Bleeker Margot, van der Horst Astrid, Bel Arjan, Sonke Jan-Jakob, van Hooft Jeanin E, Pouw R E, Hulshof Maarten C C M
Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Cancer treatment and quality of life, Imaging and biomarkers, Cancer Center Amsterdam, Amsterdam, Netherlands.
Endosc Int Open. 2023 Sep 21;11(9):E866-E872. doi: 10.1055/a-2129-2840. eCollection 2023 Sep.
Fiducial markers have demonstrated clinical value in radiotherapy in several organs, but little is known about markers in the stomach. Here, we assess the technical feasibility of endoscopic placement of markers in gastric cancer patients and their potential benefit for image-guided radiotherapy (IGRT). In this prospective feasibility study, 14 gastric cancer patients underwent endoscopy-guided gold (all patients) and liquid (7 patients) marker placements distributed throughout the stomach. Technical feasibility, procedure duration, and potential complications were evaluated. Assessed benefit for IGRT comprised marker visibility on acquired imaging (3-4 computed tomography [CT] scans and 19-25 cone-beam CTs [CBCTs] per patient) and lack of migration. Marker visibility was compared per marker type and location (gastroesophageal junction (i.e., junction/cardia), corpus (corpus/antrum/fundus), and pylorus). Of the 93 marker implantation attempts, 59 were successful, i.e., marker in stomach wall and present during entire 5-week radiotherapy course (2-6 successfully placed markers per patient), with no significant difference (Fisher's exact test; >0.05) in success rate between gold (39/66=59%) and liquid (20/27=74%). Average procedure duration was 24.4 min (range 16-38). No procedure-related complications were reported. All successfully placed markers were visible on all CTs, with 81% visible on ≥95% of CBCTs. Five markers were poorly visible (on <75% of CBCTs), possibly due to small marker volume and peristaltic motion since all five were liquid markers located in the corpus. No migration was observed. Endoscopic placement of fiducial markers in the stomach is technically feasible and safe. Being well visible and positionally stable, markers provide a potential benefit for IGRT.
基准标记物已在多个器官的放射治疗中显示出临床价值，但对于胃内标记物却知之甚少。在此，我们评估了在胃癌患者中通过内镜放置标记物的技术可行性及其在图像引导放射治疗（IGRT）中的潜在益处。在这项前瞻性可行性研究中，14例胃癌患者接受了内镜引导下的金标记物（所有患者）和液体标记物（7例患者）放置，标记物分布于整个胃内。评估了技术可行性、操作持续时间和潜在并发症。评估的IGRT益处包括在获取的影像上标记物的可见性（每位患者进行3 - 4次计算机断层扫描[CT]和19 - 25次锥形束CT[CBCT]）以及无移位。根据标记物类型和位置（胃食管交界部（即交界处/贲门）、胃体（胃体/胃窦/胃底）和幽门）比较标记物的可见性。在93次标记物植入尝试中，59次成功，即标记物位于胃壁且在整个5周放射治疗过程中存在（每位患者成功放置2 - 6个标记物），金标记物（39/66 = 59%）和液体标记物（20/27 = 74%）的成功率无显著差异（Fisher精确检验；>0.05）。平均操作持续时间为24.4分钟（范围16 - 38分钟）。未报告与操作相关的并发症。所有成功放置的标记物在所有CT上均可见，81%在≥95%的CBCT上可见。5个标记物显示不佳（在<75%的CBCT上），可能是由于标记物体积小和蠕动运动，因为这5个均为位于胃体的液体标记物。未观察到移位。内镜下在胃内放置基准标记物在技术上是可行且安全的。标记物可见性良好且位置稳定，为IGRT提供了潜在益处。
