Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan-Feb;47(1):93-99.
doi: 10.1590/S1677-5538.IBJU.2019.0713.

Endoclips as novel fiducial markers in trimodality bladder-preserving therapy of muscle-invasive bladder carcinoma: feasibility and patient outcomes

Muhammad Shahbaz  1   2   3 , Asif Ammar  4 , Yuliang Wang  3   5 , Zeeshan Farhaj  6 , Liang Qiao  3 , Jun Niu  1   2
Affiliations

Endoclips as novel fiducial markers in trimodality bladder-preserving therapy of muscle-invasive bladder carcinoma: feasibility and patient outcomes

Muhammad Shahbaz et al. Int Braz J Urol. 2021 Jan-Feb.

Abstract

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: Carcinoma; Treatment Outcome; Urinary Bladder Neoplasms.

PubMed Disclaimer

Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1. Endoclip Application and follow-up.
(A) Close-up view of a titanium endoclip used as a novel fiducial marker; (B) Endoclip application via a rigid cystoscope. The inset shows a magnified image of the location of the excised muscle-invasive bladder tumor, with an endoclip applied to tissue adjacent to the excised edge of the tumor. Another endoclip is being applied; (C) Cystoscopic view of the endoclip applied to the excised edge of the muscle-invasive bladder tumor; (D) The post-operative x-ray image of the kidney-ureter-bladder shows 3 clearly visible endoclip fiducial markers.
Figure 2
Figure 2. Precision radiotherapy planning and follow-up, Kaplan-Meier Curve.
(A-B) Computed tomographic images show the endoclip fiducial markers clearly while planning for precision radiotherapy of the target area; (C) Post-operative image of endoclips cystoscopically removed from a patient at one-year follow-up. A 5-milliliter syringe is seen alongside the markers; (D) Tumor recurrence-free survival of all patients. The time is shown in months; MIBC= Muscle-invasive bladder carcinoma
See this image and copyright information in PMC

Comment in

References

    1. Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder Cancer Incidence and Mortality: A Global Overview and Recent Trends. Eur Urol. 2017;71:96–108. - PubMed
    2. 1. Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder Cancer Incidence and Mortality: A Global Overview and Recent Trends. Eur Urol. 2017;71:96-108. - PubMed
    1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012. Estimated cancer incidence, mortality and prevalence worldwide in 2012
    2. 2. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012. Estimated cancer incidence, mortality and prevalence worldwide in 2012.
    1. Bladder cancer incidence statistics. Available from: http://www.cancerresearchuk.org/cancer-info/cancerstats/types/bladder/in...
    2. 3. Bladder cancer incidence statistics. Available from: http://www.cancerresearchuk.org/cancer-info/cancerstats/types/bladder/in....
    1. Greiman AK, Rosoff JS, Prasad SM. Association of Human Development Index with global bladder, kidney, prostate and testis cancer incidence and mortality. BJU Int. 2017;120:799–807. - PubMed
    2. 4. Greiman AK, Rosoff JS, Prasad SM. Association of Human Development Index with global bladder, kidney, prostate and testis cancer incidence and mortality. BJU Int. 2017;120:799-807. - PubMed
    1. Chang SS, Bochner BH, Chou R, Dreicer R, Kamat AM, Lerner SP, et al. Treatment of Nonmetastatic Muscle-Invasive Bladder Cancer: American Urological Association/American Society of Clinical Oncology/American Society for Radiation Oncology/Society of Urologic Oncology Clinical Practice Guideline Summary. J Oncol Pract. 2017;13:621–625. - PubMed
    2. 5. Chang SS, Bochner BH, Chou R, Dreicer R, Kamat AM, Lerner SP, et al. Treatment of Nonmetastatic Muscle-Invasive Bladder Cancer: American Urological Association/American Society of Clinical Oncology/American Society for Radiation Oncology/Society of Urologic Oncology Clinical Practice Guideline Summary. J Oncol Pract. 2017;13:621-625. - PubMed