CC BY 4.0 · Endosc Int Open 2023; 11(09): E866-E872
DOI: 10.1055/a-2129-2840
Original article

Endoscopically placed fiducial markers for image-guided radiotherapy in preoperative gastric cancer: Technical feasibility and potential benefit

1   Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands (Ringgold ID: RIN26066)
2   Cancer treatment and quality of life, Imaging and biomarkers, Cancer Center Amsterdam, Amsterdam, Netherlands
,
1   Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands (Ringgold ID: RIN26066)
3   Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands (Ringgold ID: RIN1228)
,
Arjan Bel
1   Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands (Ringgold ID: RIN26066)
2   Cancer treatment and quality of life, Imaging and biomarkers, Cancer Center Amsterdam, Amsterdam, Netherlands
,
Jan-Jakob Sonke
3   Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands (Ringgold ID: RIN1228)
,
4   Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands (Ringgold ID: RIN4501)
5   Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands (Ringgold ID: RIN26066)
,
R. E. Pouw
2   Cancer treatment and quality of life, Imaging and biomarkers, Cancer Center Amsterdam, Amsterdam, Netherlands
5   Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands (Ringgold ID: RIN26066)
,
Maarten C.C.M. Hulshof
1   Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands (Ringgold ID: RIN26066)
› Author Affiliations
Supported by: KWF Kankerbestrijding 10882

TRIAL REGISTRATION: Registration number (trial ID): NTR7241, Trial registry: Netherlands National Trial Register (http://www.trialregister.nl), Type of Study: Prospective study

Abstract

Background and study aims Fiducial markers have demonstrated clinical value in radiotherapy in several organs, but little is known about markers in the stomach. Here, we assess the technical feasibility of endoscopic placement of markers in gastric cancer patients and their potential benefit for image-guided radiotherapy (IGRT).

Patients and methods In this prospective feasibility study, 14 gastric cancer patients underwent endoscopy-guided gold (all patients) and liquid (7 patients) marker placements distributed throughout the stomach. Technical feasibility, procedure duration, and potential complications were evaluated. Assessed benefit for IGRT comprised marker visibility on acquired imaging (3–4 computed tomography [CT] scans and 19–25 cone-beam CTs [CBCTs] per patient) and lack of migration. Marker visibility was compared per marker type and location (gastroesophageal junction (i.e., junction/cardia), corpus (corpus/antrum/fundus), and pylorus).

Results Of the 93 marker implantation attempts, 59 were successful, i.e., marker in stomach wall and present during entire 5-week radiotherapy course (2–6 successfully placed markers per patient), with no significant difference (Fisher’s exact test; P>0.05) in success rate between gold (39/66=59%) and liquid (20/27=74%). Average procedure duration was 24.4 min (range 16–38). No procedure-related complications were reported. All successfully placed markers were visible on all CTs, with 81% visible on ≥95% of CBCTs. Five markers were poorly visible (on <75% of CBCTs), possibly due to small marker volume and peristaltic motion since all five were liquid markers located in the corpus. No migration was observed.

Conclusions Endoscopic placement of fiducial markers in the stomach is technically feasible and safe. Being well visible and positionally stable, markers provide a potential benefit for IGRT.

Supporting information



Publication History

Received: 12 April 2023

Accepted after revision: 13 July 2023

Accepted Manuscript online:
13 July 2023

Article published online:
21 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany