Efficacy And Safety Of Image-guided ¹²⁵I Seed Implantation Combined With Chemotherapy In The Treatment Of Pancreatic Cancer:A Meta-analysis

Objective:To explore and compare the efficacy and safety of image-guided radioactive¹²⁵I seed implantation combined with chemotherapy and chemotherapy alone in the treatment of pancreatic cancer.For patients with pancreatic cancer,who are unable or unwilling to accept radical surgery,to provide more safe and effective treatment and improve their quality of life.Methods:Using“pancreatic cancer”,“¹²⁵I particle”and“chemotherapy”,etc as key words,we searched CNKI,Wanfang database,VIP database,China biology medicine database,Pub Med,EMBASE and Cochrane Library from database establishment to December 2020.Those studies included randomized controlled trials and retrospective cohort studies of image-guided ¹²⁵I seed implantation combined with chemotherapy in the treatment of pancreatic cancer.According to the established inclusion and exclusion criteria,two researchers independently screened literatures,evaluated the quality of included literatures and extracted data.Rev Man5.4 and Stata16.0 software were used for statistical analysis.analyze and compare the efficacy and safety of image-guided ¹²⁵I seed implantation combined with chemotherapy and chemotherapy alone in the treatment of pancreatic cancer,from the aspects of tumor effective rate,clinical benefit rate,survival rate,adverse reactions,etc.When Rev Man5.4 software was used,the relative risk（RR）,95%confidence interval（95%CI）and probability P value were used for data statistical analysis.When Stata16.0software was used,Log RR value,95%CI and probability P value were used for statistical analysis.When the heterogeneity among the studies is small,the fixed effect model is used for combined analysis;When the heterogeneity among the studies is large,the random effect model is used.Heterogeneity between studies was measured by I².Rev Man5.4 software was used for sensitivity analysis and subgroup analysis to evaluate the factors that may cause heterogeneity.Sensitivity analysis was used to evaluate the stability of meta-analysis results.Stata16.0 software was used to draw funnel plot and perform egger test for qualitative and quantitative assessment of publication biasResult:According to the inclusion and exclusion criteria,a total of 20 studies involving1407 patients were included.The experimental group was treated with image-guided¹²⁵I seed implantation combined with chemotherapy（705 cases）;The control group was treated with chemotherapy alone（702 cases）.Meta analysis showed that:（1）the objective effective rate of tumor:the experimental group was higher than the control group（RR=1.99,95%CI:1.58-2.52,P<0.00001）.（2）The total clinical benefit rate:the experimental group was better than the control group（RR=2.08,95%CI:1.71-2.52,P<0.00001）;the pain relief rate（RR=2.13,95%CI:1.79-2.55,P<0.00001）,the positive rate of analgesic dosage reduction（RR=6.56,95%CI:2.05-20.94,P=0.002）,the positive rate of physical improvement（RR=2.93,95%CI:1.57-5.46,P=0.0008）and the positive rate of weight gain（RR=4.54,95%CI:1.51-13.66,P=0.007）of the experimental group were significantly better than those of the control group.（3）The short-term survival rate:the 6-month survival rate（RR=1.19,95%CI:1.01-1.39,P=0.03）,12-month survival rate（RR=1.51,95%CI:1.25-1.84,P<0.0001）and 18-month survival rate（RR=4.01,95%CI:1.64-9.81,P=0.002）of the experimental group were higher than those of the control group.（4）The laboratory indicator:the serum tumor marker CA19-9 level in the experimental group decreased more significantly（RR=2.00,95%CI:1.50-2.65,P<0.00001）.（5）The incidence of adverse reactions:there was no significant difference between the experimental group and the control group.Conclusion:（1）image-guided ¹²⁵I seed implantation combined with chemotherapy in the treatment of pancreatic cancer can improve the effective rate of solid tumor more effectively than chemotherapy alone.（2）image-guided ¹²⁵I seed implantation combined with chemotherapy in the treatment of pancreatic cancer is more effective than chemotherapy alone in improving the clinical benefit rate of patients with pancreatic cancer.（3）image-guided ¹²⁵I seed implantation combined with chemotherapy in the treatment of pancreatic cancer is more effective than chemotherapy alone in improving the short-term survival rate of patients with pancreatic cancer.（4）Compared with chemotherapy alone,image-guided ¹²⁵I seed implantation combined with chemotherapy in the treatment of pancreatic cancer can reduce the serum tumor marker CA19-9 level more effectively.（5）Compared with chemotherapy alone,image-guided radioactive ¹²⁵I seed implantation combined with chemotherapy in the treatment of pancreatic cancer does not increase the adverse reactions of patients,and the complications after image-guided radioactive ¹²⁵I seed implantation can be controlled and prevented,which indicates that image-guided radioactive ¹²⁵I seed implantation combined with chemotherapy in the treatment of pancreatic cancer is safe and feasible.