Fiducial Placement for Stereotactic Body Radiation Therapy under Only Endoscopic Ultrasonography Guidance in Pancreatic and Hepatic Malignancy: Practical Feasibility and Safety

• Published in: Gut and liver Vol. 8; no. 1; pp. 88 - 93
• Main Authors: Choi, Jun-Ho, Seo, Dong-Wan, Park, Do Hyun, Lee, Sung Koo, Kim, Myung-Hwan
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Gastroenterology; the Korean Society of Gastrointestinal Endoscopy; the Korean Association for the Study of the Liver; the Korean Society of Neurogastroenterology and Motility; Korean Association for the Study of Intestinal Diseases; Korean College of Helicobacter and Upper Gastrointestinal Research; Korean Pancreatobiliary Association; Korean Society of Gastrointestinal Cancer 01.01.2014; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: Aged; Aged, 80 and over; endosonography; Endosonography - methods; Equipment Design; Feasibility Studies; Female; Fiducial Markers; Humans; liver neoplasms; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - radiotherapy; Male; Middle Aged; Needles; Original; pancreatic neoplasms; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - radiotherapy; radiosurgery; Radiosurgery - methods; Treatment Outcome; 내과학; Fiducial markers; Endosonography; Liver neoplasms; Pancreatic neoplasms; Radiosurgery
• ISSN: 1976-2283; 2005-1212; 2005-1212
• DOI: 10.5009/gnl.2014.8.1.88

Stereotactic body radiation therapy (SBRT) for gastrointestinal malignancies requires the placement of fiducials to guide treatment delivery. This study aimed to determine the safety and technical feasibility of endoscopic ultrasonography (EUS)-guided fiducial placement for SBRT. From November 2010 to August 2012, 32 consecutive patients who were scheduled to receive SBRT for pancreatic and hepatic malignancies were referred for EUS-guided fiducial placement. Primary outcome measurements included technical success, the fiducial migration rate, and procedural complications. All 32 patients had successful fiducial placement under EUS guidance. The mean number of fiducials placed per patient was 2.94±0.24 (range, 2 to 3 seeds). Spontaneous fiducial migration was noted in one patient (3.1%). Of the 32 patients with fiducials placed, 29 patients (90.6%) successfully underwent SBRT. One patient (3.1%) developed mild pancreatitis, requiring a 2-day prolonged hospitalization after fiducial placement. Five patients (15.6%) underwent same-session, EUS-guided fine needle aspiration for histologic confirmation at the time of fiducial placement, without any procedure-related complication. EUS-guided fiducial placement is a safe and technically feasible technique for preparing patients with both pancreatic and hepatic malignancies for SBRT. The fiducial markers facilitate safe and accurate targeting of the tumor during SBRT.