Comparison of percutaneous and transarterial fiducial marker placement before proton therapy for pancreatic cancer.

PURPOSE: This study aimed to evaluate the feasibility and safety of percutaneous fiducial marker placement using a 25G needle compared with transarterial placement before proton therapy for pancreatic cancer.

MATERIALS AND

METHODS

Patients who underwent fiducial marker placement from 2013 to 2023 were retrospectively reviewed. For percutaneous placement, a 25G needle was used to place markers in or around the tumor under computed tomography (CT) guidance. For transarterial placement, a metal coil was placed as a fiducial marker in a blood vessel near the tumor using a microcatheter. Technical success was defined as the reliable use of the placed fiducial marker throughout the entire proton therapy course. Major complications were defined as grade 3 or higher. Each outcome was compared using Fisher's exact test or the Mann-Whitney U test.

RESULTS

Forty-nine and 60 patients underwent percutaneous and transarterial fiducial marker placement, respectively. The technical success rates were 89.8 and 90.0% for percutaneous and transarterial placement, respectively, with no statistically significant difference between them (P > 0.99). There were no major complications in either case. The median procedure time for percutaneous placement was significantly shorter than that for transarterial placement (3.3 vs 40.0 min; P < 0.001). The median distance between the marker and the tumor was shorter with percutaneous placement than with transarterial placement (0.0 vs 10.0 mm; P = 0.005).

CONCLUSION

Percutaneous placement of fiducial markers for pancreatic cancer proton therapy using a 25G needle could be performed faster than transarterial placement with a high success rate.