Accurate delivery of stereotactic body radiotherapy (SBRT) to pancreatic tumors relies on successful EUS-guided placement of fiducial markers. The aim of this study is to report the technical feasibility and safety of EUS-guided fiducial placement and to evaluate the characteristics and technical benefit of SBRT in a cohort of patients with pancreatic cancer (PC). A retrospective chart review was performed for all (n= 82) PC patients referred for EUS-guided fiducial placement by a single endosonographer at a tertiary cancer center. Data regarding EUS-related technical details, SBRT characteristics, adverse events, and continuous visibility of fiducials were recorded and analyzed. Most patients included in the study had either locally advanced disease (32 patients, 39%) or borderline resectable disease (29 patients, 35%). Eighty-two PC patients underwent the placement of 230 fiducial markers under EUS guidance. The technical success rate of the fiducial placement was 98%. No immediate EUS-related adverse events were reported. The average time to the simulation CT after fiducial placement was 3.1 days. Of the 216 fiducial markers used for the SBRT delivery, 202 fiducial markers were visible on both the simulation CT and the cone beam CT scan. A median dose of 40cGY was given to all the patients in five fractions. Of these, 41% of the patients reported no SBRT-related toxicities during the follow-up. Fatigue and nausea were the most reported SBRT-related toxicities, which were seen in 35% of the patients post-SBRT. Our results demonstrate that EUS-guided fiducial placement is safe and effective in target volume delineation, facilitating SBRT delivery in PC patients. Further clinical trials are needed to determine the SBRT-related survival benefits in patients with pancreatic cancer.
胰腺肿瘤立体定向放射治疗（SBRT）的精准实施依赖于超声内镜（EUS）引导下基准标记物的成功置入。本研究旨在报告EUS引导基准标记物置入的技术可行性与安全性，并评估胰腺癌患者队列中SBRT的技术特点及临床获益。研究对某三级癌症中心由同一位内镜超声医师实施EUS引导基准标记物置入的所有胰腺癌患者（n=82）进行回顾性病历分析，记录并分析EUS相关技术细节、SBRT参数、不良事件及基准标记物持续可视性等数据。纳入研究的患者多数为局部进展期（32例，39%）或临界可切除（29例，35%）胰腺癌。82例患者在EUS引导下共置入230枚基准标记物，技术成功率达98%，未发生即刻EUS相关不良事件。基准标记物置入后至模拟CT的平均时间为3.1天。在用于SBRT治疗的216枚标记物中，202枚在模拟CT和锥形束CT扫描中均保持可视。所有患者均接受中位剂量40Gy/5次分割的放疗方案，其中41%患者在随访期间未报告SBRT相关毒性反应。疲劳（35%）与恶心（35%）为最常见的SBRT相关毒性反应。本研究证实EUS引导基准标记物置入技术安全有效，能精准勾画靶区体积，为胰腺癌患者实施SBRT提供技术支持。未来需开展更多临床试验以明确SBRT对胰腺癌患者的生存获益。
肿瘤(癌症)患者之家