BACKGROUND The use of radiotherapy is frequently required in the treatment of locally advanced esophageal squamous cell carcinoma. However, the margins of the tumor are often difficult to ascertain on computed tomography. Thus, EUS-guided fiducial marker insertion can aid the localization of the margins of the tumor. However, the optimal technique of the procedure is still uncertain. METHODS This was a retrospective study of all patients that received EUS-guided fiducial marker insertion between March 2015 and December 2018. All patients suffering from esophageal squamous cell carcinoma scheduled for radiotherapy underwent the procedure within one week of the scheduled appointment. Gold fiducial markers were inserted under EUS guidance either intratumorally or within the submucosa just proximal and distal to the tumor. Outcome parameters included tumor characteristics, early and late migration rates, and tumor response rates. RESULTS During the study period, 40 patients were recruited. 10 fiducial markers were placed intratumorally and 30 markers were placed submucosally. When comparing fiducials that were placed in the submucosa versus intratumorally, significantly more fiducials had early (40% vs 0%, RR = 0.6, 95% CI 0.36, 1.00) and late migration (60% vs 0%, RR = 0.33, 95% CI 0.13, 0.84) in the intratumoral group. The submucosal group had significantly more patients intended for curative intent (96.7% vs 70%, RR = 0.34, 95%CI 0.003, 0.361) and more patients with partial and complete response. There was no difference between the gross tumor volume, the clinical target volume, and the total radiation dose. CONCLUSION In esophageal carcinomas planned for radiotherapy, fiducial markers placed in the submucosa may lead to less migration.

中文翻译：

---

EUS 引导的用于晚期食管癌放射治疗的基准标记插入：与肿瘤内插入相比，黏膜下插入可能导致更少的迁移。

背景技术在局部晚期食管鳞状细胞癌的治疗中经常需要使用放射疗法。然而，肿瘤的边缘通常难以通过计算机断层扫描确定。因此，EUS 引导的基准标记插入可以帮助定位肿瘤边缘。然而，该程序的最佳技术仍然不确定。方法 这是对 2015 年 3 月至 2018 年 12 月期间接受 EUS 引导的基准标记插入的所有患者的回顾性研究。所有计划接受放射治疗的食管鳞状细胞癌患者在预定预约的一周内接受了该程序。金基准标记物在 EUS 引导下插入肿瘤内或肿瘤近端和远端的粘膜下层内。结果参数包括肿瘤特征、早期和晚期迁移率以及肿瘤反应率。结果 在研究期间，招募了 40 名患者。10 个基准标记放置在肿瘤内，30 个标记放置在黏膜下。当比较放置在黏膜下层和肿瘤内的基准点时，明显更多的基准点有早期（40% vs 0%，RR = 0.6, 95% CI 0.36, 1.00）和晚期迁移（60% vs 0%，RR = 0.33, 95 % CI 0.13, 0.84) 在瘤内组中。黏膜下组有更多的有治愈意图的患者（96.7% vs 70%, RR = 0.34, 95%CI 0.003, 0.361）和更多的部分和完全缓解的患者。总肿瘤体积、临床靶区体积和总辐射剂量之间没有差异。