Endoscopic ultrasound-guided fiducial marker placement for neoadjuvant chemoradiation therapy for resectable pancreatic cancer.
Chemoradiation
Endoscopic ultrasound-guided fine-needle aspiration
Fiducial marker
Interventional endoscopic ultrasound
Pancreatic cancer
Resectable
Journal
World journal of gastrointestinal oncology
ISSN: 1948-5204
Titre abrégé: World J Gastrointest Oncol
Pays: China
ID NLM: 101532470
Informations de publication
Date de publication:
15 Jul 2020
15 Jul 2020
Historique:
received:
03
02
2020
revised:
13
04
2020
accepted:
12
05
2020
entrez:
1
9
2020
pubmed:
31
8
2020
medline:
31
8
2020
Statut:
ppublish
Résumé
Preoperative neoadjuvant chemoradiation therapy (NACRT) is applied for resectable pancreatic cancer (RPC). To maximize the efficacy of NACRT, it is essential to ensure the accurate placement of fiducial markers for image-guided radiation. However, no standard method for delivering fiducial markers has been established to date, and the nature of RPC during NACRT remains unclear. To determine the feasibility, safety and benefits of endoscopic ultrasound-guided (EUS) fiducial marker placement in patients with RPC. This was a prospective case series of 29 patients (mean age, 67.5 years; 62.1% male) with RPC referred to our facility for NACRT. Under EUS guidance, a single gold marker was placed into the tumor using either a 19- or 22-gauge fine-needle aspiration needle. The differences in daily marker positioning were measured by comparing simulation computed tomography and treatment computed tomography. In all 29 patients (100%) who underwent EUS fiducial marker placement, fiducials were placed successfully with only minor, self-limiting bleeding during puncture observed in 2 patients (6.9%). NACRT was subsequently administered to all patients and completed in 28/29 (96.6%) cases, with one patient experiencing repeat cholangitis. Spontaneous migration of gold markers was observed in 1 patient. Twenty-four patients (82.8%) had surgery with 91.7% (22/24) R0 resection, and two patients experienced complete remission. No inflammatory changes around the marker were observed in the surgical specimen. The daily position of gold markers showed large positional changes, particularly in the superior-inferior direction. Moreover, tumor location was affected by food and fluid intake as well as bowel gas, which changes daily. EUS fiducial marker placement following NACRT for RPC is feasible and safe. The RPC is mobile and is affected by not only aspiration, but also food and fluid intake and bowel condition.
Sections du résumé
BACKGROUND
BACKGROUND
Preoperative neoadjuvant chemoradiation therapy (NACRT) is applied for resectable pancreatic cancer (RPC). To maximize the efficacy of NACRT, it is essential to ensure the accurate placement of fiducial markers for image-guided radiation. However, no standard method for delivering fiducial markers has been established to date, and the nature of RPC during NACRT remains unclear.
AIM
OBJECTIVE
To determine the feasibility, safety and benefits of endoscopic ultrasound-guided (EUS) fiducial marker placement in patients with RPC.
METHODS
METHODS
This was a prospective case series of 29 patients (mean age, 67.5 years; 62.1% male) with RPC referred to our facility for NACRT. Under EUS guidance, a single gold marker was placed into the tumor using either a 19- or 22-gauge fine-needle aspiration needle. The differences in daily marker positioning were measured by comparing simulation computed tomography and treatment computed tomography.
RESULTS
RESULTS
In all 29 patients (100%) who underwent EUS fiducial marker placement, fiducials were placed successfully with only minor, self-limiting bleeding during puncture observed in 2 patients (6.9%). NACRT was subsequently administered to all patients and completed in 28/29 (96.6%) cases, with one patient experiencing repeat cholangitis. Spontaneous migration of gold markers was observed in 1 patient. Twenty-four patients (82.8%) had surgery with 91.7% (22/24) R0 resection, and two patients experienced complete remission. No inflammatory changes around the marker were observed in the surgical specimen. The daily position of gold markers showed large positional changes, particularly in the superior-inferior direction. Moreover, tumor location was affected by food and fluid intake as well as bowel gas, which changes daily.
CONCLUSION
CONCLUSIONS
EUS fiducial marker placement following NACRT for RPC is feasible and safe. The RPC is mobile and is affected by not only aspiration, but also food and fluid intake and bowel condition.
Identifiants
pubmed: 32864044
doi: 10.4251/wjgo.v12.i7.768
pmc: PMC7428794
doi:
Types de publication
Clinical Trial
Langues
eng
Pagination
768-781Informations de copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict-of-interest statement: Tatsuya Ioka received an advisor’s role and speaker’s fee from Taiho Pharmaceutical, and he also received a speaker’s fee from Yakult Honsha. The other authors declare no conflict of interests for this paper.
Références
Gut Liver. 2014 Jan;8(1):88-93
pubmed: 24516706
Gastrointest Endosc. 2012 Nov;76(5):962-71
pubmed: 23078921
Ann Surg. 2018 Jul;268(1):1-8
pubmed: 29334562
PLoS Med. 2010 Apr 20;7(4):e1000267
pubmed: 20422030
Endoscopy. 2013;45 Suppl 2 UCTN:E426-7
pubmed: 24338173
Pract Radiat Oncol. 2013 Jan-Mar;3(1):32-39
pubmed: 24674261
J Clin Oncol. 2008 Jul 20;26(21):3496-502
pubmed: 18640930
Gastrointest Endosc. 2010 Mar;71(3):513-8
pubmed: 20189509
J Gastrointest Surg. 2012 Apr;16(4):784-92
pubmed: 22160780
Arch Surg. 1992 Nov;127(11):1335-9
pubmed: 1359851
Cancer. 2017 Nov 1;123(21):4158-4167
pubmed: 28708929
Dig Endosc. 2013 Nov;25(6):615-21
pubmed: 23489989
Gastrointest Endosc. 2014 May;79(5):851-5
pubmed: 24518121
Int J Radiat Oncol Biol Phys. 2016 May 1;95(1):498-504
pubmed: 26883565
Korean J Radiol. 2012 May-Jun;13(3):307-13
pubmed: 22563268
Cardiovasc Intervent Radiol. 2010 Jun;33(3):586-9
pubmed: 19908085
Gastrointest Endosc. 2010 Mar;71(3):630-3
pubmed: 20189527
Ann Surg. 2009 Jul;250(1):88-95
pubmed: 19561477
Endoscopy. 2010 May;42(5):423-5
pubmed: 20232282
Ann Surg. 2013 Dec;258(6):1040-50
pubmed: 23799421
Gastrointest Endosc. 2006 Sep;64(3):412-7
pubmed: 16923491
Gastrointest Endosc. 2009 Apr;69(4):972-3
pubmed: 19152903
Br J Radiol. 2017 Apr;90(1072):20160815
pubmed: 28256908