Target delineation
Intravesical markers for delineation of target volume during external focal irradiation of bladder carcinomas

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Abstract

A clip forceps was developed which can insert markers at the border of a bladder tumour through a rigid cystoscope. This technique proved to be simple and safe and is of help for delineation of the target volume during CT simulation for focal boost irradiation of bladder cancer.

Section snippets

Materials and methods

A clip forceps has been developed which can be inserted through a rigid cystoscope (Storz-KST-3533). The hollow inner part of the forceps offers the possibility of cystoscopic guidance during insertion of markers in the mucosa of the bladder (Fig. 1). The marker is made of titanium and has a length of 5 mm (Horizon™, Titanium clips, Ref. 001201). Between November 2004 and May 2005, 19 patients with a solitary bladder tumour gave informed consent for the study, which was conducted by the

Feasibility

In 17 out of 19 patients, 54 markers could be placed adequately at the macroscopic borders of the tumour. In the remaining two cases insertion of the markers failed due to insufficient bladder capacity for adequate cystoscopy, resulting in pain when the bladder was expanded. The insertion of the clips in itself was simple, safe and quick. Including the 10 min of lidocaı¨ne installation, the whole procedure took about 15 min. Most sites of the tumour could be implanted easily with markers, except

Discussion

The current report describes a method to mark the borders of a bladder tumour with intravesical markers under endoscopic control. The procedure turned out to be both simple and safe and provided extra information for delineation of the target volume for the majority of patients. Adequate tumour delineation is a prerequisite for focal bladder tumour irradiation. Furthermore it provided tools for positional verification during radiation treatment.

Cystoscopy, and thus cystoscopical marking of the

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