The Efficacy and Safety of Iodine-125 Implantation Combined with Gemcitabine in the Treatment of Advanced Pan- creatic Cancer: A Systematic Review and Meta-analysis

A systematic review and meta-analysis was conducted to assess the efficacy and safety of iodine-125 implantation combined with gemcitabine in the treatment of advanced pancreatic cancer.

 PubMed,  Chinese  National  Knowledge  Infrastructure  database  (CNKI), Cochrane Library, Embase, and Wanfang database through Oct 2020 were searched for randomized controlled trials (RCTs) and retrospective studies assessing the efficacy and  safety  of  iodine-125  implantation  combined  with  gemcitabine  in  the  treatment  of advanced  pancreatic  cancer.  The  main  outcome  measures  included  the  overall  remission [complete  response  (CR)+partial  response  (PR)]  rate,  overall  survival  (OS),  hypofunction of the liver, clinical benefit response (CBR) rate, survival rate, and adverse events.

   Totally,   19   studies   involving   1496   patients   were   included   in   the   current systematic review and meta-analysis. The pooled results showed that efficacy and safety of  patients  treated  with  Iodine-125  combined  with  gemcitabine  were  superior  to  those undergoing  gemcitabine  alone:  overall  remission  (CR+PR)  rate  [odds  ratio  (OR)=3.10, 95% confidence interval (CI): 2.40, 4.00; P<0.00001], OS [hazard ratio (HR)=0.56, 95% CI: 0.47, 0.68; P<0.00001], hypofunction of liver (OR=1.08, 95% CI: 0.67, 1.74; P=0.75), CBR rate (OR=3.85, 95% CI: 2.83, 5.22; P<0.00001), survival rate of six months (OR=3.44 95% CI: 1.83, 6.46) and survival rate of 12 months (OR=2.67, 95% CI: 1.68, 4.26). And there was no statistical association in adverse events between the groups.

   The   combination   of   iodine-125   seed   implantation   and   gemcitabine significantly prolonged the survival of patients with pancreatic cancer, compared with the gemcitabine alone, indicating a better prognosis.