Endoscopic ultrasound-guided pancreatic fiducial placement

How important is ideal fiducial geometry?

Shounak Majumder, Tyler M. Berzin, Anand Mahadevan, Rishi Pawa, James Ellsmere, Paul S. Sepe, Salvatore A. Larosa, Douglas K. Pleskow, Ram Chuttani, Mandeep S. Sawhney

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

OBJECTIVE: Image-guided radiation therapy allows precise tumor targeting using real-time tracking of radiopaque fiducial markers. To enable appropriate tracking, it is recommended to place fiducials with "ideal fiducial geometry" (IFG). Our objectives were to determine the proportion of patients in whom IFG can be achieved when fiducials are placed by endoscopic ultrasound (EUS) and surgery and to determine if attaining IFG is necessary for delivering radiation. METHODS: This single-center retrospective cohort study included 77 patients with biopsy-proven advanced pancreatic cancer who underwent either EUS-guided or laparotomy/laparoscopy-assisted fiducial placement between September 2005 and July 2009. RESULTS: Gold fiducials were implanted by EUS in 39 patients (51%) and by surgery in 38 patients (49%). The proportion of patients with IFG was significantly higher for surgical placement [18/38, 47%; 95% confidence interval (CI), 32%-63%] compared with EUS-guided placement (7/39, 18%; 95% CI, 8%-32%), P = 0.0011. However, fiducial tracking was successfully used for Cyberknife therapy in 35 (90%) of 39 (95% CI, 77%-97%) patients in the EUS group compared with 31 (82%) of 38 (95% CI, 67%-92%) patients in the surgery group. There were 5 procedure-related complications in the EUS group. CONCLUSIONS: Achieving IFG appears unnecessary for successful tracking and delivery of radiation.

Original languageEnglish (US)
Pages (from-to)692-695
Number of pages4
JournalPancreas
Volume42
Issue number4
DOIs
StatePublished - May 1 2013
Externally publishedYes

Fingerprint

Fiducial Markers
Confidence Intervals
Image-Guided Radiotherapy
Radiation
Pancreatic Neoplasms
Gold
Laparoscopy
Laparotomy
Cohort Studies
Retrospective Studies
Biopsy
Neoplasms
Therapeutics

Keywords

  • EUS
  • Fiducials
  • geometry
  • pancreatic cancer

ASJC Scopus subject areas

  • Hepatology
  • Internal Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Majumder, S., Berzin, T. M., Mahadevan, A., Pawa, R., Ellsmere, J., Sepe, P. S., ... Sawhney, M. S. (2013). Endoscopic ultrasound-guided pancreatic fiducial placement: How important is ideal fiducial geometry? Pancreas, 42(4), 692-695. https://doi.org/10.1097/MPA.0b013e3182864559

Endoscopic ultrasound-guided pancreatic fiducial placement : How important is ideal fiducial geometry? / Majumder, Shounak; Berzin, Tyler M.; Mahadevan, Anand; Pawa, Rishi; Ellsmere, James; Sepe, Paul S.; Larosa, Salvatore A.; Pleskow, Douglas K.; Chuttani, Ram; Sawhney, Mandeep S.

In: Pancreas, Vol. 42, No. 4, 01.05.2013, p. 692-695.

Research output: Contribution to journalArticle

Majumder, S, Berzin, TM, Mahadevan, A, Pawa, R, Ellsmere, J, Sepe, PS, Larosa, SA, Pleskow, DK, Chuttani, R & Sawhney, MS 2013, 'Endoscopic ultrasound-guided pancreatic fiducial placement: How important is ideal fiducial geometry?', Pancreas, vol. 42, no. 4, pp. 692-695. https://doi.org/10.1097/MPA.0b013e3182864559
Majumder, Shounak ; Berzin, Tyler M. ; Mahadevan, Anand ; Pawa, Rishi ; Ellsmere, James ; Sepe, Paul S. ; Larosa, Salvatore A. ; Pleskow, Douglas K. ; Chuttani, Ram ; Sawhney, Mandeep S. / Endoscopic ultrasound-guided pancreatic fiducial placement : How important is ideal fiducial geometry?. In: Pancreas. 2013 ; Vol. 42, No. 4. pp. 692-695.
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abstract = "OBJECTIVE: Image-guided radiation therapy allows precise tumor targeting using real-time tracking of radiopaque fiducial markers. To enable appropriate tracking, it is recommended to place fiducials with {"}ideal fiducial geometry{"} (IFG). Our objectives were to determine the proportion of patients in whom IFG can be achieved when fiducials are placed by endoscopic ultrasound (EUS) and surgery and to determine if attaining IFG is necessary for delivering radiation. METHODS: This single-center retrospective cohort study included 77 patients with biopsy-proven advanced pancreatic cancer who underwent either EUS-guided or laparotomy/laparoscopy-assisted fiducial placement between September 2005 and July 2009. RESULTS: Gold fiducials were implanted by EUS in 39 patients (51{\%}) and by surgery in 38 patients (49{\%}). The proportion of patients with IFG was significantly higher for surgical placement [18/38, 47{\%}; 95{\%} confidence interval (CI), 32{\%}-63{\%}] compared with EUS-guided placement (7/39, 18{\%}; 95{\%} CI, 8{\%}-32{\%}), P = 0.0011. However, fiducial tracking was successfully used for Cyberknife therapy in 35 (90{\%}) of 39 (95{\%} CI, 77{\%}-97{\%}) patients in the EUS group compared with 31 (82{\%}) of 38 (95{\%} CI, 67{\%}-92{\%}) patients in the surgery group. There were 5 procedure-related complications in the EUS group. CONCLUSIONS: Achieving IFG appears unnecessary for successful tracking and delivery of radiation.",
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AU - Pawa, Rishi

AU - Ellsmere, James

AU - Sepe, Paul S.

AU - Larosa, Salvatore A.

AU - Pleskow, Douglas K.

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