Chandran Sujievvan, Vaughan Rhys, Jacob Antony, Hamilton Chris, Joon Daryl Lim, Lim Kiat, Tog Chek, Bhatia Kiron, Aly Ahmad, Sweeney Thomas, Efthymiou Marios
Department of Gastroenterology, Austin Health, University of Melbourne, Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
Department of Gastroenterology, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
Gastrointest Endosc. 2016 Feb;83(2):309-17. doi: 10.1016/j.gie.2015.06.042. Epub 2015 Aug 1.
Radiotherapy is an accepted modality in the treatment of esophageal cancers and is currently being evaluated in conjunction with chemotherapy for the neoadjuvant treatment of gastric cancers. Our aim was to assess whether a novel endoscopically inserted marker can be used to improve radiological assessment of the primary cancer and allow for image-guided radiotherapy.
A phase II feasibility study was conducted at a tertiary-care center. Twenty-six consecutive adult patients with esophagogastric cancers underwent endoscopic marking of the tumor margins with a novel radiopaque marker (mixture of lipiodol and n-butyl 2-cyanoacrylate). The main outcome measure was the successful insertion of the marker based on a combination of radiological, endoscopic, and histological assessment.
A total of 92 markers were inserted in 26 patients. Twenty-two (88%) had follow-up imaging to assess the 81 markers inserted, 79 of which (97.5%) were visible. There were no postprocedural adverse events noted in our cohort. Radiological assessment of tumor size improved such that it was in line with the endoscopic evaluation after marker placement in 18 of 21 patients (85.7%) who had appropriate follow-up radiology imaging. Ten patients (38.5%) from our cohort underwent image-guided radiotherapy (IGRT) by using the endoscopically inserted markers.
Within the limitations of our small pilot study, endoscopic placement of our novel marker was successful in the majority of our cohort without significant adverse events. Marker placement resulted in improved radiological localization in the majority of our cohort and allowed for IGRT. (Australian New Zealand Clinical Trials Registry: ACTRN12613000239763.).
放射治疗是食管癌治疗中被认可的一种方式，目前正与化疗联合用于胃癌的新辅助治疗评估。我们的目的是评估一种新型内镜插入式标记物是否可用于改善原发性癌症的放射学评估并实现图像引导放疗。
在一家三级医疗中心进行了一项II期可行性研究。26例连续的成年食管胃癌患者接受了用一种新型不透射线标记物（碘油和氰基丙烯酸正丁酯混合物）对肿瘤边缘进行内镜标记。主要结局指标是基于放射学、内镜和组织学评估相结合的标记物成功插入情况。
26例患者共插入92个标记物。22例（88%）进行了随访成像以评估所插入的81个标记物，其中79个（97.5%）可见。我们的队列中未观察到术后不良事件。对肿瘤大小的放射学评估有所改善，在21例有适当随访放射学成像的患者中，有18例（85.7%）在标记物放置后其评估结果与内镜评估相符。我们队列中的10例患者（38.5%）通过使用内镜插入的标记物接受了图像引导放疗（IGRT）。
在我们小型试点研究的局限性范围内，新型标记物的内镜放置在我们大多数队列中取得成功，且无明显不良事件。标记物放置在我们大多数队列中改善了放射学定位，并实现了IGRT。（澳大利亚新西兰临床试验注册中心：ACTRN12613000239763。）
