Endoscopic ultrasound-guided fiducial marker placement for neoadjuvant chemoradiation therapy for resectable pancreatic cancer
Endoscopic ultrasound-guided fiducial marker placement for neoadjuvant chemoradiation therapy for resectable pancreatic cancer
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DOI：
10.4251/wjgo.v12.i7.768
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发表时间：
2020-07-15
影响因子：
3
通讯作者：
Teshima, Teruki
中科院分区：
文献类型：
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作者：
Ashida, Reiko;Fukutake, Nobuyasu;Teshima, Teruki
背景术前新辅助放化疗（NACRT）用于可切除的胰腺癌（RPC）。为了最大限度地提高NACRT的疗效，必须确保准确放置图像引导放射的基准标记。然而，迄今为止，还没有建立用于提供基准标记的标准方法，并且NACRT期间RPC的性质仍然不清楚。目的确定内镜超声引导（EUS）基准标记物放置在RPC患者中的可行性、安全性和受益。方法：这是一个前瞻性病例系列的29例患者（平均年龄，67.5岁; 62.1%男性）与RPC转介到我们的设施NACRT。在EUS引导下，使用19或22号细针抽吸针将单个金标记物放置到肿瘤中。通过比较模拟计算机断层扫描和治疗计算机断层扫描来测量每日标记定位的差异。结果：在所有29例（100%）接受EUS基准标记放置的患者中，成功放置了基准点，仅2例（6.9%）患者在穿刺过程中观察到轻微的自限性出血。随后对所有患者进行了NACRT，28/29例（96.6%）病例完成了NACRT，1例患者发生了反复胆管炎。在1例患者中观察到金标记物自发迁移。24例患者（82.8%）接受了手术，其中91.7%（22/24）R 0切除，2例患者完全缓解。在手术样本中未观察到标记周围的炎症变化。黄金标记的每日位置显示出很大的位置变化，特别是在上下方向。此外，肿瘤的位置还受到食物和液体摄入以及肠道气体的影响，这些气体每天都在变化。结论NACRT治疗RPC后EUS基准点的放置是安全可行的。RPC是移动的，不仅受误吸的影响，还受食物和液体摄入以及肠道状况的影响。
BACKGROUND Preoperative neoadjuvant chemoradiation therapy (NACRT) is applied for resectable pancreatic cancer (RPC). To maximize the efficacy of NACRT, it is essential to ensure the accurate placement of fiducial markers for image-guided radiation. However, no standard method for delivering fiducial markers has been established to date, and the nature of RPC during NACRT remains unclear. AIM To determine the feasibility, safety and benefits of endoscopic ultrasound-guided (EUS) fiducial marker placement in patients with RPC. METHODS This was a prospective case series of 29 patients (mean age, 67.5 years; 62.1% male) with RPC referred to our facility for NACRT. Under EUS guidance, a single gold marker was placed into the tumor using either a 19- or 22-gauge fine-needle aspiration needle. The differences in daily marker positioning were measured by comparing simulation computed tomography and treatment computed tomography. RESULTS In all 29 patients (100%) who underwent EUS fiducial marker placement, fiducials were placed successfully with only minor, self-limiting bleeding during puncture observed in 2 patients (6.9%). NACRT was subsequently administered to all patients and completed in 28/29 (96.6%) cases, with one patient experiencing repeat cholangitis. Spontaneous migration of gold markers was observed in 1 patient. Twenty-four patients (82.8%) had surgery with 91.7% (22/24) R0 resection, and two patients experienced complete remission. No inflammatory changes around the marker were observed in the surgical specimen. The daily position of gold markers showed large positional changes, particularly in the superior-inferior direction. Moreover, tumor location was affected by food and fluid intake as well as bowel gas, which changes daily. CONCLUSION EUS fiducial marker placement following NACRT for RPC is feasible and safe. The RPC is mobile and is affected by not only aspiration, but also food and fluid intake and bowel condition.