title: EUS-guided gold fiducial insertion for image-guided radiation therapy of pancreatic cancer: 50 successful cases without fluoroscopy.
abstract: BACKGROUND
  Image-guided radiation therapy (IGRT) accurately delivers a high dose of potentially tumoricidal radiation to its target while sparing adjacent healthy tissue. Application of IGRT to unresectable pancreatic cancer requires the use of fiducials to track the precise location of the tumor. Fiducial markers have been successfully placed endoscopically.
  
  
  OBJECTIVE
  To determine the feasibility of EUS-guided gold fiducial placement for IGRT.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Tertiary medical center.
  
  
  METHODS
  Consecutively referred patients with locally advanced unresectable pancreatic adenocarcinoma for EUS-guided insertion of gold fiducials from December 2006 to February 2009.
  
  
  METHODS
  Under only EUS guidance, fiducial markers were deployed into or near the tumor by using a 19-gauge needle. In most cases, a sterile water injection technique was used to insert the fiducials. Fluoroscopy was not used in any case.
  
  
  METHODS
  Successful placement of an adequate number of fiducials to proceed with IGRT as determined by CT.
  
  
  RESULTS
  Fifty-seven consecutive patients were included. Fifty cases (88%) were successful. Of the cases in which fiducial placement was attempted and follow-up was adequate, 94% (50 of 53) of cases were successful.
  
  
  CONCLUSIONS
  Single-center, nonrandomized study.
  
  
  CONCLUSIONS
  EUS-guided fine-needle insertion was safe and effective in delivering gold fiducial markers for image-guided radiation therapy. Fluoroscopy was not required for successful fiducial placement.
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Walter G
authors.initials: WG
authors.lastname: Park
authors.forename: Brian M
authors.initials: BM
authors.lastname: Yan
authors.forename: Devin
authors.initials: D
authors.lastname: Schellenberg
authors.forename: Jeff
authors.initials: J
authors.lastname: Kim
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Chang
authors.forename: Albert
authors.initials: A
authors.lastname: Koong
authors.forename: Cheryl
authors.initials: C
authors.lastname: Patalano
authors.forename: Jacques
authors.initials: J
authors.lastname: Van Dam
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D019160:Endosonography / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006046:Gold; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000532:radiotherapy*; D015641:Radiography, Interventional; D011880:Radiotherapy Planning, Computer-Assisted
chemical_list: D006046:Gold