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Development of dynamic tumor-tracking intensitymodulated radiotherapy (DT-IMRT) assisted by EUS-guided fiducial marker placement for locally advanced unresectable pancreatic cancer (URPC).
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T. Matsumori1,
Y. Kodama1,
H. Seno1 |
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1Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine |
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| Background : Favorable outcome of intensity-modulated radiation therapy (IMRT) for pancreatic cancer has been reported. More recently, in our institution, dynamic tumor-tracking intensity-modulated radiotherapy (DT-IMRT) using fiducial marker is under development to acquire accurate irradiation fields and to reduce complications. Aims : To establish the safety and usefulness of DT-IMRT assisted by EUS-guided fiducial marker placement for URPC.Patients and Methods : We reviewed 26 URPC patients in whom fiducial markers (VISICOIL kit) were placed by EUS. Then, EUS procedure, complications, IMRT protocol, and treatment outcome of pilot cases were evaluated.Results : Success rate of EUS-guided placement was 100% (26/26). No early complication was observed. One case had migration of VISICOIL into cystic-lesion around the pancreatic tumor 3 months after the placement, but no treatment was required. Visibility rate of fiducial marker was 100% (25/25). All the 25 cases had IMRT including 7cases of breath-hold IMRT and 18 cases of DT-IMRT. Pilot study of 10 cases with DT-IMRT showed that 1year/2year survival rate and median survival time (MST) were 100%/49%, and 23.6 months, respectively. The MST of DT-IMRT was significantly longer than that of ordinary IMRT without VISICOIL placement (16.8 months).Conclusion : DT-IMRT assisted by EUS-guided fiducial marker placement is a safe treatment strategy and may contribute to improve the prognosis of URPC. |
Index Term 1: VISICOIL
Index Term 2: EUS-guided fiducial marker |
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