Permanent implant brachytherapy devices for unresectable pancreatic cancer
Topic Status Complete
Permanent implant brachytherapy devices for the treatment of locally advanced, unresectable pancreatic cancer
Outcome of the appraisal
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.
Why was this topic appraised?
Pancreatic cancer is the 12th most common cancer in Wales, but the 6th leading cause of cancer death. Symptoms are non-specific in the early stage, meaning it is commonly diagnosed when locally advanced or metastatic. At this stage, the cancer is often unresectable, with treatment focussing on slowing the effects and spread of the cancer.
Brachytherapy is a form of internal radiotherapy which involves placing radioactive material directly into the tumour to deliver a localized radiation dose. Adding brachytherapy to standard treatment for unresectable pancreatic cancer has the potential to improve local control of the tumour which may in turn lead to better progression free and overall survival.
The topic was suggested to HTW by OncoSil Medical Ltd, the manufacturers of OncoSil.
Plain language summary
The pancreas is an organ that lies behind the lower part of the stomach. It has two functions: producing enzymes that help digest food and making insulin, which helps to control blood sugar levels. Pancreatic cancer is a type of cancer that begins as a growth of cells in the pancreas.
Pancreatic cancer symptoms can be difficult to spot. These can include jaundice, sickness, losing weight, indigestion and tummy pain. Treatment plans for pancreatic cancer can include surgery, chemotherapy and radiotherapy.
Brachytherapy is a form of radiation therapy where a sealed radiation source is placed inside or next to the treatment area. Permanent implant brachytherapy uses radiated implants called pellets or seeds. These implants are very small, about the size of a grain of rice. The seeds are placed directly into a tumour with thin, hollow needles. The radiation in the seeds then treats the cancer. The seeds are left in place after the radiation has been used up.
Health Technology Wales looked for evidence on permanent implant brachytherapy for unresectable pancreatic cancer. The use of permanent implant brachytherapy devices for unresectable pancreatic cancer in addition to conventional treatment is not supported by the evidence
Topic Exploration Report
TER503 11.2023
Evidence Appraisal Report
EAR063 01.2025
Guidance
GUI063 01.2025
Health Technology Wales Partners
