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Technical advances in endoscopic ultrasound-guided fiducial placement for the treatment of pancreatic cancer.

Chavalitdhamrong D, DiMaio CJ, Siersema PD, Wagh MS - Endosc Int Open (2015)

Bottom Line: Because of the challenge of delivering an accurate and optimal radiation dose, image-guided radiation therapy can be used to improve targeting.Fiducial markers can be placed in the tumor and used for localization in patients undergoing image-guided radiation therapy.We herein review the technique, efficacy, and safety profile of EUS-guided fiducial placement.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, University of Florida, Gainesville, Florida, United States.

ABSTRACT
Radiation therapy has an important role in the treatment of locally advanced or metastatic pancreatic cancer and can be used alone or in conjunction with surgery and/or systemic chemotherapy. Because of the challenge of delivering an accurate and optimal radiation dose, image-guided radiation therapy can be used to improve targeting. Fiducial markers can be placed in the tumor and used for localization in patients undergoing image-guided radiation therapy. The safety and feasibility of endoscopic ultrasound (EUS)-guided placement of fiducials has been assessed and reported for the management of pancreatic cancer. We herein review the technique, efficacy, and safety profile of EUS-guided fiducial placement. In addition, we highlight recent advances and technological upgrades in EUS-guided fiducial delivery systems for pancreatic cancer most relevant to practicing gastroenterologists and interventional endoscopists.

No MeSH data available.


Related in: MedlinePlus

 Fluoroscopic view of the echoendoscope in a long position with four fiducials successfully deployed.
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FI197-2:  Fluoroscopic view of the echoendoscope in a long position with four fiducials successfully deployed.

Mentions: Fiducial markers are radiopaque spheres, coils, or seeds that are implanted into the target lesion in the pancreas for both localizing and tracking during radiotherapy (). These markers facilitate safe and accurate targeting of the tumor. Various types of fiducial markers and delivery systems (Fig. 1 a, b) have been developed 18. A minimum of one to two fiducial markers are required to be placed either within the target lesion or within 1 cm of a small target lesion. Fiducial markers can be placed intraoperatively, percutaneously, or endoscopically 1920. Given the excellent visualization of lesions in proximity to the gastrointestinal tract, EUS offers an improved approach for fiducial placement (Fig. 2). A higher ideal fiducial geometry for appropriate tracking has been reported with EUS when compared to surgery 21.


Technical advances in endoscopic ultrasound-guided fiducial placement for the treatment of pancreatic cancer.

Chavalitdhamrong D, DiMaio CJ, Siersema PD, Wagh MS - Endosc Int Open (2015)

 Fluoroscopic view of the echoendoscope in a long position with four fiducials successfully deployed.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554510&req=5

FI197-2:  Fluoroscopic view of the echoendoscope in a long position with four fiducials successfully deployed.
Mentions: Fiducial markers are radiopaque spheres, coils, or seeds that are implanted into the target lesion in the pancreas for both localizing and tracking during radiotherapy (). These markers facilitate safe and accurate targeting of the tumor. Various types of fiducial markers and delivery systems (Fig. 1 a, b) have been developed 18. A minimum of one to two fiducial markers are required to be placed either within the target lesion or within 1 cm of a small target lesion. Fiducial markers can be placed intraoperatively, percutaneously, or endoscopically 1920. Given the excellent visualization of lesions in proximity to the gastrointestinal tract, EUS offers an improved approach for fiducial placement (Fig. 2). A higher ideal fiducial geometry for appropriate tracking has been reported with EUS when compared to surgery 21.

Bottom Line: Because of the challenge of delivering an accurate and optimal radiation dose, image-guided radiation therapy can be used to improve targeting.Fiducial markers can be placed in the tumor and used for localization in patients undergoing image-guided radiation therapy.We herein review the technique, efficacy, and safety profile of EUS-guided fiducial placement.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, University of Florida, Gainesville, Florida, United States.

ABSTRACT
Radiation therapy has an important role in the treatment of locally advanced or metastatic pancreatic cancer and can be used alone or in conjunction with surgery and/or systemic chemotherapy. Because of the challenge of delivering an accurate and optimal radiation dose, image-guided radiation therapy can be used to improve targeting. Fiducial markers can be placed in the tumor and used for localization in patients undergoing image-guided radiation therapy. The safety and feasibility of endoscopic ultrasound (EUS)-guided placement of fiducials has been assessed and reported for the management of pancreatic cancer. We herein review the technique, efficacy, and safety profile of EUS-guided fiducial placement. In addition, we highlight recent advances and technological upgrades in EUS-guided fiducial delivery systems for pancreatic cancer most relevant to practicing gastroenterologists and interventional endoscopists.

No MeSH data available.


Related in: MedlinePlus