Endoscopic ultrasound-guided pancreatic fiducial placement: how important is ideal fiducial geometry?

Abstract:

OBJECTIVE:Image-guided radiation therapy allows precise tumor targeting using real-time tracking of radiopaque fiducial markers. To enable appropriate tracking, it is recommended to place fiducials with "ideal fiducial geometry" (IFG). Our objectives were to determine the proportion of patients in whom IFG can be achieved when fiducials are placed by endoscopic ultrasound (EUS) and surgery and to determine if attaining IFG is necessary for delivering radiation. METHODS:This single-center retrospective cohort study included 77 patients with biopsy-proven advanced pancreatic cancer who underwent either EUS-guided or laparotomy/laparoscopy-assisted fiducial placement between September 2005 and July 2009. RESULTS:Gold fiducials were implanted by EUS in 39 patients (51%) and by surgery in 38 patients (49%). The proportion of patients with IFG was significantly higher for surgical placement [18/38, 47%; 95% confidence interval (CI), 32%-63%] compared with EUS-guided placement (7/39, 18%; 95% CI, 8%-32%), P = 0.0011. However, fiducial tracking was successfully used for Cyberknife therapy in 35 (90%) of 39 (95% CI, 77%-97%) patients in the EUS group compared with 31 (82%) of 38 (95% CI, 67%-92%) patients in the surgery group. There were 5 procedure-related complications in the EUS group. CONCLUSIONS:Achieving IFG appears unnecessary for successful tracking and delivery of radiation.

journal_name

Pancreas

journal_title

Pancreas

authors

Majumder S,Berzin TM,Mahadevan A,Pawa R,Ellsmere J,Sepe PS,Larosa SA,Pleskow DK,Chuttani R,Sawhney MS

doi

10.1097/MPA.0b013e3182864559

subject

Has Abstract

pub_date

2013-05-01 00:00:00

pages

692-5

issue

4

eissn

0885-3177

issn

1536-4828

journal_volume

42

pub_type

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