Endoscopy 2019; 51(04): S186
DOI: 10.1055/s-0039-1681721
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 13:30 – 14:00: EUS therapeutic pancreas ePoster Podium 5
Georg Thieme Verlag KG Stuttgart · New York

EUS-GUIDED PLACEMENT OF NEW GOLDEN FIDUCIAL MARKERS IN STEREOTACTIC BODY RADIATION THERAPY IN LOCALLY ADVANCED PANCREATIC CANCER: PRELIMINARY RESULTS OF FEASIBILITY AND SAFETY

F Auriemma
1   Gastroenterology and Digestive Endoscopy Unit, Humanitas Mater Domini, Castellanza (VA), Italy
,
M Di Leo
2   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Rozzano (Milan), Italy
,
T Comito
3   Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, Rozzano (Milan), Italy
,
L Lamonaca
2   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Rozzano (Milan), Italy
,
A Fugazza
2   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Rozzano (Milan), Italy
,
A Anderloni
2   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Rozzano (Milan), Italy
,
P Bossi
4   Department of Pathology, Humanitas Clinical and Research Center, Rozzano (Milan), Italy
,
R Maselli
2   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Rozzano (Milan), Italy
,
E Chiara Ferrara
2   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Rozzano (Milan), Italy
,
P Alessia Galtieri
2   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Rozzano (Milan), Italy
,
M Scorsetti
3   Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, Rozzano (Milan), Italy
,
A Repici
2   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Rozzano (Milan), Italy
,
S Carrara
2   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Rozzano (Milan), Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

 

Aims:

Radiation therapy plays an emerging role in the multi-modal treatment of locally advanced pancreatic cancer (LAPC). Stereotactic body radiation therapy (SBRT) is an innovative radiation technique, characterized by high prescription dose delivered in few fractions and increased local control rate. Endoscopic ultrasound (EUS)-guided fiducials placement allows to accurately evaluate the target motionduring SBRT delivery.

Methods:

Patients with LAPC treated with induction chemotherapy according to FOLFIRINOX or Gemcitabine-Abraxane schedules were treated with ablative dose of SBRT (54 Gy in 6 daily fractions) in a prospective phase II study (NCT03158779).

Gold markers were implanted under EUS-guidance into the tumor, at the opposite extremities. Fluoroscopy was used to confirm the position. A new dedicated needle was used: a 22G needle preloaded with 4 gold fiducials (0.43 mm width for 5 mm length), EchoTip Ultra Fiducial Needle (Cook Medical).

Prior to fiducial placement the patients received iv antibiotic prophylaxis and rectal Indometacine.

Results:

From May 2017 to Nov 2018, 8 patients (mean age 66.5 years), were enrolled. After adiuvant CT, at restaging the disease was still locally advanced, with no distant progression. Tumor mean size was 31 mm.

In all but one patient 2 – 4 markers were placed. In 3 of 8 patients procedure had no technical difficulties. In 5 patients, fiducial placement was made difficult due to: increased hardness of lesion, nearest vessels, poor control in the first marker release. Patients started the SBRT protocol 10.2 days (range 6 – 19) after simulation CT-scan. A minimal migration of one fiducial (< 3 mm) occurred in 1 patient. No severe adverse events occurred, and all procedures were performed in an outpatient setting.

Conclusions:

This preliminary evaluation demonstrated the feasibility and safety of the EUS-guided fiducial placement using the new dedicated preloaded needle. Only minor technical difficulties did not affect the correct placement of the fiducials.