TY - JOUR
T1 - EUS-guided fiducial placement for GI malignancies
T2 - a systematic review and meta-analysis
AU - Coronel, Emmanuel
AU - Cazacu, Irina M.
AU - Sakuraba, Atsushi
AU - Luzuriaga Chavez, Adriana Alexandra
AU - Uberoi, Angad
AU - Geng, Yimin
AU - Tomizawa, Yutaka
AU - Saftoiu, Adrian
AU - Shin, Eun Ji
AU - Taniguchi, Cullen M.
AU - Koong, Albert C.
AU - Herman, Joseph M.
AU - Bhutani, Manoop S.
N1 - Publisher Copyright:
© 2019 American Society for Gastrointestinal Endoscopy
PY - 2019/4
Y1 - 2019/4
N2 - Background and Aims: Image-guided radiotherapy (IGRT) allows the delivery of radiation with high precision to a target lesion while minimizing toxicity to surrounding tissues. EUS provides excellent visualization of GI tumors and consequently is being used for fiducial placement with increased frequency. Our goal was to perform a systematic review and meta-analysis of studies evaluating the technical aspects, safety, and efficacy of EUS fiducial placement for IGRT in GI malignancies. Methods: A systematic literature search was carried out in the following databases: Medline, PubMed, Embase, Web of Science, and Cochrane Library, using Medical Subject Headings terms combined with text words. A random effects model was used to determine pooled proportions of technical success, migration, and adverse event rates. Heterogeneity was assessed using the I 2 statistic. Publication bias was assessed visually using a funnel plot and by the Begg and Egger tests. Results: Nine full articles and 5 abstracts reporting on 1155 patients, 49% from a single study by Dhadham et al, were included in the meta-analysis. The pooled rate of technical success was 98% (95% confidence interval [CI], 96-99). Moderate heterogeneity (I 2 = 34.18) was present, which appeared to be due to variable sample sizes. Publication bias was present, suggesting that studies with less-substantial outcomes may have not been reported (Begg test, P =.87; Egger test, P <.01). Pooled rates for fiducial migration and adverse events were 3% (95% CI, 1.0-8.0) and 4% (95% CI, 3-7), respectively. Conclusions: Our meta-analysis showed that EUS-guided insertion of gold fiducials for IGRT is technically feasible and safe. Further controlled studies assessing its long-term effectiveness in GI malignancies are needed.
AB - Background and Aims: Image-guided radiotherapy (IGRT) allows the delivery of radiation with high precision to a target lesion while minimizing toxicity to surrounding tissues. EUS provides excellent visualization of GI tumors and consequently is being used for fiducial placement with increased frequency. Our goal was to perform a systematic review and meta-analysis of studies evaluating the technical aspects, safety, and efficacy of EUS fiducial placement for IGRT in GI malignancies. Methods: A systematic literature search was carried out in the following databases: Medline, PubMed, Embase, Web of Science, and Cochrane Library, using Medical Subject Headings terms combined with text words. A random effects model was used to determine pooled proportions of technical success, migration, and adverse event rates. Heterogeneity was assessed using the I 2 statistic. Publication bias was assessed visually using a funnel plot and by the Begg and Egger tests. Results: Nine full articles and 5 abstracts reporting on 1155 patients, 49% from a single study by Dhadham et al, were included in the meta-analysis. The pooled rate of technical success was 98% (95% confidence interval [CI], 96-99). Moderate heterogeneity (I 2 = 34.18) was present, which appeared to be due to variable sample sizes. Publication bias was present, suggesting that studies with less-substantial outcomes may have not been reported (Begg test, P =.87; Egger test, P <.01). Pooled rates for fiducial migration and adverse events were 3% (95% CI, 1.0-8.0) and 4% (95% CI, 3-7), respectively. Conclusions: Our meta-analysis showed that EUS-guided insertion of gold fiducials for IGRT is technically feasible and safe. Further controlled studies assessing its long-term effectiveness in GI malignancies are needed.
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U2 - 10.1016/j.gie.2018.10.047
DO - 10.1016/j.gie.2018.10.047
M3 - Review article
C2 - 30445001
AN - SCOPUS:85060113536
SN - 0016-5107
VL - 89
SP - 659-670.e18
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -