Authors' objectives: This report aims to identify and summarise evidence that addresses the following question: what is the clinical and cost effectiveness of permanent implant brachytherapy devices for unresectable pancreatic cancer?

Authors' results and conclusions: Randomized controlled trials were identified for Iodine-125 (¹²⁵I) and colloidal Phosphorous-32 (³²P) brachytherapy. For Palladium-103 (¹⁰³Pd) and Phosphorous-32 microparticle brachytherapy, only non-comparative observational studies were found. Five RCTs for ¹²⁵I brachytherapy were reported in a systematic review, with one additional RCT. One RCT was identified for colloidal ³²P brachytherapy, and two observational studies for ³²P microparticle brachytherapy (OncoSil). For ¹⁰³Pd brachytherapy 2 observational studies were reported in 1 systematic review. The published studies suggest that ¹²⁵I brachytherapy, as an adjunct to chemotherapy alone, improves local disease control and potentially improves overall survival without increasing treatment related adverse events. ³²P colloidal brachytherapy as an adjunct to chemoradiotherapy did not improve overall survival and was associated with more serious adverse events. It was not possible to draw conclusions about the benefits and harms of ³²P microparticle brachytherapy (OncoSil) or ¹⁰³Pd brachytherapy because the evidence came from non-comparative studies. No published evidence on the cost effectiveness of permanent implant brachytherapy devices for unresectable pancreatic cancer was identified in the economic review. Whilst the identified clinical evidence did not find any evidence of statistically significant benefits to permanent implant brachytherapy devices in areas of clinical interest, an economic model was developed to compare ¹²⁵I brachytherapy in addition to chemotherapy to chemotherapy alone based on outcomes of the clinical review. This model showed that ¹²⁵I brachytherapy in addition to chemotherapy is expected to be a cost-effective treatment option when compared to chemotherapy alone.

Authors' recommendations: The use of permanent implant brachytherapy devices for unresectable pancreatic cancer in addition to conventional treatment is not supported by the evidence. Randomised controlled trials have not identified any improvement in important clinical outcomes, such as progression free survival and overall survival, as compared with chemoradiotherapy alone. The lack of statistically significant clinical benefits precludes a cost-effectiveness analysis of permanent implant brachytherapy devices compared against a clinically relevant treatment comparison. Treatment with brachytherapy is technically challenging, and there is a risk of adverse events. Therefore, the evidence does not support its use at the present.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: The Appraisal Panel recognised the importance of further research in pancreatic cancer as there are delays in diagnosis and a need for high-quality treatments that are aimed at cure as well as symptom control and palliative care. However, the panel concluded that research into brachytherapy for pancreatic cancer is not a priority area.

Project Status: Completed

URL for project: https://healthtechnology.wales/reports-guidance/permanent-implant-brachytherapy-devices-for-unresectable-pancreatic-cancer/

Year Published: 2025

URL for published report: https://healthtechnology.wales/reports-guidance/permanent-implant-brachytherapy-devices-for-unresectable-pancreatic-cancer/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk