Fiducial Marker Placement for Gated Radiotherapy Using Real-Time Tumor-Tracking in Pancreatic Cancer: A Comparative Analysis of Transarterial and Percutaneous Approaches.

Abstract

PurposeTo assess and compare the feasibility and safety of transarterial and percutaneous fiducial marker placements for gated radiotherapy using real-time tumor-tracking (RTRT) in patients with pancreatic cancer.Materials and methodsThis retrospective cohort study included 61 patients with inoperable pancreatic cancer who underwent transarterial (n = 34) or percutaneous (n = 27) fiducial marker placement between 2015 and 2023. Technical and clinical success, adverse events (AEs), procedure time, number of markers, tumor-to-marker distance, migration, per-marker availability for RTRT, and reasons for marker unavailability were assessed.ResultsBoth approaches achieved high technical and clinical success rates (transarterial approach, 91.4% and 97.1%; percutaneous approach, 96.3% and 96.3%; P = .626 and P = 1.000) without moderate or severe AEs. Mild AEs occurred in 2.9% and 7.4% of patients in the transarterial and percutaneous groups (P = .575). The median procedure time was shorter in the percutaneous group (35 vs 50 minutes, P = .006). The percutaneous group used more markers (3 vs 1 [median], P ConclusionsTransarterial and percutaneous fiducial marker placements are safe and feasible for administering RTRT in patients with pancreatic cancer.