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Zhang JX, Ding Y, Yan HT, Zhou CG, Liu J, Liu S, Zu QQ, Shi HB. Skeletal-muscle index predicts survival after percutaneous transhepatic biliary drainage for obstructive jaundice due to perihilar cholangiocarcinoma. Surg Endosc 2020; 35:6073-6080. [PMID: 33090316 DOI: 10.1007/s00464-020-08099-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/15/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sarcopenia is emerging as a prognostic factor in patients with malignant diseases. The prognostication of perihilar cholangiocarcinoma (PHC) with obstructive jaundice was complex, because these patients suffered compete mortality events beyond cancer itself. Our study was to investigate the association between low skeletal-muscle index and overall survival (OS) after percutaneous transhepatic biliary drainage (PTBD) for obstructive jaundice due to PHC. METHODS We performed a retrospective survival analysis of patients undergoing PTBD for PHC-related obstructive jaundice between January 2016 and March 2019. Using computed tomography, we measured skeletal-muscle mass at the third lumbar vertebra (L3) to obtain a skeletal-muscle index (SMI). Then, we compared OS between low- and high-SMI groups. Furthermore, factors that could potentially affect OS were assessed. RESULTS One hundred and four patients (56 males; mean age 66 ± 12 years) were analyzed. Median OS after PTBD was 150 days. OS was shorter in patients with low SMI than in those with high SMI (median OS, 120 vs. 270 days; P < 0.001). Multivariate analysis indicated that low SMI (hazard ratio [HR] 3.46; 95% confidence interval [CI] 1.14-5.60; P < 0.001), intrahepatic metastasis (HR 2.98; 95% CI 1.89-4.69; P < 0.001) and elevated carbohydrate antigen (CA) 19-9 level (HR 1.00; 95% CI 1.00-1.00; P = 0.04) were significantly associated with OS. CONCLUSION Low SMI was a predictor of dismal OS after PTBD for patients with PHC-related obstructive jaundice.
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Affiliation(s)
- Jin-Xing Zhang
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Ye Ding
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Hai-Tao Yan
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Chun-Gao Zhou
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Jin Liu
- Department of Clinical Medicine Research Institution, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Qing-Quan Zu
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
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Lei QY, Jiao DC, Han XW. Novel brachytherapy drainage tube loaded with double 125I strands for hilar cholangiocarcinoma: A case report. World J Clin Cases 2020; 8:4603-4608. [PMID: 33083424 PMCID: PMC7559681 DOI: 10.12998/wjcc.v8.i19.4603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/11/2020] [Accepted: 08/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hilar cholangiocarcinoma (CC) is a common malignant tumor with high malignancy and poor prognosis. Most patients have lost the opportunity to undergo radical surgery when diagnosed. Although palliative drainage or biliary stent placement is a preferable choice, the tumor cannot be controlled. This study aimed to develop a novel brachytherapy drainage tube for low-dose-rate brachytherapy with an effective drainage, thereby prolonging the survival time of patients.
CASE SUMMARY A 54-year-old male patient had undergone choledochal stent implantation due to obstructive jaundice. He was admitted to the hospital because of the recurrence of jaundice. Preoperative imaging and pathological biopsy revealed hilar CC (Bismuth-Corlette type IIIa). First, the patient underwent percutaneous transhepatic cholangial drainage and the symptoms of jaundice gradually relieved. To further treat hilar CC and remove the biliary drainage tube as far as possible, the patient chose to use the novel brachytherapy drainage tube after a multi-disciplinary consultation. After 1 mo of brachytherapy, the re-examination revealed that the obstructive lesions disappeared, and the drainage tube was finally removed. During the following 10 mo of follow-up, the patient's hilar CC did not recur.
CONCLUSION The novel brachytherapy drainage tube may be a new choice for patients with unresectable hilar CC.
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Affiliation(s)
- Qin-Yu Lei
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - De-Chao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Xin-Wei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
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Zhong BY, Ni CF, Teng GJ. Changes in IR from 2007 to 2017 in China. J Vasc Interv Radiol 2020; 31:1449-1452. [PMID: 32868018 DOI: 10.1016/j.jvir.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/20/2020] [Accepted: 06/01/2020] [Indexed: 01/31/2023] Open
Abstract
In this article, the updated status of interventional radiology (IR) in China is reported and compared vs that a decade ago based on a poll carried out in 2017 in Jiangsu Province, where the economy and overall health level are among the best of the 31 provinces in China. All 98 polled centers responded, and 56 IR departments (57%) had become independent departments separate from the radiology department; 74 (76%) had inpatient wards. In 2017, there were 538 interventional radiologists performing IR procedures in Jiangsu Province, with a total of 69,277 procedures performed, with interventional oncologic procedures accounting for the largest proportion (58%).
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Affiliation(s)
- Bin-Yan Zhong
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China; Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cai-Fang Ni
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Gao-Jun Teng
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China.
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Radioactive Stent Insertion for Inoperable Malignant Common Biliary Obstruction. Surg Laparosc Endosc Percutan Tech 2020; 31:61-65. [DOI: 10.1097/sle.0000000000000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/10/2020] [Indexed: 11/26/2022]
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The efficacy of the combination of percutaneous transhepatic biliary drainage and 125I stranded seeds for malignant bile duct obstruction treatment. J Contemp Brachytherapy 2020; 12:225-232. [PMID: 32695193 PMCID: PMC7366027 DOI: 10.5114/jcb.2020.96862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/22/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose To investigate the efficacy of percutaneous transhepatic biliary drainage (PTBD) combined with iodine-125 (125I) stranded seeds for the treatment of malignant bile duct obstruction (MBO). Material and methods A retrospective study was performed on 58 consecutive MBO patients. Twenty patients underwent PTBD combined with 125I stranded seeds (group A). Thirty-eight patients underwent percutaneous trans-hepatic biliary drainage (group B). Total bilirubin, direct bilirubin, and indirect bilirubin levels were compared preoperatively, 1-week, 1-month, and 3-months post-operatively. Carbohydrate antigen 19-9 (CA19-9), cancer antigen 125 (CA125), and carcino-embryonic antigen (CEA) levels were compared at preoperative and 3-month post-operative stages. The time free from biliary obstruction and survival times were compared. Results The differences in total bilirubin, direct bilirubin, and indirect bilirubin levels between the two groups were not significant preoperatively (p = 0.857, p = 0.719, and p = 0.870), and 1-week post-operatively (p = 0.259, p = 0.395, and p = 0.145). However, 1-month (p = 0.012, p = 0.005, and p = 0.049) and 3-months post-operatively (p < 0.001, p = 0.001, and p = 0.001), group A was lower than group B. Differences in CA19-9, CA125, and CEA levels between the two groups were not significant preoperatively (p = 0.229, p = 0.116, and p = 0.273) and 3-months post-operatively (p = 0.159, p = 0.342, and p = 0.306). The median biliary obstruction free time was 7.0 months for group A and 5.0 months for group B (p < 0.001). The median survival time was 9.0 months for group A and 6.0 months for group B (p = 0.001). Conclusions PTBD combined with 125I stranded seeds seem to reduce bilirubin levels and prevents biliary obstruction, promoting survival.
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Song Z, Ye J, Wang Y, Li Y, Wang W. Computed tomography-guided iodine-125 brachytherapy for unresectable hepatocellular carcinoma. J Cancer Res Ther 2020; 15:1553-1560. [PMID: 31939437 DOI: 10.4103/jcrt.jcrt_629_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose This study aimed to retrospectively assess the outcome of interstitial iodine-125 brachytherapy for unresectable hepatocellular carcinoma (HCC). Materials and Methods Between February 2013 and March 2019, 57 patients with 108 unresectable HCC lesions treated with computed tomography (CT)-guided iodine-125 seed brachytherapy were retrospectively analyzed. The primary endpoint was overall survival (OS). The secondary endpoints included local tumor control and progression-free survival (PFS). Potential factors associated with OS were assessed. Results The mean follow-up duration was 24.3 ± 15.6 months (median, 20.5 months; range, 3.9-66.8 months). The median OS time was 23.6 months (95% confidence interval [CI], 18.4-28.8 months). The 1-, 2-, and 3-year actuarial OS rates were 80.0%, 46.1%, and 24.3%, respectively. The median PFS time was 12 months (95% CI, 9.9-14.5 months). The 1- and 2-year actuarial PFS rates were 50% and 20.1%, respectively. Local progression was noted in 11 (11.3%) of 108 lesions with mean local control time of 20.5 ± 8.8 months. The 1- and 2-year local control rates were 96.5% and 88.8%, respectively. Barcelona clinic liver cancer stage and Child-Pugh score were independent risk factors affecting the prognosis (hazard ratio [HR] = 0.330 [95% CI, 0.128-0.853] and HR = 0.303 [95% CI, 0.151-0.610], respectively). Hepatic artery pseudoaneurysm was found in 1 (1.8%) patient with lesion located in the porta hepatis. No other major complications developed during follow-up. Conclusion CT-guided iodine-125 brachytherapy may be an effective and safe alternative with promising survival and increased local control rate in unresectable HCC treatment.
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Affiliation(s)
- Zhaomin Song
- Department of Oncology, The Third Hospital of Qinhuangdao City, Qinhuangdao City, Hebei Province, China
| | - Jiacheng Ye
- Department of Interventional Medicine, Nanping First Hospital Affiliated to Fujian Medical University, Nanping City, Fujian Province, China
| | - Yongzheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, Nanping City, Fujian Province, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, Nanping City, Fujian Province, China
| | - Wujie Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, Nanping City, Fujian Province, China
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Mohindra P, Beriwal S, Kamrava M. Proposed brachytherapy recommendations (practical implementation, indications, and dose fractionation) during COVID-19 pandemic. Brachytherapy 2020; 19:390-400. [PMID: 32423787 PMCID: PMC7252026 DOI: 10.1016/j.brachy.2020.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/15/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA.
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Chen G, Zhang M, Sheng YG, Yang F, Li ZQ, Liu TG, Fu YF. Stent with radioactive seeds strand insertion for malignant hilar biliary obstruction. MINIM INVASIV THER 2020; 30:356-362. [PMID: 32125207 DOI: 10.1080/13645706.2020.1735446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: This study aimed to assess clinical efficacy and long-term patient outcomes in individuals with malignant hilar biliary obstruction (MHBO) that had been treated via insertion of a stent with a radioactive seed strand (RSS).Material and methods: A total of 84 MHBO patients were treated via either normal stent insertion (n = 48) or stent with RSS insertion (n = 36) from January 2015 to December 2018.Results: The technical success rates of normal stent insertion and stent with RSS insertion were 93.8% (45/48) and 97.2% (35/36), respectively (p = .632), with clinical success rates of 93.3% (42/45) and 100% (35/35), respectively (p = .252). In these two patient groups, 11 and seven patients, respectively, suffered from stent dysfunction (p = .637). In the normal and RSS groups, median stent patency was 165 and 225 days, respectively (p < .001). All patients in the present study died due to tumor progression, with median survival times of 188 and 250 days in the normal and RSS stent groups, respectively (p < .001).Conclusion: Relative to normal stent insertion, combined stent with RSS insertion can effectively prolong both stent patency and patient survival in patients with MHBO.
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Affiliation(s)
- Gang Chen
- Department of Vascular Interventional, Binzhou Medical University Hospital, Binzhou, China
| | - Mei Zhang
- Department of Vascular Interventional, Binzhou Medical University Hospital, Binzhou, China
| | - Yu-Guo Sheng
- Department of Vascular Interventional, Binzhou Medical University Hospital, Binzhou, China
| | - Fang Yang
- Department of Infectious Disease, Binzhou Medical University Hospital, Binzhou, China
| | - Zhong-Qi Li
- Department of Critical Care Medicine, Rizhao People's Hospital, Rizhao, China
| | - Tong-Gang Liu
- Department of Infectious Disease, Binzhou Medical University Hospital, Binzhou, China
| | - Yu-Fei Fu
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
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Yang SY, Liu F, Liu Y, Xia FF, Fu YF. Stent insertion with high-intensity focused ultrasound ablation for distal biliary obstruction secondary to pancreatic carcinoma. Medicine (Baltimore) 2020; 99:e19099. [PMID: 32028435 PMCID: PMC7015571 DOI: 10.1097/md.0000000000019099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We determined the clinical effectiveness and long-term outcomes in patients with distal biliary obstruction (DBO) secondary to pancreatic carcinoma (PC) who were treated by self-expanded metallic stent (SEMS) insertion with or without high-intensity focused ultrasound (HIFU) ablation.From January 2014 to December 2018, consecutive patients with DBO secondary to PC underwent SEMS insertion with or without HIFU ablation in our center. The long-term outcomes were compared between the 2 groups.During the included period, 75 patients underwent SEMS insertion with (n = 34) or without (n = 41) HIFU ablation in our center. SEMS insertion was successfully performed in all patients. Liver function was significantly improved after SEMS insertion in both groups. An average of 2.9 HIFU treatment sessions per patient were performed. Twenty patients (stent + HIFU group: 7; stent-only group: 13) experienced stent dysfunction (P = .278). The clinical response rate to HIFU ablation was 79.4%. The median stent patency was significantly longer in the stent with HIFU group than in the stent-only group (175 vs 118 days, P = .005). The median survival was significantly longer in the stent with HIFU group compared with the stent-only group (211 versus 136 days, P = .004). An Eastern Cooperative Oncology Group (ECOG) Performance Status of 3 (hazard ratio: 0.300; P = .002) and subsequent HIFU ablation (hazard ratio: 0.508; P = .005) were associated with prolonged survival.HIFU ablation following stent insertion can prolong the stent patency and survival for patients with DBO secondary to PC.
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Affiliation(s)
- Shu-Ying Yang
- Department of gynaecology and obstetrics, Qilu Hospital of Shandong University, Jinan
| | - Fen Liu
- Department of gynaecology and obstetrics, Qilu Hospital of Shandong University, Jinan
| | | | - Feng-Fei Xia
- Department of Interventional Vascular Surgery, Binzhou People's Hospital, Binzhou
| | - Yu-Fei Fu
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
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Li W, Wang X, Wang Z, Zhang T, Cai F, Tang P, Meng J, Du H, Wang H, Li M, Li S. The role of seed implantation in patients with unresectable pancreatic carcinoma after relief of obstructive jaundice using ERCP. Brachytherapy 2020; 19:97-103. [PMID: 31564517 DOI: 10.1016/j.brachy.2019.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/27/2019] [Accepted: 08/21/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of the study was to investigate the role of iodine-125 seed implantation, guided by endoscopic ultrasound (EUS) and/or percutanous ultrasound, in patients with unresectable pancreatic carcinoma after relief of obstructive jaundice using endoscopic retrograde cholangiopancreatography (ERCP). METHODS AND MATERIALS A total of 101 patients with obstructive jaundice due to unresectable pancreatic carcinoma were enrolled between January 2010 and December 2017 in this retrospective study. Of these patients, 50 underwent implantation of iodine-125 seeds under EUS and/or percutaneous ultrasound guidance after receiving a stent via ERCP (treatment group), and 51 received a stent via ERCP without undergoing seed implantation (control group). The clinical data and therapeutic outcomes of these patients were analyzed. RESULTS Compared with the control group, the treatment group obtained significant relief of abdominal pain at the 1-week, 1-month, and 3-month followup (p < 0.05), with a significantly lower visual analog scale pain score (p < 0.05). The treatment group obtained a longer median survival (8.8 vs. 6.5 months, p = 0.02), longer median duration of stent patency (10.8 ± 1.4 vs. 6.9 ± 0.8 months, p = 0.02), and prolonged average time to gastric outlet obstruction (6.8 ± 1.6 vs. 5.3 ± 1.3 months, p = 0.02). Differences between liver function and appetite for the two groups were not significant (p > 0.05 and p = 0.59, respectively). CONCLUSIONS Iodine-125 seed implantation after relief of obstructive jaundice via ERCP prolongs survival, biliary stent patency, and time to gastric outlet obstruction and improves patient quality of life by relieving pancreatic pain in patients with unresectable pancreatic carcinoma.
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Affiliation(s)
- Wen Li
- Department of Gastroenterology and Hepatology, The Chinese PLA General Hospital, Beijing, China
| | - Xiangdong Wang
- Department of Gastroenterology and Hepatology, The Chinese PLA General Hospital, Beijing, China
| | - Zikai Wang
- Department of Gastroenterology and Hepatology, The Chinese PLA General Hospital, Beijing, China
| | - Tiantian Zhang
- Department of Gastroenterology and Hepatology, The Chinese PLA General Hospital, Beijing, China
| | - Fengchun Cai
- Department of Gastroenterology and Hepatology, The Chinese PLA General Hospital, Beijing, China
| | - Ping Tang
- Department of Gastroenterology and Hepatology, The Chinese PLA General Hospital, Beijing, China
| | - Jiangyun Meng
- Department of Gastroenterology and Hepatology, The Chinese PLA General Hospital, Beijing, China
| | - Hong Du
- Department of Gastroenterology and Hepatology, The Chinese PLA General Hospital, Beijing, China
| | - Hongbin Wang
- Department of Gastroenterology and Hepatology, The Chinese PLA General Hospital, Beijing, China
| | - Mingyang Li
- Department of Gastroenterology and Hepatology, The Chinese PLA General Hospital, Beijing, China
| | - Shuling Li
- Department of Gastroenterology and Hepatology, The Chinese PLA General Hospital, Beijing, China.
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Zhou C, Li H, Huang Q, Wang J, Gao K. Biliary self-expandable metallic stent combined with Iodine-125 seeds strand in the treatment of hilar malignant biliary obstruction. J Int Med Res 2019; 48:300060519887843. [PMID: 31884851 PMCID: PMC7783887 DOI: 10.1177/0300060519887843] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective To assess the safety and effectiveness of a self-expandable metallic stent
(SEMS) combined with Iodine-125 seeds strand to treat hilar malignant
biliary obstruction (MBO). Methods This retrospective study included patients who had received SEMS with
125I seeds strand (seeds group) or SEMS alone (controls) to
treat hilar MBO. Demographic, biochemical, stent patency, overall survival
and complications data were extracted and analysed. Results A total of 76 patients were included (seeds group, n = 40;
controls, n = 36), with a total of 608 seeds deployed in
the seeds group (mean, 15.2 ± 4.1 [range, 8–25] seeds per patient).
Statistically significant between-group differences were shown in median
stent patency time (seeds group, 387.0 ± 27.9 days [95% confidence interval
{CI} 332.4, 441.6] versus controls, 121.0 ± 9.1 days [95% CI 103.2, 138.8])
and in median overall survival (seeds group, 177.0 ± 17.9 days [95% CI
141.8, 212.2] versus controls, 123.0 ± 20.4 [95% CI 83.0, 163.0]). There
were no statistically significant between-group differences in complication
rates. Conclusion SEMS combined with 125I seeds strand is safe, feasible, and
tolerable in treating patients with hilar MBO, and may be effective in
prolonging stent patency time and overall survival.
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Affiliation(s)
- Chuanguo Zhou
- Department of Interventional Radiology, Beijing Chaoyang Hospital, Affiliated Hospital of Capital Medical University, Beijing, China
| | - Hui Li
- Department of Interventional Radiology, Beijing Chaoyang Hospital, Affiliated Hospital of Capital Medical University, Beijing, China
| | - Qiang Huang
- Department of Interventional Radiology, Beijing Chaoyang Hospital, Affiliated Hospital of Capital Medical University, Beijing, China
| | - Jianfeng Wang
- Department of Interventional Radiology, Beijing Chaoyang Hospital, Affiliated Hospital of Capital Medical University, Beijing, China
| | - Kun Gao
- Department of Interventional Radiology, Beijing Chaoyang Hospital, Affiliated Hospital of Capital Medical University, Beijing, China
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Zizzo M, Zanelli M, Sassatelli R, Iotti C, Manenti A, Annessi V. Malignant biliary obstruction due to unresectable pancreatic cancer: Is the irradiation stent the most effective palliation? Pancreatology 2019; 19:1081-1082. [PMID: 31611132 DOI: 10.1016/j.pan.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | - Magda Zanelli
- Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Romano Sassatelli
- Gastroenterology and Digestive Endoscopy Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Iotti
- Radiotherapy Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Manenti
- Department of General Surgery, Azienda Ospedaliero-Universitaria - Policlinico, Modena, Italy
| | - Valerio Annessi
- General Surgery Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Guastalla, Reggio Emilia, Italy
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Zhu X, Niu X, Li T, Liu C, Chen L, Tan G. Identification of research trends concerning application of stent implantation in the treatment of pancreatic diseases by quantitative and biclustering analysis: a bibliometric analysis. PeerJ 2019; 7:e7674. [PMID: 31660258 PMCID: PMC6815650 DOI: 10.7717/peerj.7674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/14/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES In recent years, with the development of biological materials, the types and clinical applications of stents have been increasing in pancreatic diseases. However, relevant problems are also constantly emerging. Our purpose was to summarize current hotspots and explore potential topics in the fields of the application of stent implantation in the treatment of pancreatic diseases for future scientific research. METHODS Publications on the application of stents in pancreatic diseases were retrieved from PubMed without language limits. High-frequency Medical Subject Headings (MeSH) terms were identified through Bibliographic Item Co-Occurrence Matrix Builder (BICOMB). Biclustering analysis results were visualized utilizing the gCLUTO software. Finally, we plotted a strategic diagram. RESULTS A total of 4,087 relevant publications were obtained from PubMed until May 15th, 2018. Eighty-three high-frequency MeSH terms were identified. Biclustering analysis revealed that these high-frequency MeSH terms were classified into eight clusters. After calculating the density and concentricity of each cluster, strategy diagram was presented. The cluster 5 "complications such as pancreatitis associated with stent implantation" was located at the fourth quadrant with high centricity and low density. CONCLUSIONS In our study, we found eight topics concerning the application of stent implantation in the treatment of pancreatic diseases. How to reduce the incidence of postoperative complications and improve the prognosis of patients with pancreatic diseases by stent implantation could become potential hotspots in the future research.
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Affiliation(s)
- Xuan Zhu
- Institute of Translational Medicine, China Medical University, Shenyang, Liaoning, China
- Department of General Surgery, Anshan Hospital, First Affiliated Hospital of China Medical University, Anshan, Liaoning, China
| | - Xing Niu
- Department of Second Clinical College, Shengjing Hospital affiliated to China Medical University, Shenyang, Liaoning, China
| | - Tao Li
- Department of General Surgery, Fushun Mining Bureau General Hospital, Fushun, Liaoning, China
| | - Chang Liu
- Department of General Surgery, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Lijie Chen
- Department of Third Clinical College, China Medical University, Shenyang, Liaoning, China
| | - Guang Tan
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Wang W, Li P, Wang Y, Liu B, Li Y. Percutaneous stenting and chemotherapy for unresectable pancreatic cancer: Comparison of irradiation stents vs conventional metal stents. Pancreatology 2019; 19:957-962. [PMID: 31551162 DOI: 10.1016/j.pan.2019.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/19/2019] [Accepted: 09/17/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Percutaneous stenting is a palliative method to relieve obstructive jaundice caused by unresectable pancreatic carcinoma. In this study, we aimed to compare the safety and efficacy of irradiation stents and conventional metal stents. METHODS A total of 32 patients who received irradiation stents or conventional metal stents to treat obstructive jaundice caused by locally advanced pancreatic cancer were included in this retrospective study. Chemotherapy using gemcitabine was performed after jaundice subsided. Stent patency, technical success, survival, and complications were compared between groups. RESULTS Seventeen patients were enrolled in the irradiation stent group (ISG), and 15 patients were enrolled in the uncovered stent group (USG). Median and mean stent patency time were 9.8 months (95% CI, 7.682-11.981) and 9.506 months (95% CI, 8.0-11.012) in the ISG, respectively, vs 8.8 months (95% CI, 6.528-11.072) and 7.62 months (95% CI, 5.917-9.323) in the USG, respectively (P = 0.019). Median and mean overall survival were 10.4 months (95% CI, 8.383-12.417) and 9.953 months (95% CI, 8.408-11.498), respectively, in the ISG vs 9.7 months (95% CI, 7.901-11.499) and 8.14 months (95% CI, 6.44-9.84), respectively, in the USG (P = 0.027). CONCLUSIONS Irradiation stents extend stent patency and overall survival compared with conventional biliary stents for the treatment of pancreatic carcinoma complicated by obstructive jaundice. Irradiation stents combined with chemotherapy may be a better choice for the treatment of obstructive jaundice caused by unresectable pancreatic carcinoma.
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Affiliation(s)
- Wujie Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, 247 Beiyuan Street, Jinan City, Shandong Province, 250033, China.
| | - Peimin Li
- Department of Interventional Medicine, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, China.
| | - Yongzheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, 247 Beiyuan Street, Jinan City, Shandong Province, 250033, China.
| | - Bin Liu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, 247 Beiyuan Street, Jinan City, Shandong Province, 250033, China.
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, 247 Beiyuan Street, Jinan City, Shandong Province, 250033, China.
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65
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Zhou HF, Han YQ, Lu J, Wei JW, Guo JH, Zhu HD, Huang M, Ji JS, Lv WF, Chen L, Zhu GY, Jin ZC, Tian J, Teng GJ. Radiomics Facilitates Candidate Selection for Irradiation Stents Among Patients With Unresectable Pancreatic Cancer. Front Oncol 2019; 9:973. [PMID: 31612111 PMCID: PMC6776612 DOI: 10.3389/fonc.2019.00973] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/13/2019] [Indexed: 12/24/2022] Open
Abstract
Purpose: To develop a model to select appropriate candidates for irradiation stent placement among patients with unresectable pancreatic cancer with malignant biliary obstruction (UPC-MBO). Methods: This retrospective study included 106 patients treated with an irradiation stent for UPC-MBO. These patients were randomly divided into a training group (74 patients) and a validation group (32 patients). A clinical model for predicting restenosis-free survival (RFS) was developed with clinical predictors selected by univariate and multivariate analyses. After integrating the radiomics signature, a combined model was constructed to predict RFS. The predictive performance was evaluated with the concordance index (C-index) in both the training and validation groups. The median risk score of progression in the training group was used to divide patients into high- and low-risk subgroups. Results: Radiomics features were integrated with clinical predictors to develop a combined model. The predictive performance was better in the combined model (C-index, 0.791 and 0.779 in the training and validation groups, respectively) than in the clinical model (C-index, 0.673 and 0.667 in the training and validation groups, respectively). According to the median risk score of 1.264, the RFS was significantly different between the high- and low-risk groups (p < 0.001 for the training group, and p = 0.016 for the validation group). Conclusions: The radiomics-based model had good performance for RFS prediction in patients with UPC-MBO who received an irradiation stent. Patients with slow progression should consider undergoing irradiation stent placement for a longer RFS.
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Affiliation(s)
- Hai-Feng Zhou
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Yu-Qi Han
- School of Life Science and Technology, Xidian University, Xi'an, China.,Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Jian Lu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Jing-Wei Wei
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Jin-He Guo
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Hai-Dong Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Ming Huang
- Department of Minimally Invasive Interventional Radiology, Yunnan Tumor Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian-Song Ji
- Department of Radiology, Lishui Central Hospital, Wenzhou Medical University, Lishui, China
| | - Wei-Fu Lv
- Department of Interventional Radiology, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Li Chen
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Guang-Yu Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Zhi-Cheng Jin
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Jie Tian
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China.,Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China.,Engineering Research Centre of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Gao-Jun Teng
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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Jung S, Shen S, Ye SJ. Dose perturbation and inhomogeneity of multi-arrays of 125I seed-loaded stent for treatment of portal vein tumor thrombosis. Phys Med 2019; 66:1-7. [PMID: 31563726 DOI: 10.1016/j.ejmp.2019.09.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/26/2019] [Accepted: 09/11/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To investigate the dosimetry of 125I seed-loaded stent system currently used for an adjuvant treatment of portal vein tumor thrombosis (PVTT). METHODS The stent system consisted of an inner metallic stent and outer seed-loaded capsules. Four arrays of 125I seeds were attached longitudinally to the outer surface of the stent at 90° separation. 145 Gy was prescribed at 5 mm from the axes of seed-arrays. For the geometries of the 4-array, and potential 6- and 8-array configurations, treatment planning system (TPS) and Monte Carlo (MC) calculations were performed to evaluate 3D dose distributions and dosimetric impact of the metallic stent. RESULTS The MC simulations indicated the metallic stent reduced a dose to the prescription points by over 10%, compared to the water-based TPS results. The total activity calculated by the water-based TPS to deliver the prescription dose should compensate for this amount of reduction. The MC- and TPS-calculated doses normalized to the prescription points for the current configuration were in agreements within 4.3% on a cylindrical surface along 5 mm from the axes of seed-arrays. The longitudinal underdosage worsened as approaching the edge of arrays, and ranged from 2.8% to 25.5%. The angular underdosage between neighboring arrays was 2.1%-8.9%. CONCLUSIONS With this compensation and a special care of near-edge underdosage, the current 4-array system can provide adequate dose coverage for treatment of PVTT. Further dosimetric homogeneity can be achieved using 6-or 8-array configurations.
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Affiliation(s)
- Seongmoon Jung
- Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Sui Shen
- Department of Radiation Oncology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Sung-Joon Ye
- Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea; Robotics Research Laboratory for Extreme Environment, Advanced Institutes of Convergence Technology, Seoul National University, Suwon, Gyeonggi-do, South Korea.
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Zhou HF, Lu J, Zhu HD, Guo JH, Huang M, Ji JS, Lv WF, Li YL, Xu H, Chen L, Zhu GY, Teng GJ. Early Warning Models to Estimate the 30-Day Mortality Risk After Stent Placement for Patients with Malignant Biliary Obstruction. Cardiovasc Intervent Radiol 2019; 42:1751-1759. [PMID: 31482338 DOI: 10.1007/s00270-019-02331-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To develop, validate, and compare early warning models of the 30-day mortality risk for patients with malignant biliary obstruction (MBO) undergoing percutaneous transhepatic biliary stent placement (PTBS). MATERIALS AND METHODS Between January 2013 and October 2018, this multicenter retrospective study included 299 patients with MBOs who underwent PTBS. The training set consisted of 166 patients from four cohorts, and another two independent cohorts were allocated as external validation sets A and B with 75 patients and 58 patients, respectively. A logistic model and an artificial neural network (ANN) model were developed to predict the risk of 30-day mortality after PTBS. The predictive performance of these two models was validated internally and externally. RESULTS The ANN model had higher values of area under the curve than the logistic model in the training set (0.819 vs 0.797), especially in the validation sets A (0.802 vs 0.714) and B (0.732 vs 0.568). Both models had high accuracy in the three sets (75.9-83.1%). Along with a high specificity, the ANN model improved the sensitivity. The net reclassification improvement and integrated discrimination improvement also demonstrated that the ANN model led to improvements in predictive ability compared with the logistic model. CONCLUSIONS Early warning models were proposed to predict the risk of 30-day mortality after PTBS in patients with MBO. The ANN model has higher accuracy and better generalizability than the logistic model.
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Affiliation(s)
- Hai-Feng Zhou
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Jian Lu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Hai-Dong Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Jin-He Guo
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Ming Huang
- Department of Minimally Invasive Interventional Radiology, Yunnan Tumor Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650106, China
| | - Jian-Song Ji
- Department of Radiology, Lishui Central Hospital, Wenzhou Medical University, Lishui, 323000, China
| | - Wei-Fu Lv
- Department of Interventional Radiology, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China (USTC), Hefei, 230001, China
| | - Yu-Liang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, 250033, China
| | - Hao Xu
- Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Li Chen
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Guang-Yu Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Gao-Jun Teng
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
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Zhou HF, Huang M, Ji JS, Zhu HD, Lu J, Guo JH, Chen L, Zhong BY, Zhu GY, Teng GJ. Risk Prediction for Early Biliary Infection after Percutaneous Transhepatic Biliary Stent Placement in Malignant Biliary Obstruction. J Vasc Interv Radiol 2019; 30:1233-1241.e1. [PMID: 31208946 DOI: 10.1016/j.jvir.2019.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/15/2019] [Accepted: 03/04/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To establish a nomogram for predicting the occurrence of early biliary infection (EBI) after percutaneous transhepatic biliary stent (PTBS) placement in malignant biliary obstruction (MBO). MATERIALS AND METHODS In this multicenter study, patients treated with PTBS for MBO were allocated to a training cohort or a validation cohort. The independent risk factors for EBI selected by multivariate analyses in the training cohort were used to develop a predictive nomogram. An artificial neural network was applied to assess the importance of these factors in predicting EBI. The predictive accuracy of this nomogram was determined by concordance index (c-index) and a calibration plot, both internally and externally. RESULTS A total of 243 patients (training cohort: n = 182; validation cohort: n = 61) were included in this study. The independent risk factors were length of obstruction (odds ratio [OR], 1.061; 95% confidence interval [CI], 1.013-1.111; P = .012), diabetes (OR, 5.070; 95% CI, 1.917-13.412; P = .001), location of obstruction (OR, 2.283; 95% CI, 1.012-5.149; P = .047), and previous surgical or endoscopic intervention (OR, 3.968; 95% CI, 1.709-9.217; P = .001), which were selected into the nomogram. The c-index values showed good predictive performance in the training and validation cohorts (0.792 and 0.802, respectively). The optimum cutoff value of risk was 0.25. CONCLUSIONS The nomogram can facilitate the early and accurate prediction of EBI in patients with MBO who underwent PTBS. Patients with high risk (> 0.25) should be administered more effective prophylactic antibiotics and undergo closer monitoring.
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Affiliation(s)
- Hai-Feng Zhou
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Medical School, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Ming Huang
- Department of Minimally Invasive Interventional Radiology, Yunnan Tumor Hospital, the Third Affiliated Hospital of Kunming Medical University, Kunming 650106, China
| | - Jian-Song Ji
- Department of Radiology, Lishui Central Hospital, Wenzhou Medical University, Lishui, China
| | - Hai-Dong Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Medical School, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Jian Lu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Medical School, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Jin-He Guo
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Medical School, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Li Chen
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Medical School, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Bin-Yan Zhong
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Medical School, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Guang-Yu Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Medical School, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Gao-Jun Teng
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Medical School, Zhongda Hospital, Southeast University, Nanjing 210009, China.
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Study of Percutaneous Stent Placement with Iodine-125 Seed Strand for Malignant Biliary Obstruction. Cardiovasc Intervent Radiol 2018; 42:268-275. [PMID: 30506169 DOI: 10.1007/s00270-018-2117-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/08/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the effectiveness and safety of simultaneous placement of a self-expandable metallic stents (SEMS) and iodine-125 seed strand in the management of malignant obstructive jaundice (MOJ). MATERIALS AND METHODS This study included 132 patients with MOJ treated from November 2015 to October 2017. Forty-five patients underwent insertion of SEMS with iodine-125 seed strands (Seeds group); the remaining 87 patients underwent SEMS placement alone (Control group). Technical success was defined as accurate, successful deployment of SEMS with or without iodine-125 seed strand; clinical success was defined as 20% reduction in serum bilirubin within 1 week after the procedure, compared with baseline. Complications, duration of primary stent patency, and overall survival were evaluated. RESULTS Technical success was achieved in all patients in both groups. In the Seeds group, an average of 14 seeds (range 8-22) were implanted in the bile duct as a strand. Clinical success rates were similar between the groups (Seeds group, 93.3%; Control group, 95.4%). Major complications occurred in only one patient, in the Control group. The median period of primary stent patency was significantly longer in the Seeds group (194 days) than in the Control group (86 days; P = 0.049). The median overall survival was also significantly longer in the Seeds group (194 days) than in the Control group (96 days; P = 0.031). CONCLUSION SEMS combined with iodine-125 seed strands is effective and safe in the management of MOJ and can improve stent patency and patient survival.
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Zhu HD, Lu J, Teng GJ. Reply to: "Potential limitations of irradiation stent implantation in unresectable malignant biliary obstruction". J Hepatol 2018; 69:557-558. [PMID: 29751032 DOI: 10.1016/j.jhep.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 04/19/2018] [Accepted: 05/01/2018] [Indexed: 12/04/2022]
Affiliation(s)
- Hai-Dong Zhu
- Department of Radiology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Jian Lu
- Department of Radiology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Gao-Jun Teng
- Department of Radiology, Zhongda Hospital, Southeast University, Nanjing 210009, China.
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Liu HC, Hu XS, Pang Q, Jin H, Wang Y. Potential limitations of irradiation stent implantation in unresectable malignant biliary obstruction. J Hepatol 2018; 69:556-557. [PMID: 29776715 DOI: 10.1016/j.jhep.2018.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/13/2018] [Indexed: 12/04/2022]
Affiliation(s)
- Hui-Chun Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China.
| | - Xiao-Si Hu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China
| | - Qing Pang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China
| | - Hao Jin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China
| | - Yong Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China
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Wang Y, Lu J, Guo JH, Zhu GY, Zhu HD, Chen L, Wang C, Teng GJ. A Novel Tracheobronchial Stent Loaded with 125I Seeds in Patients with Malignant Airway Obstruction Compared to a Conventional Stent: A Prospective Randomized Controlled Study. EBioMedicine 2018; 33:269-275. [PMID: 29909977 PMCID: PMC6085500 DOI: 10.1016/j.ebiom.2018.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/31/2018] [Accepted: 06/06/2018] [Indexed: 12/13/2022] Open
Abstract
Background To evaluate the safety and efficacy of a novel radioactive bare metal stent (RBMS) compared with a conventional bare metal stent (CBMS) in patients with inoperable malignant airway obstruction. Methods This prospective study was approved by the Institutional Ethics Committee, and informed consent was obtained from each participant. Patients with malignant airway obstruction who had dyspnea were randomly assigned to receive RBMS or CBMS placement. The primary endpoint was stenosis grade, while the secondary endpoints were technical success, overall survival, and complications. A p value of <0·05 was considered statistically significant. Results Between September 2013 and July 2015, 66 patients with inoperable malignant airway obstruction received stent placement fluoroscopically (33 in either group). The median follow-up time was 154 days (range, 15–335 days). The baseline stenosis was immediately relieved in both groups after stent placement, and the stenosis grades in the RBMS group were significantly lower than that in the CBMS group since the second month (p < 0·05). The technical success rates of stent placement were 100% in both groups. The median survival in the RBMS group was significantly longer than that in the CBMS group (170 days vs. 123 days, p < 0·05). There was no significant difference in the incidence of complications between the two groups (p < 0·05). Conclusions The placement of RBMS in patients with inoperable malignant airway obstruction is feasible and safe, and it significantly reduces restenosis and improves overall survival compared with the placement of CBMS. The baseline stenosis was immediately relieved in both groups after stent placement. The stenosis grades in the RBMS group were significantly lower than that in the CBMS group since the second month. The technical success rates of stent placement were 100% in both groups. The median survival in the RBMS group was significantly longer than that in the CBMS group. There was no significant difference of the incidence of complications between the two groups.
Malignant airway obstruction (MAO) is a serious situation of 20-30% cases of lung cancer, resulting in dyspnea, decreased functional status, and asphyxiation risk. Conventional stent placement provides immediate palliation of dyspnea. However, stent restenosis occurs during the follow up. A novel radioactive bare metal stent (RBMS) loaded with 125I seed was developed for preventing such restenosis. Our study showed that placement of RBMS in patients with inoperable malignant airway obstruction is feasible and safe, and it significantly reduces the restenosis and improves overall survival compared with placement of conventional stent.
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Affiliation(s)
- Yong Wang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Jian Lu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Jin-He Guo
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Guang-Yu Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Hai-Dong Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Li Chen
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Chao Wang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China
| | - Gao-Jun Teng
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China.
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Ma J, Luo J, Gu J, Liu Q, Liu L, Zhang W, Zhang Z, Yan Z. Malignant obstructive jaundice treated with intraluminal placement of Iodine-125 seed strands and metal stents: An analysis of long-term outcomes and prognostic features. Brachytherapy 2018; 17:689-695. [PMID: 29748084 DOI: 10.1016/j.brachy.2018.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/15/2018] [Accepted: 04/03/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to analyze the long-term outcomes, including safety, efficacy, and prognostic features, of intraluminal brachytherapy with Iodine-125 (125I) seed strand and stent placement for treatment of patients with malignant obstructive jaundice (MOJ). METHODS AND MATERIALS From January 2009 to December 2013, 107 consecutive patients with MOJ were treated with intraluminal placement of 125I seed strands and metal stents. A retrospective evaluation of therapeutic outcomes, including overall survival (OS), stent patency rate, complications, and prognostic features, was conducted in 101 patients. RESULTS 125I seed strands and stents were all successfully implanted. The median followup time was 231 (45-1015) days, and the median OS was 394.0 (95% confidence interval: 319.1-468.9) days. The cumulative OS rates at 3, 6, 12, and 24 months were 95%, 77%, 53%, and 20%, respectively. The median stent patency period was 278.0 (95% confidence interval: 164.1-391.9) days, and cumulative patency rates at 3, 6, 12, and 24 months were 92%, 69%, 45%, and 13%, respectively. Multivariate analysis indicated that the serum conjugated/total bilirubin ≥88% before procedure (p = 0.032) and whether the patient receiving further treatment (p = 0.041) appear to be the prognostic factors of OS. There is no statistical prognostic factor for stent patency. CONCLUSIONS The intraluminal placement of 125I seed strands and stents appears to be a safe and efficient therapy on MOJ. The patient with serum conjugated/total bilirubin ≥88% before procedure and receiving further treatment seems to live longer.
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Affiliation(s)
- Jingqin Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China
| | - Jianjun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China.
| | - Junying Gu
- Shanghai Institution of Medical Imaging, Shanghai, China; Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Qingxin Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China
| | - Lingxiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China
| | - Zihan Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institution of Medical Imaging, Shanghai, China
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