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Jiao D, Xu K, Mukhiya G, Liu Y, Wu K, Li Z, Ren J, Han X. Brachytherapy Drainage Catheter and Chemotherapy for Unresectable Pancreatic Carcinoma Combined with Obstructive Jaundice. Front Oncol 2022; 12:941336. [PMID: 35912255 PMCID: PMC9329565 DOI: 10.3389/fonc.2022.941336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMost patients with advanced pancreatic cancer do not have the chance to undergo surgery or chemotherapy because of their poor conditions. Biliary drainage is a palliative treatment to restore liver function and alleviate jaundice, but most patients still face the risk of biliary obstruction in the short term after operation. The purpose of this study is to evaluate the efficacy and safety of brachytherapy drainage catheter (BDC)-combined chemotherapy in the treatment of pancreatic cancer complicated with obstructive jaundice.Patients and MethodsFrom November 2017 and May 2019, 48 patients underwent the BDC or conventional drainage catheter (CDC) intervention with chemotherapy. The outcomes/endpoints analyzed were technical and clinical success, early complications, stent patency period, and survival.ResultsThe technical and clinical success rates in both groups were 100%, and the early complication rates were not significantly different (P = 0.43). The median stent patency in the BDC group was significantly longer than that in the CDC group (7.8 ± 1.5 vs. 5.7 ± 0.7 months, P = 0.001), and the median overall survival period in the BDC group was prone to significant difference than that in the CDC group (9.4 ± 4.0 vs. 8.2 ± 0.3 months, P = 0.089).ConclusionThe findings of this study show that BDC with chemotherapy was associated with better stent patency and survival. However, since the sample size was very small, large randomized controlled multicenter studies are needed to further evaluate the long-term survival effects of BDC in patients with advanced pancreatic carcinoma combined with obstructive jaundice.
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Chen S, Sheng Z, Huang N. Radiofrequency Ablation Combined with Radioactive Seed Implantation for Nonsmall Cell Lung Cancer. J Healthc Eng 2022; 2022:4016081. [PMID: 35356608 PMCID: PMC8959999 DOI: 10.1155/2022/4016081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/07/2022] [Indexed: 12/20/2022]
Abstract
The aim of this study is to investigate the value of radiofrequency ablation combined with radioactive seed implantation in nonsmall cell lung cancer treatment. 30 patients with primary nonsmall cell lung cancer were randomly divided into two groups. Group A was treated with radiofrequency ablation combined with radiation seed implantation, and group B was treated with radiofrequency ablation only. We compared the incidence of complications in the two groups and reviewed the effective percentage every 3 months. All patients were treated successfully, and there were no deaths during treatment. There were no deaths and no cases of distant organ metastasis in nine months of follow-up. There were no significant differences in treatment-related complications between the two groups. The early postoperative (three and six months) effective percentage was not significantly different (P > 0.05). After 9 months, the postoperative effective rate for group A (9/15) was significantly different from that for group B (radiofrequency ablation) (6/15) (P < 0.05). Radiofrequency ablation combined with radiation 125I seed implantation can complement each other in the treatment of nonsmall cell lung cancer.
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Affiliation(s)
- Su Chen
- Department of thoracic Surgery, FuXing Hospital, Capital Medical University, Beijing 100038, China
| | - Zhengzuo Sheng
- Department of thoracic Surgery, FuXing Hospital, Capital Medical University, Beijing 100038, China
| | - Naixiang Huang
- Department of thoracic Surgery, FuXing Hospital, Capital Medical University, Beijing 100038, China
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Chen WY, Kong CL, Meng MM, Chen WQ, Zheng LY, Mao JT, Fang SJ, Chen L, Shu GF, Yang Y, Weng QY, Chen MJ, Xu M, Ji JS. Percutaneous biliary stent combined with brachytherapy using 125I seeds for treatment of unresectable malignant obstructive jaundice: A meta-analysis. World J Clin Cases 2021; 9:10979-10993. [PMID: 35047608 PMCID: PMC8678863 DOI: 10.12998/wjcc.v9.i35.10979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/03/2021] [Accepted: 11/04/2021] [Indexed: 02/06/2023] Open
Abstract
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 125I seed-based brachytherapy for MOJ patients, and various outcomes have been reported.
AIM To assess the efficacy and safety of percutaneous biliary stents with 125I 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 125I 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 125I seed stents, while 471 were treated with conventional stents. Unadjusted pooled analysis demonstrated that compared to conventional stents, 125I 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 125I 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 125I 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.
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Affiliation(s)
- Wei-Yue Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Chun-Li Kong
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Miao-Miao Meng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Wei-Qian Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Li-Yun Zheng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Jian-Ting Mao
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Shi-Ji Fang
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Li Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Gao-Feng Shu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Yang Yang
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Qiao-You Weng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Min-Jiang Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Min Xu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - 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
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Sha KH, Liu TG, Yang F, Zhang LG, Jiao ZS, Xia FF. Irradiation stent insertion for inoperable malignant biliary obstruction: a meta-analysis of randomized controlled trials. Abdom Radiol (NY) 2021; 46:2173-81. [PMID: 33156948 DOI: 10.1007/s00261-020-02851-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 12/29/2022]
Abstract
The purpose of the study was to compare the relative clinical efficacies of irradiation stent (IRS) and conventional stent (CVS) insertions for the treatment of patients with malignant biliary obstruction (MBO). Pubmed, Embase, and Cochrane Library databases were searched for relevant randomized controlled trials (RCTs) from the date of inception through to August 2020. Data analysis was performed using RevMan v5.3. This meta-analysis included eight RCTs which included a total of 319 patients who had undergone IRS insertion, and 328 who had undergone CVS insertion. No significant differences in pooled Δ total bilirubin values (MD 0.34; P = 0.92), incident rates of cholangitis (P = 0.47), hemobilia (P = 0.60), or pancreatitis (P = 0.89) were detected between two groups. The rate of stent dysfunction was significantly lower in the IRS group compared to the CVS group (22.2% vs. 37.7%, P = 0.02). The pooled stent patency (P < 0.00001) and survival (P < 0.00001) were significantly longer in the IRS group compared to the CVS group. Significant heterogeneity was detected in the endpoints of rate of stent dysfunction (I2 = 52%; P = 0.08) and survival (I2 = 77%; P = 0.0005). Subgroup analysis was performed based on the different IRS types and showed significantly longer survival in the IRS group based on both types of IRS. Funnel plot analyses did not detect any evidence of publication bias. This meta-analysis included eight RCTs which included a total of 319 patients who had undergone IRS insertion, and 328 who had undergone CVS insertion. No significant differences in pooled Δ total bilirubin values (MD 0.34; P = 0.92), incident rates of cholangitis (P = 0.47), hemobilia (P = 0.60), or pancreatitis (P = 0.89) were detected between 2 groups. The rate of stent dysfunction was significantly lower in the IRS group compared to the CVS group (22.2% vs. 37.7%, P = 0.02). The pooled stent patency (P < 0.00001) and survival (P < 0.00001) were significantly longer in the IRS group compared to the CVS group. Significant heterogeneity was detected in the endpoints of rate of stent dysfunction (I2 = 52%; P = 0.08) and survival (I2 = 77%; P = 0.0005). Subgroup analysis was performed based on the different IRS types and showed significantly longer survival in the IRS group based on both types of IRS. Funnel plot analyses did not detect any evidence of publication bias. Our meta-analysis demonstrates that IRS insertion can prolong stent patency and the survival of patients with MBO compared to CVS insertion.
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Wang HW, Li XJ, Li SJ, Lu JR, He DF. Biliary stent combined with iodine-125 seed strand implantation in malignant obstructive jaundice. World J Clin Cases 2021; 9:801-811. [PMID: 33585626 PMCID: PMC7852634 DOI: 10.12998/wjcc.v9.i4.801] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/23/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Malignant obstructive jaundice is mainly caused by cholangiocarcinoma. Only a few patients are indicated for surgical resection, and the 3-year survival rate is < 50%. For patients who are not eligible for surgery, biliary stent placement can relieve biliary obstruction and improve liver function and quality of life. However, restenosis after biliary stents has a poor prognosis and is a clinical challenge. Biliary stent combined with iodine-125 (125I) seed implantation can prolong stent patency and improve survival.
AIM To evaluate the safety and efficacy of biliary stent combined with 125I seed strand implantation in malignant obstructive jaundice.
METHODS We enrolled 67 patients between January 2016 and June 2018 with malignant obstructive jaundice and randomized them into a biliary stent combined with 125I seed strand treatment (combined) group (n = 32) and biliary stent (control) group (n = 35). All patients underwent enhanced computed tomography and magnetic resonance imaging and were tested for biochemical and cancer markers. Twelve patients underwent pathological examination before surgery. All patients were followed up by telephone or clinical visit. Postoperative liver function improvement, postoperative complications, stent patency time, and survival time were compared between the two groups. Prognostic risk factors were evaluated.
RESULTS Technical success was achieved in all patients in both groups. Postoperative liver function improved significantly in all patients (total bilirubin, direct bilirubin, alanine aminotransferase, and aspartate aminotransferase decreased significantly in all patients, the P values were less than 0.05). There was no significant difference in preoperative or postoperative indexes between the two groups for changes in total bilirubin (P = 0.147), direct bilirubin (P = 0.448), alanine aminotransferase (P = 0.120), and aspartate aminotransferase (P = 0.387) between the two groups. The median stent patency time of the combined group was 9.0 ± 1.4 mo [95% confidence interval (CI): 6.3-11.8 mo], which was significantly longer than the that of the control group (6.0 ± 0.3 mo, 95%CI: 5.5-6.5 mo, P = 0.000). The median survival time of the combined group was 11.0 ± 1.4 mo (95%CI: 8.2-13.7 mo), which was significantly longer than that of the control group (7.0 ± 0.3 mo, 95%CI: 6.4-7.6 mo, P = 0.000). Location of obstruction and number of stents were independent risk factors affecting prognosis.
CONCLUSION Biliary stent combined with 125I seed strand implantation is safe and effective in malignant obstructive jaundice and improves stent patency time and median survival time.
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Affiliation(s)
- Hui-Wen Wang
- Department of Interventional, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Xiao-Jing Li
- Department of Interventional, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Shi-Jie Li
- Department of Interventional, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Jun-Rong Lu
- Department of Interventional, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Dong-Feng He
- Department of Interventional, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
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Xiang Y, Lu S, Li Y, Liu Z, Wang W. Iodine-125 Seeds Combined With Biliary Stent Placement Versus Stent Placement Alone For Unresectable Malignant Biliary Obstruction: A Meta-Analysis Of Randomized Controlled Trials. J Cancer 2021; 12:1334-1342. [PMID: 33531978 PMCID: PMC7847662 DOI: 10.7150/jca.49663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022] Open
Abstract
Background and Aims: Malignant biliary obstruction is always caused by tumors which are unresectable so that palliative stent placement is conducted for drainage of bile duct tree. Recently, irradiation stent with 125I seeds has been used to improve the stent patency and survival time of patients. We conducted this meta-analysis to evaluate the therapeutic efficacy and safety of biliary stent placement with 125I seeds compared with stent placement alone in patients with malignant biliary obstruction. Methods: We searched Pubmed, Web of Science, ClinicalTrials.gov, Cochrane Library, Embase and CNKI databases for all relevant studies up to 1 May 2020. Patient survival, stent patency, and adverse events were the primary outcome measured. Also, Review Manager 5.3 and Stata/SE15.0 were used to perform the analysis. Results: Eleven randomized controlled trials with a total of 767 patients were included for meta-analysis. Stent combined with 125I seeds showed lower risk of stent occlusion at 3 month (Odds Ratios(OR) = 0.15; 95%CI: 0.05-0.49, P =0.002), 6 month (OR = 0.18; 95%CI: 0.08-0.44, P = 0.0001), 9 month (OR = 0.10; 95%CI: 0.05-0.20, P < 0.00001) and 1 year (OR = 0.15; 95%CI: 0.07-0.31, P < 0.00001) and better mean survival (MD = 125days; 95% CI 91-159 days; P < 0.00001) compared with stent placement alone. Also, reconstructed Kaplan-Meier data demonstrated improved survival in patients treated with stent plus 125I seeds (hazard ratio(HR)= 1.886; 95% CI: 1.609 to 2.210; P < 0.0001) Moreover, our analysis did not show significant difference between the two groups about the risk of adverse events including abdominal pain, hemobilia, pancreatitis, cholangitis and cholecystitis. Conclusion: 125I seeds combined with stent demonstrated superior stent patency and improved survival time compared to stent alone with acceptable complications.
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Affiliation(s)
- Yucheng Xiang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang 310009
| | - Sinan Lu
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang 310009
| | - Yufeng Li
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang 310009
| | - Zhenghao Liu
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang 310009
| | - Weilin Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang 310009
- Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou, Zhejiang 310009
- Clinical Research Center of Hepatobiliary and Pancreatic diseases of Zhejiang Province, Hangzhou, Zhejiang 310009
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Li S, Li B, Li L, Yang X, Xu F, Wang W. The efficacy of the combination of percutaneous transhepatic biliary drainage and 125I stranded seeds for malignant bile duct obstruction treatment. J Contemp Brachytherapy 2020; 12:225-32. [PMID: 32695193 DOI: 10.5114/jcb.2020.96862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [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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