Endoscopic ultrasound-guided placement of fiducial markers for stereotactic body radiation therapy of pancreatic metastases from renal cell carcinoma.

Isolated pancreatic metastases from renal cell carcinoma (RCC) have traditionally been treated with surgery or systemic therapy [1]. More recently, focal therapies such as endoscopic ultrasound (EUS)-guided radiofrequency ablation or stereotactic body radiation therapy (SBRT) have been reported in selected patients [2] [3] [4]. SBRT uses precision technology to accurately deliver high doses of radiation in a few treatment fractions to the tumor volume, while sparing the surrounding healthy tissues. Many SBRT protocols require the placement of fiducial markers in or near the tumor to facilitate accurate targeting [4] [5]. Here we report EUS-guided fiducial placement for SBRT of pancreatic metastases in a 75-year-old woman with a history of left nephrectomy for RCC 20 years previously and a recent finding of two hypervascular pancreatic tumors on computed tomography (CT) scanning.