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EUS-Guided Fiducial Placement

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Interventional Endoscopic Ultrasound

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Abstract

Fiducial markers are radiopaque markers implanted inside or adjacent to a tumor to aid in image-guided radiation therapy. Image-guided radiation therapy (IGRT) enables precise targeting of the lesion, minimizes toxicity to adjacent normal structures, and takes into account motion of the tumor during respiration. Traditionally, fiducial markers were placed percutaneously or surgically. More recently, endoscopic ultrasound (EUS)-guided fiducial placement has been reported. Both retrospective and prospective studies have demonstrated that EUS-guided fiducial placement is safe and feasible in various malignancies with low complication rates. There are several fiducial deployment techniques and different commercially available fiducial types that have been described in the literature. Technical success rates have ranged between 85 and 100%, with higher success rates in more recent studies even without the use of fluoroscopy. Data on long-term durability of fiducials during radiation therapy are favorable, although studies evaluating survival benefit are lacking. This chapter will summarize the role of EUS in the placement of fiducial markers to aid IGRT to treat various gastrointestinal and nongastrointestinal malignancies.

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Authors and Affiliations

  1. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Aamir N. Dam & Jason B. Klapman

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  1. Aamir N. Dam
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  2. Jason B. Klapman
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Correspondence to Jason B. Klapman .

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Editors and Affiliations

  1. Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Douglas G. Adler, MD, FACG, AGAF, FASGE

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EUS deployment of fiducials using the back-loading technique (MP4 137992 kb)

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Dam, A.N., Klapman, J.B. (2019). EUS-Guided Fiducial Placement. In: Adler, MD, FACG, AGAF, FASGE, D. (eds) Interventional Endoscopic Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-319-97376-0_10

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  • DOI: https://doi.org/10.1007/978-3-319-97376-0_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-97375-3

  • Online ISBN: 978-3-319-97376-0

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