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PURPOSE: To explore the efficacy and safety of percutaneous transhepatic cholangial drainage (PTCD)-based biliary stent placement combined with iodine-125 (125I) particle intracavitary irradiation versus palliative internal biliary-intestinal drainage in the treatment of pancreatic head cancer-induced obstructive jaundice. METHODS: The clinical data of 110 patients with pancreatic head cancer, who were admitted to and treated in our hospital from July 2013 to July 2016 were registered. Among them, 55 patients underwent PTCD-based biliary metallic stent placement combined with 125I particle intracavitary irradiation (125I group), while the other 55 patients received palliative internal biliary-intestinal drainage (Surgery group). The jaundice index, and liver function parameters before and after treatment, duration of stent patency, tumor growth and incidence of adverse reactions were compared between the two groups of patients, and the patient overall survival (OS) time was followed up and recorded. RESULTS: The two therapies both effectively alleviated jaundice and improved liver function in patients. There were no statistically significant differences in the preoperative liver function parameters albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and direct bilirubin (DBIL) between the two groups of patients, and the liver function was significantly improved at each period of time after operation, showing a statistically significant difference. At 3 months after operation, 125I group had substantially lower levels of ALT, AST, TBIL and DBIL, but a prominently higher level of ALB than Surgery group. The complications of patients mainly included pancreatitis, recurrent biliary infections and stent blockage, which were resolved after symptomatic treatments. After operation, the maximum diameter of tumors was enlarged in both groups, and the tumor size in Surgery group and 125I group was increased from 3 months after operation to 6 months after operation, with a more obvious increase in Surgery group. The total clinical benefit rate (CBR) was 61.8% (34) and 54.5% (30), and the mean survival time of patients was 13.4±4.9 months and 12.7±4.6 months in 125I group and Surgery group, respectively. Moreover, the OS in 125I group was notably superior to that in Surgery group. CONCLUSION: PTCD-based biliary metallic stent placement combined with 125I particle intracavitary irradiation can effectively relieve jaundice, improve liver function, repress tumor growth, prolong survival and produce tolerable adverse reactions in the patients with pancreatic head cancer who lose the opportunity for surgery or are intolerant to surgery.

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OBJECTIVE: To evaluate the efficacy and safety of raltitrexed plus oxaliplatin-based transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC). METHODS: A total of 123 patients with unresectable HCC were recruited into the prospective cohort study. Raltitrexed plus oxaliplatin-based TACE was performed according to the traditional method at monthly intervals and was repeated for up to 4 cycles if no disease progression or intolerable toxicity occurred. The primary efficacy endpoint was overall survival (OS), and the secondary endpoints were progression-free survival (PFS) and tumor response rate. The Cox proportional-hazards regression model was used to assess the independent prognostic factors of OS. Adverse events were also observed. RESULTS: The median OS time and PFS were 623 days (95% CI: 461, 785) and 338 days (95% CI: 302, 704), respectively. The disease control rate was 95.5% (118/123). The Cox proportional-hazards regression model indicated that age, ECOG performance status and response to TACE as independent prognostic factors of OS. No treatment-related mortality occurred within 30 days of treatment procedure. The most common complications included postembolization syndrome, liver dysfunction and hematological toxicity. Grade 3 pain, transglutaminase abnormality and thrombocytopenia were observed in 16 (13%), 15 (12.2%) and 3 (2.4%) patients, respectively. No grade 4 adverse events were observed. CONCLUSION: Raltitrexed plus oxaliplatin-based TACE led to high tumor response rate and promising PFS and OS, and was considered safe and tolerable in patients with unresectable HCC.

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BACKGROUND: Treatment options for patients with cavernous transformation of portal vein (CTPV) are limited. This study aimed to evaluate the feasibility, efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) to prevent recurrent esophageal variceal bleeding in patients with CTPV. METHODS: We retrospectively analyzed 67 consecutive patients undergone TIPS from January 2011 to December 2016. All patients were diagnosed with CTPV. The indication for TIPS was a previous episode of variceal bleeding. The data on recurrent bleeding, stent patency, hepatic encephalopathy and survival were retrieved and analyzed. RESULTS: TIPS procedure was successfully performed in 56 out of 67 (83.6%) patients with CTPV. TIPS was performed via a transjugular approach alone (n = 15), a combined transjugular/transhepatic approach (n = 33) and a combined transjugular/transsplenic approach (n = 8). Mean portosystemic pressure gradient (PSG) decreased from 28.09 ±â€¯7.28 mmHg to 17.53 ±â€¯6.12 mmHg after TIPS (P < 0.01). The probability of the remaining free recurrent variceal bleeding was 87.0%. The probability of TIPS patency reached 81.5%. Hepatic encephalopathy occurrence was 27.8%, and survival rate was 88.9% until the end of follow-up. Four out of 11 patients who failed TIPS died, and 4 had recurrent bleeding. CONCLUSIONS: TIPS should be considered a safe and feasible alternative therapy to prevent recurrent esophageal variceal bleeding in patients with CTPV, and to achieve clinical improvement.

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