EUS-guided gold fiducial insertion for image-guided radiation therapy of pancreatic cancer: 50 successful cases without fluoroscopy

Park, Walter G.; Yan, Brian; Schellenberg, Devin; Kim, Jeff; Chang, Daniel T.; Koong, Albert C.; Patalano, Cheryl; Dam, Jacques Van

doi:10.1016/j.gie.2009.10.030

Cited by 143 publications

(97 citation statements)

References 18 publications

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“…Complications were infrequent and negligible. 61 Sanders et al 62 produced similar results in 51 patients with locally advanced or recurrent pancreatic cancer. Successful EUSguided fiducial placement was achieved in 90% of their patients.…”

Section: Innovative Eus Interventions In Pancreatic Diseasementioning

confidence: 83%

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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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Section: Innovative Eus Interventions In Pancreatic Diseasementioning

confidence: 83%

“…4). Park et al 61 successfully placed fiducials via EUS in 88% of their 57 patients with unresectable pancreatic cancer who were candidates for SBRT. Complications were infrequent and negligible.…”

Section: Innovative Eus Interventions In Pancreatic Diseasementioning

confidence: 99%

Novel diagnostic and therapeutic modalities using endoscopic ultrasound in pancreatic disease

Luthra

Mishra

2017

Int J Gastrointest Interv

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“…In a retrospective review by Kothary et al of 61 cases of CT guided percutaneous fiducial marker implantation for pancreatic cancer performed between 2003 and 2008, 3.3% were complicated by minor hemorrhage (53). Authors such as Park et al have hypothesized that the placement of fiducial markers using EUS reduces the risk of bleeding secondary to damage or puncture of vascular structures due to the ability to use real time Doppler imaging (54). In his own prospective case series of 57 patients who underwent fiducial marker implantation for locally advanced pancreatic adenocarcinoma, one case was reported to be complicated by "minor bleeding…with no significant decrease in hemoglobin," ultimately limiting the number of fiducials able to be placed (54).…”

Section: Placement Of Fiducial Markers By Eus Versus Traditional Methodsmentioning

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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“…They are deployed into the mass by using the 19G or the less stiff 22G needle, by means of a stylet, or by injecting sterile water into the needle. A mean number of 2-4 fiducial markers per patient have to be placed [134]. The "ideal fiducial geometry" was studied in 77 patients and the placement of fiducials judged to be better by surgery than by EUS; however, this geometry was unnecessary for successful tracking and delivery of radiation [135].There is migration of 0.8-2 mm in relation to bony landmarks [133,136], and in one study the procedure had to be repeated in 7% of the patients [137].…”

Section: Eus Fiducial Implantationmentioning

confidence: 99%

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

Seicean¹

2014

Pancreatic Cancer - Insights Into Molecular Mechanisms and Novel Approaches to Early Detection and Treatment

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EUS-guided gold fiducial insertion for image-guided radiation therapy of pancreatic cancer: 50 successful cases without fluoroscopy

Cited by 143 publications

References 18 publications

Novel diagnostic and therapeutic modalities using endoscopic ultrasound in pancreatic disease

Novel diagnostic and therapeutic modalities using endoscopic ultrasound in pancreatic disease

Endoscopic ultrasound in pancreatic cancer: innovative applications beyond the basics

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

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