INTENSITY-MODULATED RADIATION THERAPY FOR PANCREATIC CANCER USING A GOLD MARKER : APPLICATION OF EUS-GUIDED FINE NEEDLE ASPIRATION

Abstract

Introduction : Treatment with chemoradiotherapy is recommended for locally advanced, unresectable pancreatic cancer. Intensity-modulated radiation therapy (IMRT) for dose concentration-enhancement with placement of a gold marker to determine the three-dimensional radiation field, is available at some hospitals. We evaluated the efficacy of radiation treatment with IMRT after gold marker placement for pancreatic cancer using endoscopic ultrasound (EUS)-guided fine needle aspiration (EUS-FNA).

Methods : Six patients with stage Ⅰ-stage ⅣA pancreatic cancer were treated with IMRT after gold marker placement using EUS-FNA procedures in our hospital from December 2013 to December 2014.

Results : The gold marker was placed successfully in all six patients. No serious adverse events were observed. In addition, the treatment was completed without the gold marker falling off during IMRT. The treatment effect was stable disease in five patients and progressive disease in one patient. In the five patients with stable disease, FDG uptake was decreased on positron emission tomography/computed tomography. At one year after the end of treatment, four patients were still alive.

Conclusion : IMRT with gold marker placement, which is an application of the EUS-FNA technique, is beneficial for the treatment of pancreatic cancer. Our experience is limited to a few cases thus far, but we have confirmed that the procedure is safe and expect to apply it in the clinical setting.