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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 fiducial insertion for response assessment and anatomic localizat...

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Autores principales: Chandran, Sujievvan, Vaughan, Rhys, Efthymiou, Marios, Sia, Joseph, Hamilton, Christopher
Formato: Online Artículo Texto
Lenguaje:English
Publicado: © Georg Thieme Verlag KG 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440364/
https://www.ncbi.nlm.nih.gov/pubmed/26134962
http://dx.doi.org/10.1055/s-0034-1377523
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author Chandran, Sujievvan
Vaughan, Rhys
Efthymiou, Marios
Sia, Joseph
Hamilton, Christopher
author_facet Chandran, Sujievvan
Vaughan, Rhys
Efthymiou, Marios
Sia, Joseph
Hamilton, Christopher
author_sort Chandran, Sujievvan
collection PubMed
description 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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spelling pubmed-44403642015-06-23 A pilot study of EUS-guided fiducial insertion for the multidisciplinary management of gastric cancer Chandran, Sujievvan Vaughan, Rhys Efthymiou, Marios Sia, Joseph Hamilton, Christopher Endosc Int Open Article 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. © Georg Thieme Verlag KG 2014-09 2014-07-18 /pmc/articles/PMC4440364/ /pubmed/26134962 http://dx.doi.org/10.1055/s-0034-1377523 Text en © Thieme Medical Publishers
spellingShingle Article
Chandran, Sujievvan
Vaughan, Rhys
Efthymiou, Marios
Sia, Joseph
Hamilton, Christopher
A pilot study of EUS-guided fiducial insertion for the multidisciplinary management of gastric cancer
title A pilot study of EUS-guided fiducial insertion for the multidisciplinary management of gastric cancer
title_full A pilot study of EUS-guided fiducial insertion for the multidisciplinary management of gastric cancer
title_fullStr A pilot study of EUS-guided fiducial insertion for the multidisciplinary management of gastric cancer
title_full_unstemmed A pilot study of EUS-guided fiducial insertion for the multidisciplinary management of gastric cancer
title_short A pilot study of EUS-guided fiducial insertion for the multidisciplinary management of gastric cancer
title_sort pilot study of eus-guided fiducial insertion for the multidisciplinary management of gastric cancer
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440364/
https://www.ncbi.nlm.nih.gov/pubmed/26134962
http://dx.doi.org/10.1055/s-0034-1377523
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