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EUS GUIDED GOLD FIDUCIAL INSERTION FOR IMAGE GUIDED RADIATION THERAPY OF PANCREATIC CANCER
BM Yan1, D Schellenberg2, A Koong2, J Van Dam1
1Division of Gastroenterology and Hepatology; 2Department of Radiation Oncology, Stanford University, Stanford, California
Background and Aims: Image guided radiation therapy (IGRT) is a method of accurately delivering high dose radiation which may allow for increased radiation dose delivery to tumors and less radiation to normal tissues. We have utilized these techniques in patients with unresectable pancreatic cancer. This is accomplished via implanted fiducial markers used to track the position of tumors during IGRT. This study analyzes the feasibility of EUS guided fine needle insertion of gold fiducial markers for the purpose of IGRT in pancreatic cancer.
METHODS: Patients with unresectable pancreatic adenocarcinoma underwent linear echoendosonography. Gold fiudical markers were manually back-loaded into the tip of a 19 gauge FNA needle and retained using lubricating jelly or bone wax. Under real time EUS guidance, the needle was placed inside the tumor and gold deployed by sterile water injection. Gold fiducial placement was assessed one week later using radiation therapy planning CT scans. All patients with appropriate seed placement underwent IGRT.
RESULTS: A total of 18 pts were included. Technical success of gold delivery was achieved in 15 patients (83%). In one patient the stylet
malfunctioned, in one patient the fiducials were lost, and one tumor was fibrotic and did not permit easy puncture by the 19 gauge needle. Functional outcome, as defined by successful execution of IGRT, was assessable in 14 patients and successful in all. No early or delayed complications secondary to EUS guided FNI were observed.
CONCLUSION: EUS guided fine needle insertion is a safe and effective method for the delivery gold fiducial markers for IGRT. The development of other inert fiducial markers may facilitate image-guided radiation therapy.