Login to Access Video or Poster Abstract: MP05-18
Sources of Funding: None

Introduction

Fiducial marker placement is required in patients undergoing robotic-based Stereotactic Body Radiotherapy (SBRT) for prostate cancer in order to track the six degrees of prostate motion that occur intrafractionally, during treatment. Many patients take anti-coagulant medication due to other comorbidities. Anticoagulation therapy can cause patients to bleed during procedures and, in general practice, are often temporarily discontinued prior to invasive medical procedures to reduce that risk. Some patients may not be able to temporarily discontinue anticoagulation therapy due to an increased risk of a thromboembolic event from their comorbid medical conditions_x000D_ _x000D_ _x000D_

Methods

From August 2015-October 2016 23 consecutive patients on chronic anticoagulation therapy who were not cleared to stop these medications underwent TRUS-guided fiducial marker placement for SBRT/Image Guided Radiation Therapy. The reasons for patients being on anticoagulation therapy were recent stent placement (11,) myocardial infarction (7,)atrial fibrillation (3,) and pulmonary embolus (2.)The anticoagulation consisted of Plavix (9,)Aspirin (7,)Coumadin (3,)Lovenox (2,)Eliquis (1,)Brillinta (1,)Pradaxa (1,)and Effient (1,) All patients received 4 fiducial markers placed under Transrectal ultrasound guidance (TRUS.) EMLA Cream and lidocaine gel were used to numb the perineum and rectum. 2 needles each double loaded with 2 gold fiducial markers with a spacer in between were placed transperineally into the prostate. 2 fiducial markers were placed at the right and left base and 2 fiducial markers were placed at the right and left apex. Patients had a CT scan after procedure to confirm ideal geometry of the marker placement. The needles were withdrawn as was the ultrasound transducer. Gentle pressure was applied by the nursing staff. All patients were monitored for bleeding afterwards by a registered nurse_x000D_ _x000D_ _x000D_

Results

All 23 patients who were on anticoagulation and underwent fiducial marker placement were discharged home the same day of the procedure. No patient experienced significant bleeding in the peri-procedural window and no patient had any untoward cardiovascular event._x000D_

Conclusions

This series suggests active anticoagulation is not an absolute contraindication to fiducial marker placement _x000D_ in patients undergoing SBRT or IGRT for prostate cancer._x000D_ Transperineal fiducial marker placement appears to be safe in patients on active anticoagulation medication. These patients should be closely monitored after the procedure for bleeding complications._x000D_

Funding

None