EUS-Guided Fiducial Marker Insertion to Guide Radiotherapy in Advanced Esophageal Carcinoma
Refereed conference paper presented and published in conference proceedings


The use of radiotherapy with or without concurrent chemotherapy is frequently required in treatment of advanced esophageal squamous cell carcinoma. It is usually given in an adjuvant, neoadjuvant or definitive setting. However, the margins of the tumor are often difficult to ascertain on computed tomography. Thus, EUS-guided fiducial marker insertion has an important role to aid the localization of the proximal and distal margins of the esophageal tumor. However, the optimal technique of the procedure is still uncertain.

This was a retrospective study of all patients that received EUS-guided fiducial marker insertion between March 2015 and November 2016. All patients suffering from esophageal squamous cell carcinoma scheduled for radiotherapy underwent the procedure within one week of the scheduled appointment. Gold fiducial markers 5mm x 0.35mm (Visicoil, IBA Dosimetry, USA) were back loaded on to 22 gauge needles (Vizishot, Olympus Medical, Japan) or (Expect, Boston Scientific, USA). In non-obstructing tumors, a linear echoendoscope (GF-UCT260, Olympus Medical, Japan) was used. In obstructing tumors, the tumor was first traversed with a 5.4mm ultrathin gastroscope (GIF-XP290, Olympus Medical, Japan). A guidewire was then placed across the tumor to guide insertion of a linear ultrasound bronchoscope (EBUS) (BF-UCF260FW, Olympus Medical, Japan). The markers were placed under EUS guidance either intratumorally or in the normal submucosa just proximal and distal to the tumor. Outcome parameters included tumor characteristics, migration rates and tumor response rates.

During the study period, 25 patients received the procedure. The mean (S.D.) age was 59.6 (10.2) years old. The mean (S.D.) length and volume of the tumor were 6.7 (4.2) cm and 24.6 (15.8) ml respectively and 88% of the patients had stage 3 disease. 20 patients had markers inserted by EBUS and 60% in the submucosa. When comparing fiducials that were placed in the submucosa versus intratumorally, significantly more fiducials had early (42.9% vs 0 %, P = 0.017) and late migration (100% vs 0%, P < 0.001) in the intratumoral group. There were no differences in the stage of disease (P = 0.657), percentage of patients that completed radiotherapy (P = 0.299) and response rate (P = 0.515).

In obstructing esophageal carcinomas, fiducial markers should be placed in the submucosa just proximal and distal to the tumor by EBUS.
著者Teoh AY, Yip HC, Chan SM, Wong VW, Chiu PWY, Ng EK
會議名稱Digestive Disease Week 2017
會議地點Chicago, Illinois
會議論文集題名Gastrointestinal Endoscopy
期次5 Supplement
頁次AB472 - AB472
Web of Science 學科類別Gastroenterology & Hepatology;Gastroenterology & Hepatology

上次更新時間 2020-05-08 於 02:50