title: EUS-guided fiducial placement before targeted radiation therapy for prostate cancer.
abstract: BACKGROUND
  Image-guided radiation therapy allows the delivery of precisely aimed radiation beams to tumors while minimizing radiation to adjacent normal tissue. This is particularly important in the prostate, a moving target whose positioning depends on the dynamics of its neighboring bladder and rectum. Targeted radiation therapy can be achieved by using implantable radiographic markers, or fiducials, which serve as reference points to accurately delineate tumors.
  
  
  OBJECTIVE
  To determine the feasibility and safety of placing fiducials in the prostate under linear array EUS guidance to facilitate targeted radiation therapy.
  
  
  METHODS
  Retrospective analysis of a prospective database.
  
  
  METHODS
  University of Miami Hospital and Clinics, a tertiary cancer referral center.
  
  
  METHODS
  Localized prostate cancer patients scheduled to undergo intensity-modulated radiation therapy.
  
  
  METHODS
  A total of 16 patients underwent EUS-guided fiducial placement to delineate the prostate before planned radiation therapy.
  
  
  RESULTS
  Fiducial placement was successful in all patients (100%). A total of 71 gold markers were deployed in a 4-quadrant manner outlining the prostate. Seven of 16 patients had an additional fiducial placed to ensure adequate prostate delineation. Patients tolerated the procedure well with minimal discomfort. No complications developed from the procedure.
  
  
  CONCLUSIONS
  Single-center experience, small sample size.
  
  
  CONCLUSIONS
  EUS-guided placement of fiducials to facilitate image-guided radiation therapy for prostate cancer is a feasible alternative to transperineal or transrectal US approaches, thereby adding to the expanding list of indications for linear EUS. This procedure can be safely performed by endosonographers familiar with perirectal anatomy and transrectal FNA technique.
authors: Division of Gastroenterology, University of Miami, Miller School of Medicine, Miami, Florida, USA.
authors: Julie
authors: J
authors: Yang
authors: May
authors: M
authors: Abdel-Wahab
authors: Afonso
authors: A
authors: Ribeiro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D004307:Dose-Response Relationship, Radiation; D019160:Endosonography / Q000379:methods*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome