A novel endoscopic marker for radiological localization and image-guided radiotherapy in esophageal and gastric cancers (with video)

Chandran, Sujievvan; Vaughan, Rhys; Jacob, Antony; Hamilton, C.S.; Joon, Daryl Lim; Lim, Kiat Hon; Tog, Chek; Bhatia, Kiron; Aly, Ahmad; Sweeney, Thomas M.; Efthymiou, Marios

doi:10.1016/j.gie.2015.06.042

Cited by 7 publications

(7 citation statements)

References 33 publications

(49 reference statements)

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“…Iodized oil-based liquid fiducials are less expensive and can be inserted by an endoscopist who perform gastroscopies. This was described for the first time in our pilot study in 2016[ 20 ], in which we demonstrated that similar results could be achieved compared to solid fiducials. Although the data from this study has enabled conclusions on the safety and technical efficacy of the use of liquid fiducials, long-term efficacy data focused on the patients that received LF-IGRT was not available.…”

Section: Introductionsupporting

confidence: 77%

“…In this study, we describe the OS and PFS of patients with gastroesophageal tumors that underwent LF-IGRT with liquid fiducials inserted through standard gastroscopy injection technique. This report is a follow-up to our initial study which first described this technique[ 20 ]. We believe this to be the largest observational cohort study of its kind, adding to the limited body of knowledge on the long-term outcomes of F-IGRT for gastrooesophageal tumors using liquid fiducials.…”

Section: Discussionmentioning

confidence: 99%

“…Step 7: The gastroscope accessory channel is subsequently flushed with water. Images and a video of these steps can be found in a previous publication[ 20 ].…”

Section: Methodsmentioning

confidence: 99%

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Long-term clinical outcomes of lipiodol marking using standard gastroscopy for image-guided radiotherapy of upper gastrointestinal cancers

Be¹,

Khor²,

Joon³

et al. 2021

WJG

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BACKGROUND Image-guided radiotherapy (IGRT) has significantly improved the precision in which radiotherapy is delivered in cancer treatment. Typically, IGRT uses bony landmarks and key anatomical structures to locate the tumor. Recent studies have demonstrated the feasibility of peri-tumor fiducials in enabling even more accurate delineation of target and normal tissue. The use of gold coils as fiducials in gastrointestinal tumors has been extensively studied. However, placement requires expertise and specialized endoscopic ultrasound equipment. This article reports the long-term outcomes of using a standard gastroscopy to inject liquid fiducials for the treatment of oesophageal and gastric tumors with IGRT. AIM To assess the long-term outcomes of liquid fiducial-guided IGRT in a cohort of oesophageal and gastric cancer patients. METHODS A retrospective cohort study of consecutive adults with Oesophagogastric cancers referred for liquid fiducial placement before definitive/neo-adjuvant or palliative IGRT between 2013 and 2021 at a tertiary hospital in Melbourne, Australia was conducted. Up to four liquid fiducials were inserted per patient, each injection consisting of 0.2-0.5mL of a 1:1 mixture of iodized oil (Lipiodol; Aspen Pharmacare) and n-butyl 2-cyanoacrylate (Histoacryl ® ; B. Braun). A 23-gauge injector (Cook Medical) was used for the injection. All procedures were performed by or under the supervision of a gastroenterologist. Liquid fiducial-based IGRT (LF-IGRT) consisted of computer-assisted direct matching of the fiducial region on cone-beam computerised tomography at the time of radiotherapy. Patients received standard-IGRT (S-IGRT) if fiducial visibility was insufficient, consisting of bone match as a surrogate for tumor position. Radiotherapy was delivered to 54Gy in 30 fractions for curative patients and up to 45Gy in 15 fractions for palliative treatments. RESULTS 52 patients were referred for liquid fiducial placement within the study period. A total of 51 patients underwent liquid fiducial implantation. Of these a total of 31 patients received radiotherapy. Among these, the median age was 77.4 years with a range between 57.5 and 88.8, and 64.5% were male. Twenty-seven out of the 31 patients were able to have LF-IGRT while four had S-IGRT. There were no complications after endoscopic implantation of liquid fiducials in our cohort. The cohort overall survival (OS) post-radiotherapy was 19 mo (range 0 to 87 mo). Whilst the progression-free survival (PFS) post-radiotherapy was 13 mo (range 0 to 74 mo). For those treated with curative intent, the median OS was 22.0 mo (range 0 to 87 mo) with a PFS median of 14.0 mo (range 0 to 74 mo). Grade 3 complication rate post-radiotherapy was 29%. CONCLUSION LF-IGRT is feasible in 87.1% of patients undergoing liquid fiducial placement through standard gastroscopy injection technique. Our cohort has an o...

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Section: Introductionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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Long-term clinical outcomes of lipiodol marking using standard gastroscopy for image-guided radiotherapy of upper gastrointestinal cancers

Be¹,

Khor²,

Joon³

et al. 2021

WJG

Self Cite

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“…Other studies have reported the technical feasibility and safety of endoscopy-guide marker placement of both solid and liquid markers in oesophageal cancer. [13][14][15] In a study by Machiels et al 13 three types of markers including gold seeds, flexible coils and a liquid polymer based fiducial marker were investigated. Marker retention rate varied to a large extend between the three marker types.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a novel liquid fiducial marker for use in image guided radiotherapy of oesophageal cancer

Blanck

Scherman-Rydhög

Siemsen

et al. 2018

The British Journal of Radiology

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“…Lipiodol fiducial markers are frequently used in bladder cancer RT, although they are prone to extravasation into surrounding tissues. Other studies reported on the use of Lipiodol in lung cancer, prostate cancer, and esophageal cancer RT . The visibility of various fiducial markers on CT, cone‐beam CT, and MRI has been reported .…”

Section: Discussionmentioning

confidence: 99%

Visibility of fiducial markers used for image‐guided radiation therapy on optical coherence tomography for registration with CT: An esophageal phantom study

et al. 2017

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A novel endoscopic marker for radiological localization and image-guided radiotherapy in esophageal and gastric cancers (with video)

Cited by 7 publications

References 33 publications

Long-term clinical outcomes of lipiodol marking using standard gastroscopy for image-guided radiotherapy of upper gastrointestinal cancers

Long-term clinical outcomes of lipiodol marking using standard gastroscopy for image-guided radiotherapy of upper gastrointestinal cancers

Feasibility of a novel liquid fiducial marker for use in image guided radiotherapy of oesophageal cancer

Visibility of fiducial markers used for image‐guided radiation therapy on optical coherence tomography for registration with CT: An esophageal phantom study

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