EUS-guided fiducial placement for CyberKnife radiotherapy of mediastinal and abdominal malignancies

Pishvaian, Aline Charabaty; Collins, Brian T.; Gagnon, Gregory; Ahlawat, Sushil; Haddad, Nadim

doi:10.1016/j.gie.2006.01.048

Cited by 169 publications

(118 citation statements)

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“…The markers (cylindrical markers) contained in larger gauge needles (17 G and 18 G) can not break and do not need to mass during their placement. Therefore they can not change their CT number ( Figure 1) [17][18][19][20][21] . The placement of fi ducial markers may be burdened by complications due to puncture or related to the gold markers.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic usability of two different fiducial gold markers for robotic stereotactic radiosurgery of liver malignancies: A pilot study

Marsico¹,

Gabbani²,

Livi³

et al. 2016

WJH

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AIM:To assess how the application of different types of markers affects the tracking accuracy of CyberKnife's. METHODS:Fifteen patients were recruited and subjected to the ultrasound-guided placement of markers. Two different type of needles 25 gauge (G) and 17 G containing two different fiducial marker, gold notched flexible anchor wire 0.28 mm × 10 mm (25 G needle) and gold cylindrical grain 1 mm × 4 mm (17 G), were used. Seven days after the procedure, a CyberKnife planning computed tomography (CT) for the simulation of radiation treatment was performed on all patients. Therapeutic usability of two different fiducial gold markers for robotic stereotactic radiosurgery of liver malignancies: A pilot study Clinical Trials Study ORIGINAL ARTICLEA binary CT score was assigned to the fiducial markers visualization. Also, the CT number was calculated for each fiducial and the values compared with a specific threshold. RESULTS:For each patient from 1 to 5, intra-hepatic markers were placed (one in 2 patients, three in 8 patients, four in 3 patients, and five in 2 patients). A total of 48 needles were used (thirty-two 17 G and sixteen 25 G) and 48 gold markers were placed (32 Grain shaped markers and 16 Gold Anchor). The result showed that the CT visualization of the grain markers was better than the anchor markers (P = 5 × 10 -9 ). Furthermore, the grain markers were shown to present minor late complications (P = 3 × 10 -6 ), and the best CT threshold number (P = 0.0005). CONCLUSION:The study revealed that the Gold Anchor fiducial marker is correlated with a greater number of late minor complications and low visualization by the CT. Core tip: Robotic radiosurgery can employ different systems for the localization of the neoplastic targets to treat. The purpose of this study is to assess how the application of different types of markers affects the tracking accuracy of CyberKnife's. Fifteen patients have been recruited and analyzed for the study and two types of markers were used for the procedure. The computed tomography (CT) visualization of grain markers was better than anchor markers P = 5 × 10 -9. Grain markers presented minor late complications of P = 3 × 10 -6, and the best CT threshold number. The study revealed that the Gold Anchor fiducial marker is correlated with a greater number of late minor complication.Marsico M, Gabbani T, Livi L, Biagini MR, Galli A. Therapeutic usability of two different fiducial gold markers for robotic stereotactic radiosurgery of liver malignancies: A pilot study.

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Section: Introductionmentioning

confidence: 99%

Therapeutic usability of two different fiducial gold markers for robotic stereotactic radiosurgery of liver malignancies: A pilot study

Marsico¹,

Gabbani²,

Livi³

et al. 2016

WJH

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“…This technique was successful in 6 pancreatic cancer patients, and there were no associated complications. 6,60 Since this case series, there has been a considerable increase in the use of EUS-guided fiducial placement in nonoperable pancreatic cancer (Fig. 4).…”

Section: Innovative Eus Interventions In Pancreatic Diseasementioning

confidence: 99%

“…The CyberKnife radiosurgery system (Accuray, Sunnyvale, CA, USA) was approved for use with locally advanced tumors at any location in the body. 60 Historically, fiducial placement has been with a percutaneous or intraoperative approach under CT guidance. Pishvaian et al 60 firstly used EUS-guided placement of fiducials using a 19-guage FNA needle in 13 patients, 7 of which had pancreatic adenocarcinoma.…”

Section: Innovative Eus Interventions In Pancreatic Diseasementioning

confidence: 99%

“…60 Historically, fiducial placement has been with a percutaneous or intraoperative approach under CT guidance. Pishvaian et al 60 firstly used EUS-guided placement of fiducials using a 19-guage FNA needle in 13 patients, 7 of which had pancreatic adenocarcinoma. This technique was successful in 6 pancreatic cancer patients, and there were no associated complications.…”

Section: Innovative Eus Interventions In Pancreatic Diseasementioning

confidence: 99%

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Novel diagnostic and therapeutic modalities using endoscopic ultrasound in pancreatic disease

Luthra

Mishra

2017

Int J Gastrointest Interv

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“…All the techniques described have utilized linear-array EUS, however, variations exist in the gauge of needle used, how fiducials are loaded within the needle, and how the fiducial is ultimately advanced and deployed. Many of the early techniques include the use of a 19-gauge needle, in order to accommodate the commercially available fiducials at the time (62). More recently, however, fiducial markers have been designed that are compatible with 22-gauge needles.…”

Section: Technique Of Eus-guided Fiducial Implantationmentioning

confidence: 99%

Endoscopic ultrasound in pancreatic cancer: innovative applications beyond the basics

Yoo¹,

Kistler²,

Yan³

et al. 2016

J. Gastrointest. Oncol.

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Endoscopic ultrasound (EUS) has become a mainstay in assisting in the diagnosis and staging of pancreatic cancer. In addition, EUS provides a modality to treat chronic pain through celiac plexus neurolysis. Currently, there is growing data and utilization of EUS in more diverse and innovative applications aimed at providing more sophisticated diagnostic, prognostic and therapeutic options for patients with pancreatic cancer. EUS delivery of chemotherapy, viral and biological vectors and fiducial markers may eventually revolutionize the way clinicians approach the care of a patient with pancreatic cancer. J Gastrointest Oncol 2016;7(6):1019-1029 jgo.amegroups.com pancreatic tumor, thus preventing side effects of systemic chemotherapy. It also allows for a more comprehensive realtime image, a shorter puncture pathway, and a lower risk of complications when compared to via computed tomography (CT) or abdominal ultrasound (US)-guided procedures.EUS-guided fine needle injections (EUS-FNIs) were initially studied in a porcine model where they injected paclitaxel into the pancreas; clinically detectable concentrations of the drug could not be detected beyond a distance of 30-50 mm from the injection site (6). Levy et al. studied EUS-FNI of gemcitabine in patients with unresectable cancer and demonstrated that several patients were able to be down staged and undergo subsequent resection (7). EUS-FNI of chemotherapy can be limited by the high density of fibrosis in pancreatic cancer, making it difficult to pierce the needle into the pancreatic tumor, and make it challenging to inject adequate amounts of an injected solution into the mass (7). Although interventional EUS has not been shown to significantly improve the survival rate and prolong the survival time in patients with pancreatic cancer, it can effectively induce tumor cell death. Additional studies are needed to further explore this therapeutic application in the future. EUS in predicting prognosis and response to chemotherapyIn addition to the potential for directly administering chemotherapy, assessing the prognosis and response to therapy is another developing role for EUS. Currently, many academic institutions and industry trials have adopted the response evaluation criteria in solid tumors (RECIST) criteria to help standardize the assessment of prognosis and response to therapies (8). RECIST criteria are largely based on radiographic cross-sectional imaging. It has been proposed that tumor response to neoadjuvant chemotherapy (defined by the RECIST criteria) would be required prior to surgery for borderline resectable pancreatic tumors. However, in a study by Katz et al. only 12% of cases had radiographic changes associated with neoadjuvant chemotherapy that met the RECIST criteria (9). Furthermore, only one patient out of 129 patients had enough of a reduction in tumor size to be reclassified as resectable via radiographic criteria, and yet 60% of those patients underwent surgical resection, suggesting that surgical resection in patients with bor...

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EUS-guided fiducial placement for CyberKnife radiotherapy of mediastinal and abdominal malignancies

Cited by 169 publications

References 16 publications

Therapeutic usability of two different fiducial gold markers for robotic stereotactic radiosurgery of liver malignancies: A pilot study

Therapeutic usability of two different fiducial gold markers for robotic stereotactic radiosurgery of liver malignancies: A pilot study

Novel diagnostic and therapeutic modalities using endoscopic ultrasound in pancreatic disease

Endoscopic ultrasound in pancreatic cancer: innovative applications beyond the basics

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