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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

 Needle with fiducial marker.
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FI197-3:  Needle with fiducial marker.

Mentions: There are two basic techniques by which the fiducial marker can be loaded into the EUS needle. The most common technique employed is the back-loading method 25. The stylet of the needle is withdrawn approximately 2 – 3 cm. The fiducial delivery system, typically consisting of a fiducial marker loaded on a needle carrier, is then inserted “retrograde” into the needle tip (Fig. 3). The fiducial is then deployed into the needle tip by removing the needle carrier. Finally, the tip of the EUS needle is plugged or sealed with a small amount of sterile bone wax to prevent inadvertent loss of the fiducial while advancing the needle down the accessory channel. A new variation of this method is the “wet-fill technique” where the EUS needle is submerged in sterile saline and the stylet is slowly retracted approximately 10 cm. This effectively fills the distal end of the EUS needle with fluid 24, and the fiducial marker is then back-loaded into the EUS needle as previously described. Bone wax is not required to seal the needle tip because the fiducial is held in place within the needle via the surface tension of the saline. This technique may have potential advantages of avoiding failure of deployment related to bone wax and possible complication of granuloma formation following implantation of bone wax into tissue 26. A potential disadvantage to using this back-loading method is the possibility of needle stick injuries. This is of particular concern when one EUS needle is reloaded between fiducial deployments. A solution to this problem is to have multiple preloaded needles readily available.


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)

 Needle with fiducial marker.
© Copyright Policy
Related In: Results  -  Collection

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

FI197-3:  Needle with fiducial marker.
Mentions: There are two basic techniques by which the fiducial marker can be loaded into the EUS needle. The most common technique employed is the back-loading method 25. The stylet of the needle is withdrawn approximately 2 – 3 cm. The fiducial delivery system, typically consisting of a fiducial marker loaded on a needle carrier, is then inserted “retrograde” into the needle tip (Fig. 3). The fiducial is then deployed into the needle tip by removing the needle carrier. Finally, the tip of the EUS needle is plugged or sealed with a small amount of sterile bone wax to prevent inadvertent loss of the fiducial while advancing the needle down the accessory channel. A new variation of this method is the “wet-fill technique” where the EUS needle is submerged in sterile saline and the stylet is slowly retracted approximately 10 cm. This effectively fills the distal end of the EUS needle with fluid 24, and the fiducial marker is then back-loaded into the EUS needle as previously described. Bone wax is not required to seal the needle tip because the fiducial is held in place within the needle via the surface tension of the saline. This technique may have potential advantages of avoiding failure of deployment related to bone wax and possible complication of granuloma formation following implantation of bone wax into tissue 26. A potential disadvantage to using this back-loading method is the possibility of needle stick injuries. This is of particular concern when one EUS needle is reloaded between fiducial deployments. A solution to this problem is to have multiple preloaded needles readily available.

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