BioXmark® Liquid Fiducials to Enable Radiotherapy Tumor Boosting in Rectal Cancer, a Feasibility Trial

Overview

Journal Clin Transl Radiat Oncol

Specialty Oncology

Date 2022 Nov 21

PMID 36407490

Authors

Thirza J S Opbroek

Yves C P Willems

Frank Verhaegen

Rogier de Ridder

Chantal Hoge

Jarno Melenhorst

Frans Bakers

Heike I Grabsch

Jeroen Buijsen

Evert J Van Limbergen

Richard A M Canters

Maaike Berbee

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Dose-escalation in rectal cancer (RCa) may result in an increased complete response rate and thereby enable omission of surgery and organ preservation. In order to implement dose-escalation, it is crucial to develop a technique that allows for accurate image-guided radiotherapy. The aim of the current study was to determine the performance of a novel liquid fiducial marker (BioXmark®) in RCa patients during the radiotherapy course by assessing its positional stability on daily cone-beam CT (CBCT), technical feasibility, visibility on different imaging modalities and safety.

Materials And Methods: Prospective, non-randomized, single-arm feasibility trial with inclusion of twenty patients referred for neoadjuvant chemoradiotherapy for locally advanced RCa. Primary study endpoint was positional stability on CBCT. Furthermore, technical aspects, safety and clinical performance of the marker, such as visibility on different imaging modalities, were evaluated.

Results: Seventy-four markers from twenty patients were available for analysis. The marker was stable in 96% of the cases. One marker showed clinically relevant migration, one marker was lost before start of treatment and one marker was lost during treatment. Marker visibility was good on computed tomography (CT) and CBCT, and moderate on electronic portal imaging (). Marker visibility on magnetic resonance imaging (MRI) was poor during response evaluation.

Conclusion: The novel liquid fiducial marker demonstrated positional stability. We provide evidence of the feasibility of the novel fiducial marker for image-guided radiotherapy on daily cone beam CT for RCa patients.

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References

But-Hadzic J, Anderluh F, Brecelj E, Edhemovic I, Secerov-Ermenc A, Hudej R . Acute Toxicity and Tumor Response in Locally Advanced Rectal Cancer After Preoperative Chemoradiation Therapy With Shortening of the Overall Treatment Time Using Intensity-Modulated Radiation Therapy With Simultaneous Integrated Boost: A Phase 2.... Int J Radiat Oncol Biol Phys. 2016; 96(5):1003-1010. DOI: 10.1016/j.ijrobp.2016.08.031. View

Enker W, Thaler H, Cranor M, Polyak T . Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg. 1995; 181(4):335-46. View

Machiels M, Voncken F, Jin P, van Dieren J, Bartels-Rutten A, Alderliesten T . A Novel Liquid Fiducial Marker in Esophageal Cancer Image Guided Radiation Therapy: Technical Feasibility and Visibility on Imaging. Pract Radiat Oncol. 2019; 9(6):e506-e515. DOI: 10.1016/j.prro.2019.06.018. View

Amodeo S, Rosman A, Desiato V, Hindman N, Newman E, Berman R . MRI-Based Apparent Diffusion Coefficient for Predicting Pathologic Response of Rectal Cancer After Neoadjuvant Therapy: Systematic Review and Meta-Analysis. AJR Am J Roentgenol. 2018; 211(5):W205-W216. DOI: 10.2214/AJR.17.19135. View

Sauer R, Fietkau R, Wittekind C, Rodel C, Martus P, Hohenberger W . Adjuvant vs. neoadjuvant radiochemotherapy for locally advanced rectal cancer: the German trial CAO/ARO/AIO-94. Colorectal Dis. 2003; 5(5):406-15. DOI: 10.1046/j.1463-1318.2003.00509.x. View

Peng H, Wang C, Xiao W, Lin X, You K, Dong J . Analysis of Clinical characteristics to predict pathologic complete response for patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy. J Cancer. 2018; 9(15):2687-2692. PMC: 6072814. DOI: 10.7150/jca.25493. View

Maas M, Nelemans P, Valentini V, Das P, Rodel C, Kuo L . Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol. 2010; 11(9):835-44. DOI: 10.1016/S1470-2045(10)70172-8. View

Alongi F, Fersino S, Mazzola R, Fiorentino A, Giaj-Levra N, Ricchetti F . Radiation dose intensification in pre-operative chemo-radiotherapy for locally advanced rectal cancer. Clin Transl Oncol. 2016; 19(2):189-196. DOI: 10.1007/s12094-016-1522-0. View

Lupattelli M, Matrone F, Gambacorta M, Osti M, Macchia G, Palazzari E . Preoperative intensity-modulated radiotherapy with a simultaneous integrated boost combined with Capecitabine in locally advanced rectal cancer: short-term results of a multicentric study. Radiat Oncol. 2017; 12(1):139. PMC: 5568311. DOI: 10.1186/s13014-017-0870-4. View

10.

Maas M, Beets-Tan R, Lambregts D, Lammering G, Nelemans P, Engelen S . Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol. 2011; 29(35):4633-40. DOI: 10.1200/JCO.2011.37.7176. View

11.

Hupkens B, Martens M, Stoot J, Berbee M, Melenhorst J, Beets-Tan R . Quality of Life in Rectal Cancer Patients After Chemoradiation: Watch-and-Wait Policy Versus Standard Resection - A Matched-Controlled Study. Dis Colon Rectum. 2017; 60(10):1032-1040. DOI: 10.1097/DCR.0000000000000862. View

12.

Nougaret S, Rouanet P, Molinari N, Pierredon M, Bibeau F, Azria D . MR volumetric measurement of low rectal cancer helps predict tumor response and outcome after combined chemotherapy and radiation therapy. Radiology. 2012; 263(2):409-18. DOI: 10.1148/radiol.12111263. View

13.

Riisgaard de Blanck S, Rydhog J, Larsen K, Clementsen P, Josipovic M, Aznar M . Long term safety and visibility of a novel liquid fiducial marker for use in image guided radiotherapy of non-small cell lung cancer. Clin Transl Radiat Oncol. 2018; 13:24-28. PMC: 6154396. DOI: 10.1016/j.ctro.2018.07.004. View

14.

Suzuki T, Sadahiro S, Tanaka A, Okada K, Saito G, Kamijo A . Relationship between histologic response and the degree of tumor shrinkage after chemoradiotherapy in patients with locally advanced rectal cancer. J Surg Oncol. 2013; 109(7):659-64. DOI: 10.1002/jso.23550. View

15.

Rydhog J, Mortensen S, Larsen K, Clementsen P, Jolck R, Josipovic M . Liquid fiducial marker performance during radiotherapy of locally advanced non small cell lung cancer. Radiother Oncol. 2016; 121(1):64-69. DOI: 10.1016/j.radonc.2016.06.012. View

16.

van den Ende R, Rigter L, Kerkhof E, van Persijn van Meerten E, Rijkmans E, Lambregts D . MRI visibility of gold fiducial markers for image-guided radiotherapy of rectal cancer. Radiother Oncol. 2019; 132:93-99. DOI: 10.1016/j.radonc.2018.11.016. View

17.

Kang J, Kim Y, Kim H, Kim Y, Hur H, Kim J . Tumor volume changes assessed by three-dimensional magnetic resonance volumetry in rectal cancer patients after preoperative chemoradiation: the impact of the volume reduction ratio on the prediction of pathologic complete response. Int J Radiat Oncol Biol Phys. 2009; 76(4):1018-25. DOI: 10.1016/j.ijrobp.2009.03.066. View

18.

Lambregts D, Rao S, Sassen S, Martens M, Heijnen L, Buijsen J . MRI and Diffusion-weighted MRI Volumetry for Identification of Complete Tumor Responders After Preoperative Chemoradiotherapy in Patients With Rectal Cancer: A Bi-institutional Validation Study. Ann Surg. 2014; 262(6):1034-9. DOI: 10.1097/SLA.0000000000000909. View

19.

Yeo S, Kim D, Park J, Oh J, Kim S, Chang H . Tumor volume reduction rate after preoperative chemoradiotherapy as a prognostic factor in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2011; 82(2):e193-9. DOI: 10.1016/j.ijrobp.2011.03.022. View

20.

Clerc-Renaud B, Boss M, Griffin L, LaRue S, Leary D . Potential for BioXmark liquid fiducial marker to improve identification of superficial component of canine oral tumors for computer-based radiation therapy planning. Can Vet J. 2019; 60(10):1072-1080. PMC: 6741831. View