CT-guided implantation of intrahepatic fiducial markers for proton beam therapy of liver lesions: assessment of success rate and complications.

OBJECTIVE. The purpose of this study is to evaluate the safety and complications of CT-guided implantation of intrahepatic fiducial markers for proton beam therapy. MATERIALS AND METHODS. In this retrospective study, we reviewed 69 patients who underwent 149 percutaneous fiducial marker implantations for primary and metastatic hepatic tumors from April 2007 through July 2013. The implantations enabling satisfactory treatment planning and CT simulation were considered as technically successful. Major and minor procedure-related complications during and after fiducial marker implantation were documented. RESULTS. The success rate of fiducial marker implantation was 99.3% (148/149). In one patient, a fiducial marker migrated into the vascular system, which was realized during the procedure and required reimplantation. None of the patients was required to return for additional implantations. The major and minor complication rates were 0% and 2.9% (2/69), respectively. Both minor complications included small pneumothorax not requiring hospital admission. CONCLUSION. CT-guided placement of gold fiducial markers is associated with a high technical success rate with few complications, which is an essential step in the overall treatment planning and performance of proton beam therapy for the management of hepatic tumors.