1598 FEASIBILITY STUDY: A NOVEL ULTRA-SMALL FIDUCIARY MARKER DESIGN AND DELIVERY PROTOCOL TO IMPROVE CONFORMAL RADIATION THERAPY FOR BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive1 Apr 20111598 FEASIBILITY STUDY: A NOVEL ULTRA-SMALL FIDUCIARY MARKER DESIGN AND DELIVERY PROTOCOL TO IMPROVE CONFORMAL RADIATION THERAPY FOR BLADDER CANCER Maurice Garcia, Alex Gottschalk, Jocelyn Speight, Badrinath Konety, and Peter Carroll Maurice GarciaMaurice Garcia San Francisco, CA More articles by this author , Alex GottschalkAlex Gottschalk San Francisco, CA More articles by this author , Jocelyn SpeightJocelyn Speight San Francisco, CA More articles by this author , Badrinath KonetyBadrinath Konety Minneapolis, MN More articles by this author , and Peter CarrollPeter Carroll San Francisco, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1648AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder radiation is an important management option for carefully selected patients with bladder cancer. However, unreliable visualization of the tumor site on CT imaging and day to day variability in bladder volume limit efficacy and increase side effects. The smallest area that can generally be targeted to receive higher (boost) radiation dosage is ¼ of total bladder area. More accurate and reliable target localization would likely improve treatment outcomes. METHODS Six consecutive patients with stage T2 bladder cancer elected management with combination radiation-chemotherapy. All underwent endoscopic placement of modified 24-K gold fiduciary markers (1.1 mm. x 3.2 mm., and 0.65 mm. x 2.1 mm.) into healthy submucosa 1 cm. from the margin of the tumor resection site using a custom-made steel coaxial needle. Retention and migration was confirmed by KUB, dosimetry-planning CT-scan, and portal imaging. Patients were assessed for adverse effects of marker placement. RESULTS A total of 22 markers (3–4 per tumor site) were placed. All markers were easily visualized by KUB (Figure 1), CT scan, and portal imaging, and no marker migration occurred. One patient did not undergo any radiation therapy, and was managed with surveillance. The other has not yet begun radiation therapy. Four patients completed radiation therapy. In 1 patient, during the last quarter of radiation therapy, 1 marker was spontaneously passed. All other markers (14/15) were present through the end of radiation therapy. No intraoperative or post-operative complications occurred. These markers allowed the area targeted to receive higher-dose radiation to be reduced to 1/2 to 1/6 of the area that would be irradiated without the markers. CONCLUSIONS The novel fiduciary marker design and placement protocol we present is technically simple to perform, well tolerated, and designed to minimize risk of marker migration. This allows the exact site of bladder tumor resection to be localized in 3-dimensions throughout dosimetry planning and therapy, while minimizing the high (boost)-dose treatment area. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e641-e642 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maurice Garcia San Francisco, CA More articles by this author Alex Gottschalk San Francisco, CA More articles by this author Jocelyn Speight San Francisco, CA More articles by this author Badrinath Konety Minneapolis, MN More articles by this author Peter Carroll San Francisco, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...