Figueiredo Mariana, Bouchart Christelle, Moretti Luigi, Mans Laura, Engelholm Jean-Luc, Bali Maria-Antonietta, Van Laethem Jean-Luc, Eisendrath Pierre
Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Belgium.
Department of Radiation-Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Belgium.
Endosc Int Open. 2021 Feb;9(2):E253-E257. doi: 10.1055/a-1324-2892. Epub 2021 Feb 3.
In borderline resectable/locally advanced pancreatic ductal adenocarcinoma (PDAC), stereotactic body radiation therapy (SBRT) is an emerging neoadjuvant treatment option. Endoscopic ultrasound (EUS)-guided insertion of fiducial markers being a prerequisite, our aim was to assess its feasibility and safety and also to evaluate its success, from both the endoscopist's and radiotherapist's perspectives. We prospectively collected data concerning PDAC patients submitted to EUS-guided fiducial placement, from February 2018 to November 2019. Technical success was defined as at least one marker presumed inside the tumor. Quality success was assessed at pre-SBRT computed tomography, accordingly to the number of markers inside or < 1 cm from the tumor, number of markers at the tumor extremity, their location in different planes, the distance between them, and their distance from the biliary stent (if present). A new quality score was then proposed and high-quality success defined as at least six of 12 points. Thirty-seven patients were enrolled. A total of 97 fiducials were implanted, with a median of three fiducials per patient (0-4). The technical success rate was 92 %, with failure of fiducial placement in three patients. Three patients (8 %) had adverse events (fever, mild acute pancreatitis, and biliary stent migration). At pre-SBRT evaluation, two patients' markers had migrated. The high-quality success rate was 62.5 %. Our results contribute to demonstrating the feasibility and safety of EUS-guided fiducial placement for SBRT treatment in PDAC. It is hoped that the newly proposed quality score will pave the way for improving fiducial positioning and SBRT delivery.
在可切除边缘/局部晚期胰腺导管腺癌（PDAC）中，立体定向体部放射治疗（SBRT）是一种新兴的新辅助治疗选择。内镜超声（EUS）引导下插入基准标记是前提条件，我们的目的是从内镜医师和放疗医师的角度评估其可行性和安全性，并评估其成功率。我们前瞻性收集了2018年2月至2019年11月接受EUS引导下基准标记放置的PDAC患者的数据。技术成功定义为至少有一个标记推测位于肿瘤内。在SBRT前的计算机断层扫描中评估质量成功情况，根据肿瘤内或距肿瘤<1 cm的标记数量、肿瘤末端的标记数量、它们在不同平面的位置、它们之间的距离以及它们与胆道支架（如果存在）的距离。然后提出了一个新的质量评分，高质量成功定义为12分中至少6分。共有37例患者入组。共植入97个基准标记，每位患者的中位数为3个基准标记（0 - 4个）。技术成功率为92%，3例患者基准标记放置失败。3例患者（8%）出现不良事件（发热、轻度急性胰腺炎和胆道支架移位）。在SBRT前评估时，2例患者的标记发生了移位。高质量成功率为62.5%。我们的结果有助于证明EUS引导下基准标记放置用于PDAC的SBRT治疗的可行性和安全性。希望新提出的质量评分将为改善基准标记定位和SBRT实施铺平道路。
