CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(11): E1357-E1364
DOI: 10.1055/a-0958-2148
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

EUS-guided fiducial marker placement for radiotherapy in rectal cancer: feasibility of two placement strategies and four fiducial types

Lisanne S. Rigter
1   Department of Gastroenterology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
,
Eva C. Rijkmans
2   Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
,
Akin Inderson
3   Leiden Center for Interventional Endoscopy, Department of Gastroenterology, Leiden University Medical Center, Leiden, The Netherlands
,
Roy P.J. van den Ende
2   Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
,
Ellen M. Kerkhof
2   Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
,
Martijn Ketelaars
2   Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
,
Jolanda van Dieren
1   Department of Gastroenterology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
,
Roeland A. Veenendaal
3   Leiden Center for Interventional Endoscopy, Department of Gastroenterology, Leiden University Medical Center, Leiden, The Netherlands
,
Baukelien van Triest
4   Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
,
Corrie A.M. Marijnen
2   Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
,
Uulke A. van der Heide
4   Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
,
Monique E. van Leerdam
1   Department of Gastroenterology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

submitted 03 October 2018

accepted after revision 03 December 2018

Publication Date:
22 October 2019 (online)

Abstract

Background and study aims To facilitate image guidance during radiotherapy of rectal cancer, we investigated the feasibility of fiducial marker placement. This study aimed to evaluate technical success rate and safety of two endoscopic ultrasound (EUS)-guided placement strategies and four fiducial types for rectal cancer patients.

Patients and methods This prospective multicenter study included 20 participants who were scheduled to undergo rectal cancer treatment with neoadjuvant short-course radiotherapy or chemoradiation. EUS-guided endoscopy was used for fiducial placement at the tumor site (n = 10) or in the mesorectal fat and in the tumor (n = 10). Four fiducial types were used (Visicoil 0.75 mm, Visicoil 0.50 mm, Cook, Gold Anchor). The endpoints were technical success rate and retention of fiducials, the latter of which was evaluated on cone-beam computed tomography scans during the first five radiotherapy fractions.

Results A total of 64 fiducials were placed in 20 patients. For each fiducial type, at least three fiducials were successfully placed in all patients. Technical failure consisted of fiducial blockage within the needle (n = 2) and ejection of two preloaded fiducials at once (n = 4). No serious adverse events were reported. In three patients, one of the fiducials was misplaced without clinical consequences; two in the prostate and one in the intraperitoneal cavity. After a median time of 17 days after placement (range 7 – 47 days), a total of 42/64 (66 %) fiducials were still present (24/44 intratumoral vs. 18/20 mesorectal fiducials, P = 0.009).

Conclusions Placement of fiducials in rectal cancer patients is feasible, however, retention rates for intratumoral fiducials were lower (55 %) than for mesorectal fiducials (90 %).

 
  • References

  • 1 van Gijn W, Marijnen CA, Nagtegaal ID. et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 2011; 12: 575-582
  • 2 Sebag-Montefiore D, Stephens RJ, Steele R. et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 2009; 373: 811-820
  • 3 Sauer R, Becker H, Hohenberger W. et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351: 1731-1740
  • 4 Peeters KC, Marijnen CA, Nagtegaal ID. et al. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 2007; 246: 693-701
  • 5 Dahlberg M, Glimelius B, Graf W. et al. Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study. Dis Colon Rectum 1998; 41: 543-549 discussion 549-551
  • 6 Marijnen CA, van de Velde CJ, Putter H. et al. Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 2005; 23: 1847-1858
  • 7 Birgisson H, Pahlman L, Gunnarsson U. et al. Occurrence of second cancers in patients treated with radiotherapy for rectal cancer. J Clin Oncol 2005; 23: 6126-6131
  • 8 Peeters KC, van de Velde CJ, Leer JW. et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients--a Dutch colorectal cancer group study. J Clin Oncol 2005; 23: 6199-6206
  • 9 Swellengrebel HA, Marijnen CA, Vincent A. et al. Evaluating long-term attachment of two different endoclips in the human gastrointestinal tract. World J Gastrointest Endosc 2010; 2: 344-348
  • 10 Vuong T, Devic S, Moftah B. et al. High-dose-rate endorectal brachytherapy in the treatment of locally advanced rectal carcinoma: technical aspects. Brachytherapy 2005; 4: 230-235
  • 11 Davila Fajardo R, Lekkerkerker SJ, van der Horst A. et al. EUS-guided fiducial markers placement with a 22-gauge needle for image-guided radiation therapy in pancreatic cancer. Gastrointest Endosc 2014; 79: 851-855
  • 12 Moman MR, van der Heide UA, Kotte AN. et al. Long-term experience with transrectal and transperineal implantations of fiducial gold markers in the prostate for position verification in external beam radiotherapy; feasibility, toxicity and quality of life. Radiother Oncol 2010; 96: 38-42
  • 13 Dhadham GC, Hoffe S, Harris CL. et al. Endoscopic ultrasound-guided fiducial marker placement for image-guided radiation therapy without fluoroscopy: safety and technical feasibility. Endosc Int Open 2016; 4: E378-E382
  • 14 Moningi S, Walker AJ, Malayeri AA. et al. Analysis of fiducials implanted during EUS for patients with localized rectal cancer receiving high-dose rate endorectal brachytherapy. Gastrointest Endosc 2015; 81: 765-769 e761
  • 15 Vorwerk H, Liersch T, Rothe H. et al. Gold markers for tumor localization and target volume delineation in radiotherapy for rectal cancer. Strahlenther Onkol 2009; 185: 127-133
  • 16 Pishvaian AC, Collins B, Gagnon G. et al. EUS-guided fiducial placement for CyberKnife radiotherapy of mediastinal and abdominal malignancies. Gastrointest Endosc 2006; 64: 412-417
  • 17 Fernandez DC, Hoffe SE, Barthel JS. et al. Stability of endoscopic ultrasound-guided fiducial marker placement for esophageal cancer target delineation and image-guided radiation therapy. Pract Rad Oncology 2013; 3: 32-39
  • 18 de Souza Lawrence L, Ford E, Gilbert C. et al. Novel applications of an injectable radiopaque hydrogel tissue marker for management of thoracic malignancies. Chest 2013; 143: 1635-1641
  • 19 Park WG, Yan BM, Schellenberg D. et al. EUS-guided gold fiducial insertion for image-guided radiation therapy of pancreatic cancer: 50 successful cases without fluoroscopy. Gastrointest Endosc 2010; 71: 513-518
  • 20 Machiels M, van Hooft J, Jin P. et al. Endoscopy/EUS-guided fiducial marker placement in patients with esophageal cancer: a comparative analysis of 3 types of markers. Gastrointest Endosc 2015; 82: 641-649
  • 21 Choi JH, Seo DW, Park DH. et al. Fiducial placement for stereotactic body radiation therapy under only endoscopic ultrasonography guidance in pancreatic and hepatic malignancy: practical feasibility and safety. Gut Liver 2014; 8: 88-93
  • 22 Varadarajulu S, Trevino JM, Shen S. et al. The use of endoscopic ultrasound-guided gold markers in image-guided radiation therapy of pancreatic cancers: a case series. Endoscopy 2010; 42: 423-425
  • 23 Sanders MK, Moser AJ, Khalid A. et al. EUS-guided fiducial placement for stereotactic body radiotherapy in locally advanced and recurrent pancreatic cancer. Gastrointest Endosc 2010; 71: 1178-1184
  • 24 Khashab MA, Kim KJ, Tryggestad EJ. et al. Comparative analysis of traditional and coiled fiducials implanted during EUS for pancreatic cancer patients receiving stereotactic body radiation therapy. Gastrointest Endosc 2012; 76: 962-971
  • 25 Brierley JD, Dawson LA, Sampson E. et al. Rectal motion in patients receiving preoperative radiotherapy for carcinoma of the rectum. Int J Radiat Oncol Biol Phys 2011; 80: 97-102