Department of Medicine, University of Connecticut, Farmington, CT, USA.
Pancreas. 2013 May;42(4):692-5. doi: 10.1097/MPA.0b013e3182864559.
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.
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.
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.
Achieving IFG appears unnecessary for successful tracking and delivery of radiation.
图像引导放射治疗通过实时跟踪不透射线的基准标记物，实现精确的肿瘤靶向。为了实现适当的跟踪，建议使用“理想基准几何形状（IFG）”放置基准。我们的目标是确定通过内镜超声（EUS）和手术放置基准时，能够实现 IFG 的患者比例，并确定实现 IFG 是否对放射治疗的实施是必要的。
这项单中心回顾性队列研究纳入了 2005 年 9 月至 2009 年 7 月间，经活检证实患有晚期胰腺癌并接受 EUS 引导或剖腹手术/腹腔镜辅助放置基准的 77 例患者。
EUS 引导下植入金基准 39 例（51%），手术植入 38 例（49%）。与 EUS 引导组（7/39，18%；95%置信区间[CI]，8%-32%）相比，手术组 IFG 患者比例明显更高[18/38，47%；95%CI，32%-63%]，P = 0.0011。然而，在 EUS 组的 39 例（95%CI，77%-97%）患者中，有 35 例（90%）成功使用 Cyberknife 治疗进行了基准跟踪，而在手术组的 38 例（95%CI，67%-92%）患者中，有 31 例（82%）成功使用 Cyberknife 治疗进行了基准跟踪。EUS 组有 5 例与操作相关的并发症。
实现 IFG 似乎对成功跟踪和放射治疗的实施并非必要。
