BioXmark® liquid fiducials to enable radiotherapy tumor boosting in rectal cancer, a feasibility trial

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 Berbée

doi:10.1016/j.ctro.2022.10.013

BioXmark® liquid fiducials to enable radiotherapy tumor boosting in rectal cancer, a feasibility trial

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 Berbée^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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 (EPI). 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.

Original language	English
Pages (from-to)	90-95
Number of pages	6
Journal	Clinical and Translational Radiation Oncology
Volume	38
Issue number	1
DOIs	https://doi.org/10.1016/j.ctro.2022.10.013
Publication status	Published - Jan 2023

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10.1016/j.ctro.2022.10.013Licence: CC BY

Cite this

Opbroek, T. J. S., Willems, Y. C. P., Verhaegen, F., de Ridder, R., Hoge, C., Melenhorst, J., Bakers, F., Grabsch, H. I., Buijsen, J., Van Limbergen, E. J., Canters, R. A. M., & Berbée, M. (2023). BioXmark® liquid fiducials to enable radiotherapy tumor boosting in rectal cancer, a feasibility trial. Clinical and Translational Radiation Oncology, 38(1), 90-95. https://doi.org/10.1016/j.ctro.2022.10.013

@article{7b09651928f34fecb02bb984e7a89b72,

title = "BioXmark{\textregistered} liquid fiducials to enable radiotherapy tumor boosting in rectal cancer, a feasibility trial",

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{\textregistered}) 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 (EPI). 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.",

author = "Opbroek, {Thirza J S} and Willems, {Yves C P} and Frank Verhaegen and {de Ridder}, Rogier and Chantal Hoge and Jarno Melenhorst and Frans Bakers and Grabsch, {Heike I} and Jeroen Buijsen and {Van Limbergen}, {Evert J} and Canters, {Richard A M} and Maaike Berb{\'e}e",

note = "{\textcopyright} 2022 MAASTRO.",

year = "2023",

month = jan,

doi = "10.1016/j.ctro.2022.10.013",

language = "English",

volume = "38",

pages = "90--95",

journal = "Clinical and Translational Radiation Oncology",

issn = "2405-6308",

publisher = "Elsevier Ireland Ltd",

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Opbroek, TJS, Willems, YCP, Verhaegen, F , de Ridder, R , Hoge, C , Melenhorst, J , Bakers, F , Grabsch, HI , Buijsen, J , Van Limbergen, EJ, Canters, RAM & Berbée, M 2023, 'BioXmark® liquid fiducials to enable radiotherapy tumor boosting in rectal cancer, a feasibility trial', Clinical and Translational Radiation Oncology, vol. 38, no. 1, pp. 90-95. https://doi.org/10.1016/j.ctro.2022.10.013

TY - JOUR

T1 - BioXmark® liquid fiducials to enable radiotherapy tumor boosting in rectal cancer, a feasibility trial

AU - Opbroek, Thirza J S

AU - Willems, Yves C P

AU - Verhaegen, Frank

AU - de Ridder, Rogier

AU - Hoge, Chantal

AU - Melenhorst, Jarno

AU - Bakers, Frans

AU - Grabsch, Heike I

AU - Buijsen, Jeroen

AU - Van Limbergen, Evert J

AU - Canters, Richard A M

AU - Berbée, Maaike

PY - 2023/1

Y1 - 2023/1

N2 - 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 (EPI). 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.

AB - 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 (EPI). 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.

U2 - 10.1016/j.ctro.2022.10.013

DO - 10.1016/j.ctro.2022.10.013

M3 - Article

C2 - 36407490

SN - 2405-6308

VL - 38

SP - 90

EP - 95

JO - Clinical and Translational Radiation Oncology

JF - Clinical and Translational Radiation Oncology

IS - 1

ER -