Christoph G Trumm1, Sophia M Häussler2, Alexander Muacevic3, Robert Stahl2, Sebastian Stintzing4, Philipp M Paprottka2, Frederik Strobl2, Tobias F Jakobs5, Maximilian F Reiser2, Ralf-Thorsten Hoffmann6. 1. Department of Clinical Radiology, Ludwig-Maximilians-University, Munich. Electronic address: christoph.trumm@med.lmu.de. 2. Department of Clinical Radiology, Ludwig-Maximilians-University, Munich. 3. European CyberKnife Center Munich, Barmherzige Brüder Hospital Munich, Munich. 4. Norris Cancer Center, University of Southern California, Los Angeles, California. 5. Department of Radiology, Barmherzige Brüder Hospital Munich, Munich. 6. Department and Policlinics of Diagnostic Radiology, Carl Gustav Carus University Dresden, Dresden, Germany.
Abstract
PURPOSE: To evaluate technical outcome and safety of computed tomographic (CT) fluoroscopy-guided percutaneous fiducial marker placement before CyberKnife stereotactic radiosurgery. MATERIALS AND METHODS: Retrospective analysis was performed of 196 patients (106 men) undergoing CT fluoroscopy-guided fiducial marker placement in 222 consecutive procedures under local anesthesia from March 2006 to February 2012. Technical success was defined as fiducial marker location in the tumor or vicinity suitable for CyberKnife radiosurgery evaluated on postinterventional planning CT. Complications were classified per Society of Interventional Radiology (SIR). RESULTS: One hundred ninety-six patients (age, 61.5 y ± 13.1) underwent percutaneous placement of 321 fiducial markers (mean per tumor, 1.2 ± 0.5; range, 1-4) in 37 primary tumors and 227 metastases in the thorax (n = 121), abdomen (n = 122), and bone (n = 21). Fiducial marker placement was technically successful in all procedures: intratumoral localization in 193 (60.1%), at tumor margin in 50 (15.6%), and outside of tumor in 78 cases (24.3%; mean distance to marker, 0.4 cm ± 0.6; range, 0-2.9 cm). Complications were observed in 63 placement procedures (28.4%), including minor self-limiting pneumothorax (n = 21; SIR class B) and self-limiting pulmonary hemorrhage (n = 35; SIR class A), and major pneumothorax requiring thoracostomy/drainage insertion (n = 14; SIR class D) and systemic toxicity of local anesthetic drug (n = 1; SIR class D). CONCLUSIONS: CT fluoroscopy-guided percutaneous fiducial marker placement can be performed with high technical success under local anesthesia in various anatomic regions. Although self-limiting in most cases, pneumothorax and pulmonary hemorrhage are frequently observed during fiducial marker implantation into lung tumors.
PURPOSE: To evaluate technical outcome and safety of computed tomographic (CT) fluoroscopy-guided percutaneous fiducial marker placement before CyberKnife stereotactic radiosurgery. MATERIALS AND METHODS: Retrospective analysis was performed of 196 patients (106 men) undergoing CT fluoroscopy-guided fiducial marker placement in 222 consecutive procedures under local anesthesia from March 2006 to February 2012. Technical success was defined as fiducial marker location in the tumor or vicinity suitable for CyberKnife radiosurgery evaluated on postinterventional planning CT. Complications were classified per Society of Interventional Radiology (SIR). RESULTS: One hundred ninety-six patients (age, 61.5 y ± 13.1) underwent percutaneous placement of 321 fiducial markers (mean per tumor, 1.2 ± 0.5; range, 1-4) in 37 primary tumors and 227 metastases in the thorax (n = 121), abdomen (n = 122), and bone (n = 21). Fiducial marker placement was technically successful in all procedures: intratumoral localization in 193 (60.1%), at tumor margin in 50 (15.6%), and outside of tumor in 78 cases (24.3%; mean distance to marker, 0.4 cm ± 0.6; range, 0-2.9 cm). Complications were observed in 63 placement procedures (28.4%), including minor self-limiting pneumothorax (n = 21; SIR class B) and self-limiting pulmonary hemorrhage (n = 35; SIR class A), and major pneumothorax requiring thoracostomy/drainage insertion (n = 14; SIR class D) and systemic toxicity of local anesthetic drug (n = 1; SIR class D). CONCLUSIONS: CT fluoroscopy-guided percutaneous fiducial marker placement can be performed with high technical success under local anesthesia in various anatomic regions. Although self-limiting in most cases, pneumothorax and pulmonary hemorrhage are frequently observed during fiducial marker implantation into lung tumors.
Authors: Maksat Haytmyradov; Rakesh Patel; Hassan Mostafavi; Murat Surucu; Adam Wang; Matthew M Harkenrider; John C Roeske Journal: Phys Med Biol Date: 2019-01-21 Impact factor: 3.609
Authors: Paul J Keall; Doan Trang Nguyen; Ricky O'Brien; Pengpeng Zhang; Laura Happersett; Jenny Bertholet; Per R Poulsen Journal: Int J Radiat Oncol Biol Phys Date: 2018-04-14 Impact factor: 7.038
Authors: Marco Mueller; Per Poulsen; Rune Hansen; Wilko Verbakel; Ross Berbeco; Dianne Ferguson; Shinichiro Mori; Lei Ren; John C Roeske; Lei Wang; Pengpeng Zhang; Paul Keall Journal: Med Phys Date: 2021-12-29 Impact factor: 4.071
Authors: Sharath K Bhagavatula; Kunj Upadhyaya; Brendyn J Miller; Patrick Bursch; Alex Lammers; Michael J Cima; Stuart G Silverman; Oliver Jonas Journal: Med Phys Date: 2019-09-26 Impact factor: 4.071
Authors: Pengpeng Zhang; Margie Hunt; Arina B Telles; Hai Pham; Michael Lovelock; Ellen Yorke; Guang Li; Laura Happersett; Andreas Rimner; Gig Mageras Journal: Med Phys Date: 2018-11-13 Impact factor: 4.071