Vol. 46 (x): 2020 March 3.[Ahead of print]
Muhammad Shahbaz 1, 2, 3, Asif Ammar 4, Yuliang Wang 3, 5, Zeeshan Farhaj 6, Liang Qiao 3, Jun Niu 1, 2
1 Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, China; 2 The Institute of Laparoscopic-Endoscopic Minimally Invasive Surgery of Shandong University, Shandong, China; 3 Department of Urology, Weifang People´s Hospital, Shandong, Weifang 261041, China; 4 Department of Urology, Combined Military Hospital, Kharian, Pakistan; 5 Weifang Medical University,Shandong, Weifang 261041, China; 6 Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, China
Hypothesis: Endoclip can be used as fiducial marker in urology.
Objective: To assess the feasibility, cost effectiveness and reliability of endoclips as novel fiducial markers in precision radiotherapy, as part of a trimodality bladder-preserving treatment (TBPT) of muscle-invasive bladder carcinoma.
Materials and Methods: This retrospective study was performed at Weifang People’s Hospital (Weifang, China) from January 2015 to June 2018. A total of 15 patients underwent TBPT. Endoclips were applied to healthy edges of the resected bladder wall as novel fiducial markers. Radio-sensitizing chemotherapy and routine precision radiotherapy were given. The number and position of the endoclips during radiotherapy sessions were monitored. Complications and tumor recurrence were analyzed.
Results: The mean age (±standard deviation) of the patients was 67±10 years (range 46-79). There were 3 females and 12 males. Forty-nine endoclips were applied in all patients (3.3±0.8). The tumor was completely visibly resected in all patients. The number of endoclips remained the same through the planned last radiotherapy session (3.3±0.8), i.e., none were lost. All endoclips were removed after the last radiotherapy session. The average number of follow-up months was 38.9±13.2 (range 11-52). There were no procedure-related complications at discharge or follow-up. At one-year, overall recurrence-free survival was 93.3%. Two patients had recurrences at 18 months and 10 months after TBPT, respectively, and salvage radical cystectomy was performed with no further recurrences. Another patient died due to metastasis 9 months after the completion of therapy.
Conclusions: Endoclips are reliable, safe and cost-effective as novel fiducial markers in precision-radiotherapy post-TBPT.
Keywords: Urinary Bladder Neoplasms; Carcinoma; Treatment Outcome