PDF herunterladen
CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(02): E253-E257
DOI: 10.1055/a-1324-2892
Original article

EUS-guided placement of fiducial markers for stereotactic body radiation therapy in pancreatic cancer: feasibility, security and a new quality score

Mariana Figueiredo
1   Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Belgium
,
Christelle Bouchart
2   Department of Radiation-Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
,
Luigi Moretti
2   Department of Radiation-Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
,
Laura Mans
1   Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Belgium
,
Jean-Luc Engelholm
3   Department of Radiology, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
,
Maria-Antonietta Bali
3   Department of Radiology, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
,
Jean-Luc Van Laethem‡
1   Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Belgium
,
Pierre Eisendrath‡
1   Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Belgium
4   Department of Gastroenterology, Saint-Pierre University Hospital, Université Libre de Bruxelles, Belgium
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Background and study aims In borderline resectable/locally advanced pancreatic ductal adenocarcinoma (PDAC), stereotactic body radiation therapy (SBRT) is an emerging neoadjuvant treatment option. Endoscopic ultrasound (EUS)-guided insertion of fiducial markers being a prerequisite, our aim was to assess its feasibility and safety and also to evaluate its success, from both the endoscopist’s and radiotherapist’s perspectives.

Patients and methods We prospectively collected data concerning PDAC patients submitted to EUS-guided fiducial placement, from February 2018 to November 2019. Technical success was defined as at least one marker presumed inside the tumor. Quality success was assessed at pre-SBRT computed tomography, accordingly to the number of markers inside or < 1 cm from the tumor, number of markers at the tumor extremity, their location in different planes, the distance between them, and their distance from the biliary stent (if present). A new quality score was then proposed and high-quality success defined as at least six of 12 points.

Results Thirty-seven patients were enrolled. A total of 97 fiducials were implanted, with a median of three fiducials per patient (0–4). The technical success rate was 92 %, with failure of fiducial placement in three patients. Three patients (8 %) had adverse events (fever, mild acute pancreatitis, and biliary stent migration). At pre-SBRT evaluation, two patients’ markers had migrated. The high-quality success rate was 62.5 %.

Conclusions Our results contribute to demonstrating the feasibility and safety of EUS-guided fiducial placement for SBRT treatment in PDAC. It is hoped that the newly proposed quality score will pave the way for improving fiducial positioning and SBRT delivery.



Publikationsverlauf

Artikel online veröffentlicht:
03. Februar 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019; 69: 7-34
    CrossrefPubMedSuche in Google Scholar
  • 2 Maisonneuve P. Epidemiology and burden of pancreatic cancer. Presse Médicale 2019; 48: e113-e123
    CrossrefPubMedSuche in Google Scholar
  • 3 Ducreux M, Cuhna AS, Caramella C. et al. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26: v56-v68
    CrossrefPubMedSuche in Google Scholar
  • 4 Moningi S, Marciscano AE, Rosati LM. et al. Stereotactic body radiation therapy in pancreatic cancer: the new frontier. Expert Rev Anticancer Ther 2014; 14: 1461-1475
    CrossrefPubMedSuche in Google Scholar
  • 5 Herman JM, Chang DT, Goodman KA. et al. Phase 2 multi-institutional trial evaluating gemcitabine and stereotactic body radiotherapy for patients with locally advanced unresectable pancreatic adenocarcinoma: SBRT for Unresectable Pancreatic Cancer. Cancer 2015; 121: 1128-1137
    CrossrefPubMedSuche in Google Scholar
  • 6 Bouchart C, Navez J, Closset J. et al. Novel strategies using modern radiotherapy to improve pancreatic cancer outcomes: toward a new standard?. Ther Adv Med Oncol 2020; 12
    CrossrefPubMedSuche in Google Scholar
  • 7 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
    CrossrefPubMedSuche in Google Scholar
  • 8 Wani S, Han S, Simon V. et al. Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees. Gastrointest Endosc 2019; 89: 1160-1168.e9
    CrossrefPubMedSuche in Google Scholar
  • 9 Banks PA, Bollen TL, Dervenis C. et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111
    CrossrefPubMedSuche in Google Scholar
  • 10 Coronel E, Cazacu IM, Sakuraba A. et al. EUS-guided fiducial placement for GI malignancies: a systematic review and meta-analysis. Gastrointest Endosc 2019; 89: 659-670.e18
    CrossrefPubMedSuche in Google Scholar
  • 11 Chandnani M, Faisal MF, Glissen-Brown J. et al. EUS-guided fiducial placement for pancreatobiliary malignancies: safety, infection risk, and use of peri-procedural antibiotics. Endosc Int Open 2020; 08: E179-E185
    Thieme ConnectPubMedSuche in Google Scholar
  • 12 Olender D. Fiducials for target localization. CyberKnife Radiosurgery Pract. Guide. Heilbrun MP. Sunnyvale (CA): CyberKnife Society; 2003
    Suche in Google Scholar
  • 13 Goldstein SD, Ford EC, Duhon M. et al. Use of respiratory-correlated four-dimensional computed tomography to determine acceptable treatment margins for locally advanced pancreatic adenocarcinoma. Int J Radiat Oncol 2010; 76: 597-602
    CrossrefPubMedSuche in Google Scholar
  • 14 Dhadham G, Hoffe S, Harris C. et al. Endoscopic ultrasound-guided fiducial marker placement for image-guided radiation therapy without fluoroscopy: safety and technical feasibility. Endosc Int Open 2016; 04: E378-E382
    Thieme ConnectPubMedSuche in Google Scholar