ObjectiveTo evaluate the clinical efficacy, safety, and survival outcomes of CT-guided iodine-125 seed implantation in patients with stage Ⅲ–Ⅳ pancreatic cancer, and to analyze the relevant factors influencing prognosis. MethodsClinical data of patients with stage Ⅲ–Ⅳ pancreatic cancer who underwent CT-guided iodine-125 seed implantation and had complete follow-up records at the First Affiliated Hospital of Army Medical University from June 2013 to February 2023 were retrospectively collected. Post-treatment efficacy, the Karnofsky performance status (KPS) score and numeric rating scale (NRS) score for pain at one month post-procedure, and postoperative complications were analyzed. The overall survival (OS) was also analyzed. Univariate and multivariate Cox proportional hazards regression models were employed to identify risk factors influencing OS. ResultsA total of 44 eligible patients with stage Ⅲ–Ⅳ pancreatic cancer were included in this study. According to the response evaluation criteria in solid tumors 1.1 criteria, the objective response rate was 61.4% (27/44) and the disease control rate was 95.5% (42/44). At one month postoperatively, the KPS score significantly improved from a preoperative value of (78.18±5.40) points to (86.82±5.18) points (P<0.001); the pain NRS score significantly decreased from a preoperative median [interquartile range (IQR)] of 4 (3, 5) to 1 (0, 2.5), P<0.001. The preoperative planned target volume D90 was 120 (116, 125) Gy, and the postoperative delivered D90 was 124 (119, 127) Gy (P=0.060). The median overall survival (OS) was 17.0 months for stage Ⅲ patients and 12.0 months for stage Ⅳ patients (P=0.05). Multivariate analysis revealed that clinical stage [Stage Ⅳ vs. Ⅲ: HR (95%CI)=2.29 (1.16, 4.50), P=0.016] and gross tumor volume [HR (95%CI)=1.01 (1.00, 1.02), P=0.012] were independent prognostic factors affecting OS. ConclusionsBased on the retrospective analysis results of this study, CT-guided iodine-125 seed implantation, as a local treatment modality for stage Ⅲ–Ⅳ pancreatic cancer, can effectively achieve local tumor control, alleviate pain, improve quality of life, and prolong survival of patients, with particularly significant benefits observed in stage Ⅲ patients, and demonstrates a favorable safety profile. Clinical stage Ⅳ and increased gross tumor volume are identified as independent factors affecting OS. This technique provides a treatment option for patients with inoperable stage Ⅲ–Ⅳ pancreatic cancer.
