Endovascular Treatment Of Cancer-associated Venous Obstruction:Comparison Of Efficacy Between Stent Alone And Stent Combined With Linear Radioactive Seeds Strand

Objective:To investigate the safety and efficacy of a stent combined with a linear strand of¹²⁵I seeds to treat malignant cancer-associated venous obstruction.Methods:We retrospectively analysed the data of 57 patients with malignant cancer-associated the brachiocephalic vein–superior vena cava and inferior vena cava–iliac and femoral veins obstruction.19 patients underwent the placement of a bare mental stent combined with a linear strand of ¹²⁵I seeds（group A）,and 38patients underwent the placement of a bare mental stent（group B）.The following parameters were compared between the two groups of patients:symptom relief rate,duration of venous patency,survival time,quality of life,and adverse events.Results:A total of 34 bare mental stents and 527 seeds were implanted in group A,while a total of 57 bare mental stents were implanted in group B.The surgery success rate was 96.5%,and no serious complications related to the surgery were reported.Symptoms of venous obstruction improved significantly after surgery.The score of group A decreased from 14.74±0.562 points before surgery to 2.79±1.357 points after surgery（P<0.001）,and the score of group B decreased from 13.79±1.398points before surgery to 5.55±3.674 points after surgery（P<0.001）.The patency rate of group A was significantly higher than that of group B during 1-6 months after surgery（100%,84.2%,68.4%,63.2%,36.8%,21.1%vs.68.4%,23.7%,18.4%,7.9%,5.3%,2.6%respectively）（P<0.05）.Before treatment,there was no statistically significant difference in the KPS score between the groups（P=0.791）.The score decreased significantly from 1 to 6 months after treatment（P<0.001）,and the KPS score was significantly higher in group A than in group B（P=0.013）.The median patency duration in groups A and B was 125 days（95%confidence interval（CI）:80.018-169.982）and 35 days（95%CI:20.501-49.499）,respectively（P<0.001）.The median survival time of group A was 155 days（95%CI:110.406-199.594）,and that of group B was 98 days（95%CI:55.712-140.288）（P=0.325）.Multivariate analysis showed that the implantation of a bare mental stent combined with a linear strand of¹²⁵I seeds and the KPS score（≥80 points）were independent factors of long-term patency after bare mental stent placement.Conclusion:The placement of a bare mental stent combined with a linear strand of ¹²⁵I seeds is a safe and effective treatment for related venous obstruction caused by malignant tumours.This treatment provides prolonged patency compared with the placement of bare mental stent,and while it does not significantly improve the survival time of patients,it can improve their quality of life.