| Objective : To systematically evaluate the effects and safety of iodine-125 Implatation in patients with inoperable pancreatic cancer.Methods:Electronic searches were conducted to identify randomized controlled trials(RCTs) for comparing the effects and safety of iodine-125 brachytherapy with chemotherapy and other methods in treatment of advanced pancreatic carcinoma. The Cochrane library, Embase, Medline, ISI Web of Science, Chinese Biological Medicine database(CBMDisc), WANFANG database and CNKI were searched by computer. We also searched five English oncology journals by manual. We included all the randomized and quasi-randomized controlled trials which evaluated the efficacy and safety of combination of iodine-125 brachytherapy with the other therapy versus the latter therapy alone in treatment of unresectable pancreatic cancer. Methodological quality of trials was assessed in terms of methods of allocation sequence, allocation concealment, whether use blinding and intention-to-treat or not. Two reviewers evaluated quality of the studies and collected data and results independently. We evaluate the effects and safety of iodine-125 Implantion for treatment of advanced pancreatic cancer by estimating the progression-free survival(PFS), overall survival(OS), objective tumor response(CR+PR), clinical benefit response(CBR, pain decrease, anesthetics reduction), complications(gastrointestinal bleeding, seeds shift, pancreatitis, pancreatic fistula, et al ), quality of life(QOL), et al. Analysis was performed by using RevMan5.0.23 which was provided by Cochrane collaboration, Dichotomous outcomes will be expressed by odds ratio(OR), while continuous scales of measurement were illustrated by the weighted mean difference (MD) or the standardised mean difference (SMD) if different scales have been used. The effects of both will use 95% confidence interval(CI) to show. Results:Eleven RCTs were included with totally 468 participants. The methodological quality was generally low. Results of the meta-analysis showed that (1) PFS: There is no significant difference in PFS reported by two cases, Jiang 2008 P=0.160, Zhang 2009 P=0.160. (2) OS: There is no significant difference in OS of one study. The median survival time of experimental group vs control group was 11 months [95%CI 1.835±20.165] vs six months [95%CI 3.391±8.609],(P>0.05), in Jiang 2008. Seven studies showed that experimental cases superior control cases, The median survival time of experimental group vs control group was 13.1 months vs 8.7months,(P <0. 05), in Gao 2008 ;Hu 2007 reported 12 months survival rate was 43.75%,12.5%,(P <0. 05), median survival time in Li 2005 12.2 months vs 6.6 months,(P <0. 05). Li 2007 median survival time 18±4. 57 months vs 7. 6±1. 97 months,(P <0. 05), Sun 2007 median survival time 11 months vs 7 months,(P <0. 05), Wang 2004 median survival time 10.6months vs 5.6months,(P <0. 05),Yu 2009, median survival time 12.7months vs 6.3 months,(P <0. 05). Conclusions:The current studies provide limited envidences for this research. It showed that iodine-125 brachytherapy had no obvious advantages for unresectable pancreatic cancer in DFS and OS compared with other therapies. Iodine-125 brachytherapy can in some extent relieve pain , but we can not declare it is better than chemotherapy. Whether the brachytherapy could improve QOL has not been proved. iodine-125 brachytherapy can be considered safe in treatment of inoperation pancreatic cancer, however, it should be cautious to make this conclusion due to the low methodological quality of the included studies. More randomized trials with enough sample size, uniform standard,further high-quality and scientically sound methodology should be performed.
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