Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2021; 9(35): 10979-10993
Published online Dec 16, 2021. doi: 10.12998/wjcc.v9.i35.10979
Percutaneous biliary stent combined with brachytherapy using 125I seeds for treatment of unresectable malignant obstructive jaundice: A meta-analysis
Wei-Yue Chen, Chun-Li Kong, Miao-Miao Meng, Wei-Qian Chen, Li-Yun Zheng, Jian-Ting Mao, Shi-Ji Fang, Li Chen, Gao-Feng Shu, Yang Yang, Qiao-You Weng, Min-Jiang Chen, Min Xu, Jian-Song Ji
Wei-Yue Chen, Chun-Li Kong, Miao-Miao Meng, Wei-Qian Chen, Li-Yun Zheng, Jian-Ting Mao, Shi-Ji Fang, Li Chen, Gao-Feng Shu, Yang Yang, Qiao-You Weng, Min-Jiang Chen, Min Xu, Jian-Song Ji, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
Author contributions: Chen WY, Kong CL, and Meng MM acquired, analyzed, and interpreted the data, and drafted the manuscript; Chen WQ, Zheng LY, Mao JT, and Fang SJ analyzed the data and drafted the manuscript; Chen L, Shu GF, and Yang Y interpreted the data and revised the manuscript; Ji JS, Xu M, Chen MJ, and Weng QY conceptualized and designed the study, and critically revised the manuscript; all authors approved the final manuscript.
Supported by the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission, No. 2020KY1086 and No. 2020KY1087.
Conflict-of-interest statement: The authors deny any conflict of interest related to this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Song Ji, MD, PhD, Chief Doctor, Surgical Oncologist, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, No. 289 Kuocang Road, Liandu District, Lishui 323000, Zhejiang Province, China. jijiansong@zju.edu.cn
Received: June 24, 2021
Peer-review started: June 24, 2021
First decision: July 27, 2021
Revised: August 3, 2021
Accepted: November 2, 2021
Article in press: November 2, 2021
Published online: December 16, 2021
Processing time: 168 Days and 15.4 Hours
ARTICLE HIGHLIGHTS
Research background

Malignant obstructive jaundice (MOJ) is a common condition caused by various adenocarcinomas. Less than 20% of patients are suitable for radical surgery, leading to a poor overall prognosis. Recently, several clinical studies have raised concern regarding the clinical effectiveness of intraluminal 125I seed-based brachytherapy for patients with unresectable MOJ; hence, we analyzed evidence from randomized controlled trials (RCTs) and cohort studies comparing 25I seed stents and conventional stents.

Research motivation

Recently, there has been growing concern regarding the efficacy and safety of intraluminal 125I seed-based brachytherapy in the treatment of unresectable MOJ. However, most studies are single-center or retrospective with relatively small sample sizes and thus provide less convincing clinical evidence. The purpose of our study was to conduct a rigorous meta-analysis of RCTs and cohort studies on irradiated stents.

Research objectives

To investigate the clinical efficacy and safety of percutaneous biliary stents with 125I seeds compared with conventional metal stents in patients with unresectable MOJ.

Research methods

We performed a meta-analysis of RCTs and cohort studies. Four English-language databases (PubMed, Embase, Cochrane Library, and Web of Science) were searched up to June 2020 for studies comparing stents with and without 125I seeds in the treatment of unresectable MOJ.

Research results

A total of ten studies were included (6 RCTs and 4 cohort studies), involving a total of 875 patients. Our study revealed that compared with conventional stents, 125I seed stents extended the stent patency time and overall survival period. No extra complications or severe liver damage was caused by 125I seed stents. This topic remains to be studied, and more research is needed to further assess the long-term therapeutic outcomes and safety of stents irradiated using 125I seeds.

Research conclusions

Percutaneous biliary stents combined with brachytherapy using 125I seeds offers a longer stent patency and higher overall survival than conventional stents for patients with unresectable MOJ, resulting in equivalent complications and serum index outcomes.

Research perspectives

To promote the clinical application of 125I seed stents for the treatment of MOJ, future studies are needed to conduct in-depth comparative studies on the applicable conditions and cost-effectiveness of the three types of irradiated stents. In addition, it is necessary to compare the efficacy of irradiation stents using 125I seeds for MOJ caused by different adenocarcinomas.