A pilot study of EUS-guided fiducial insertion for the multidisciplinary management of gastric cancer
Background and study aims: The 5-year survival rates for gastric cancer remain poor despite evolving therapies, and fiducial insertion via endoscopic ultrasound (EUS) is novel within this setting. We aimed to assess the feasibility of fiduc...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2014-07-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1377523 |
| Summary: | Background and study aims: The 5-year survival rates for gastric cancer
remain poor despite evolving therapies, and fiducial insertion via endoscopic
ultrasound (EUS) is novel within this setting. We aimed to assess the
feasibility of fiducial insertion for response assessment and anatomic
localization in patients with gastric cancer.
Patients and methods: A prospective phase II feasibility study was
undertaken at Austin Health (Victoria, Australia) from February 2011 to November
2012. Consecutive adult patients were enrolled who had primary adenocarcinoma of
the stomach with American Joint Committee on Cancer stage T1 – 3,N0 – 1,M0 – 1a
and Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1. In
addition, the patients were medically suitable for gastrectomy and
chemotherapy/chemoradiotherapy. Gold fiducial markers were inserted under EUS
guidance into the margins of the gastric cancer primary. The main outcome was
successful insertion of the fiducial without complications for response
assessment and anatomic localization.
Results: A total of 15 fiducials were successfully inserted into 7 (88 %)
of 8 patients. No immediate or delayed complications were noted. One patient
proceeded to image-guided radiotherapy through the use of fiducials and is
disease free at 12 months. Fiducials were used to assess treatment response in
all patients who underwent computed tomographic imaging after insertion.
Follow-up computed tomography with fiducial placement improved anatomic
localization and estimation of the gastric cancer primary size in 3 (60 %) of 5
patients.
Conclusions: Within the limitations of our small study cohort, fiducials
were placed in gastric cancers under EUS guidance without complications, and
placement was successful in the majority of our patients. Although potential
benefits exist, there remain substantial limitations to the generalization of
this technique across our patient population. |
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| ISSN: | 2364-3722 2196-9736 |