相关死亡病例。结论开放式磁共振引导125I放射性粒子植入治疗脑胶质瘤及转移瘤安全、可行、有效;MR透视实时引导技术操作简便、导引精确,可有效降低并发症发生率。
