title: A novel endoscopic marker for radiological localization and image-guided radiotherapy in esophageal and gastric cancers (with video).
abstract: OBJECTIVE
  Radiotherapy is an accepted modality in the treatment of esophageal cancers and is currently being evaluated in conjunction with chemotherapy for the neoadjuvant treatment of gastric cancers. Our aim was to assess whether a novel endoscopically inserted marker can be used to improve radiological assessment of the primary cancer and allow for image-guided radiotherapy.
  
  
  METHODS
  A phase II feasibility study was conducted at a tertiary-care center. Twenty-six consecutive adult patients with esophagogastric cancers underwent endoscopic marking of the tumor margins with a novel radiopaque marker (mixture of lipiodol and n-butyl 2-cyanoacrylate). The main outcome measure was the successful insertion of the marker based on a combination of radiological, endoscopic, and histological assessment.
  
  
  RESULTS
  A total of 92 markers were inserted in 26 patients. Twenty-two (88%) had follow-up imaging to assess the 81 markers inserted, 79 of which (97.5%) were visible. There were no postprocedural adverse events noted in our cohort. Radiological assessment of tumor size improved such that it was in line with the endoscopic evaluation after marker placement in 18 of 21 patients (85.7%) who had appropriate follow-up radiology imaging. Ten patients (38.5%) from our cohort underwent image-guided radiotherapy (IGRT) by using the endoscopically inserted markers.
  
  
  CONCLUSIONS
  Within the limitations of our small pilot study, endoscopic placement of our novel marker was successful in the majority of our cohort without significant adverse events. Marker placement resulted in improved radiological localization in the majority of our cohort and allowed for IGRT. (Australian New Zealand Clinical Trials Registry: ACTRN12613000239763.).
authors.affiliation: Department of Gastroenterology, Austin Health, University of Melbourne, Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Sujievvan
authors.initials: S
authors.lastname: Chandran
authors.affiliation: Department of Gastroenterology, Austin Health, University of Melbourne, Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Rhys
authors.initials: R
authors.lastname: Vaughan
authors.affiliation: Department of Gastroenterology, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Antony
authors.initials: A
authors.lastname: Jacob
authors.affiliation: Department of Radiation Oncology, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Hamilton
authors.affiliation: Department of Radiation Oncology, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Daryl Lim
authors.initials: DL
authors.lastname: Joon
authors.affiliation: Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Kiat
authors.initials: K
authors.lastname: Lim
authors.affiliation: Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Chek
authors.initials: C
authors.lastname: Tog
authors.affiliation: Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Kiron
authors.initials: K
authors.lastname: Bhatia
authors.affiliation: Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Aly
authors.affiliation: Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Sweeney
authors.affiliation: Department of Gastroenterology, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Marios
authors.initials: M
authors.lastname: Efthymiou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004659:Enbucrilate / Q000494:pharmacology; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D005240:Feasibility Studies; D005260:Female; D057918:Fiducial Markers; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D049268:Positron-Emission Tomography / Q000379:methods*; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*
chemical_list: D004659:Enbucrilate