Are pancreatic fiducials necessary when delivering dose escalated radiation therapy for inoperable pancreatic cancer and using cone beam CT for IGRT?   

Some form of precise respiratory motion management is necessary to cover the GTV optimally. Deep inspiration breath hold or end expiratory gating are preferred. Both require a metallic fiducial for set up. We do not recommend trying to set up to soft tissue. We often use the metallic endobiliary ste...