Patel Jaymon B, Revanur Vakya, Forcione David G, Bechtold Matthew L, Puli Srinivas R
Department of Gastroenterology, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States.
Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States.
World J Gastrointest Endosc. 2020 Aug 16;12(8):231-240. doi: 10.4253/wjge.v12.i8.231.
Pancreatic cancer (PC) mortality remains high despite advances in therapy. Combination chemoradiotherapy offers modest survival benefit over monotherapy with either. Fiducial markers serve as needed landmarks for image-guided radiotherapy (IGRT). Traditionally, these markers were placed surgically or percutaneously with limitations of each. Endoscopic ultrasound-guided placement overcomes these limitations.
To evaluate the safety, efficacy, and feasibility of endoscopic ultrasound (EUS)-guided fiducial placement for PC undergoing IGRT.
Articles were searched in MEDLINE, PubMed, and Ovid journals. Pooling was conducted by fixed and random effects models. Heterogeneity was assessed using Cochran's test based upon inverse variance weights.
Initial search identified 1024 reference articles for EUS-guided fiducial placement in PC. Of these, 261 relevant articles were reviewed. Data was extracted from 11 studies ( = 820) meeting inclusion criteria. Pooled proportion of successful placement was 96.27% (95%CI: 95.35-97.81) with fiducial migration rates low at 4.33% (95%CI: 2.45-6.71). Adverse event rates remained low, with overall pooled proportion of 4.85% (95%CI: 3.04-7.03).
EUS-guided placement of fiducial markers for IGRT of PC is safe, feasible, and efficacious. The ability to target deep structures under direct visualization while remaining minimally invasive are added benefits. Moreover, the ability to perform fine needle aspiration or celiac plexus neurolysis add value and increase patient-care efficiency. Whether EUS-guided fiducial placement improves outcomes in IGRT or offers any mortality benefits over traditional placement remains unknown and future studies are needed.
尽管治疗取得了进展，但胰腺癌（PC）的死亡率仍然很高。联合放化疗比单纯使用其中任何一种疗法在生存获益方面更为适度。基准标记物作为图像引导放射治疗（IGRT）所需的地标。传统上，这些标记物通过手术或经皮放置，每种方法都有局限性。内镜超声引导下放置克服了这些局限性。
评估内镜超声（EUS）引导下为接受IGRT的PC患者放置基准标记物的安全性、有效性和可行性。
在MEDLINE、PubMed和Ovid期刊中检索文章。采用固定效应模型和随机效应模型进行汇总。基于逆方差权重，使用 Cochr an检验评估异质性。
初步检索确定了1024篇关于EUS引导下在PC中放置基准标记物的参考文献。其中，对261篇相关文章进行了综述。从11项符合纳入标准的研究（n = 820）中提取数据。成功放置的合并比例为96.27%（95%CI：95.35 - 97.81），基准标记物迁移率较低，为4.33%（95%CI：2.45 - 6.71）。不良事件发生率仍然较低，总体合并比例为4.85%（95%CI：3.04 - 7.03）。
EUS引导下为PC的IGRT放置基准标记物是安全、可行且有效的。在直接可视化下靶向深部结构同时保持微创的能力是额外的优势。此外，进行细针穿刺抽吸或腹腔神经丛神经松解的能力增加了价值并提高了患者护理效率。EUS引导下放置基准标记物是否能改善IGRT的结果或比传统放置方法提供任何死亡率益处仍不清楚，需要进一步的研究。
