Transarterial fiducial marker implantation for CyberKnife radiotherapy to treat pancreatic cancer: an experience with 14
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ORIGINAL ARTICLE
Transarterial fiducial marker implantation for CyberKnife radiotherapy to treat pancreatic cancer: an experience with 14 cases Akira Imaizumi1 · Takuji Araki1 · Hiroki Okada1 · Yu Sasaki1 · Takafumi Komiyama1 · Toshihiro Suzuki2 · Hiroshi Takahashi2 · Hiroshi Onishi1 Received: 31 March 2020 / Accepted: 26 August 2020 © The Author(s) 2020
Abstract Purpose The purpose of this study was to evaluate the safety and feasibility of transarterial fiducial marker implantation for CyberKnife radiotherapy to treat locally advanced pancreatic cancer. Materials and methods Fifteen pancreatic cancer patients were enrolled for transarterial marker implantation. Embolization platinum coils were implanted as a fiducial marker within 20 mm of the cancer edge, and preferably within 3 mm. The technical success of the implantation was defined as implantation of at least one fiducial marker within 20 mm of the target tumor. Irradiation was performed using the CyberKnife system. Results For 14 of 15 patients, transarterial implantation was successfully performed, and for 13 of 14 patients, the tracking marker was implanted within 3 mm of the cancer. Tracking instability was observed in two patients, but irradiation was accomplished in all 14 patients. No major complications caused by the implantation procedure were observed. The median overall survival after irradiation was 13.8 months, and the 1- and 2-years survival rates were 62.9% and 32.3%, respectively. Conclusion Transarterial fiducial marker implantation for pancreatic cancer can be safely performed for tracking, and it will be a valuable alternative approach to percutaneous fiducial marker implantation. Keywords Transarterial fiducial marker implantation · Pancreatic cancer · CyberKnife radiotherapy · Real-time tumor tracking
Introduction Previous studies have shown that CyberKnife radiotherapy is effective in patients with locally advanced pancreatic cancer [1]. This therapy decreases delays in the systemic treatment of pancreatic cancer while increasing local tumor control. Local tumor control improves patient quality of life, by controlling pain and decreasing the occurrence of gastric obstruction or duodenal obstruction [2]. Further, local control of tumors achieved through CyberKnife radiotherapy prevents distant metastasis [2]. Real-time tumor tracking during CyberKnife radiotherapy is currently used in the treatment of lungs, abdominal, and pelvic tumors, which
have respiratory movement. The pancreas is an organ that has respiratory movement [3]. Therefore, to perform CyberKnife radiotherapy for pancreatic cancer, real-time tumor tracking is needed. For implantation of fiducial marker to real-time tracking, computed tomography (CT) or ultrasound (US)guided percutaneous implantation is commonly used [4, 5]. However, the percutaneous approach is difficult to perform when other organs are located between the puncture point and the target. To overcome this, we performed transarterial fiducial marker implantation by microcatheter, guided by angiogra
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