Intravascular Placement of Metallic Coils as Lung Tumor Markers for CyberKnife Stereotactic Radiation Therapy

다국어 초록 (Multilingual Abstract)

To present our experience with placing endovascular coils in pulmonary arteries used as a fiducial marker for CyberKnife therapy and to describe the technical details and complications of the procedure.
Between June 2005 and September 2013, 163 patients with primary or secondary lung malignancies, referred for fiducial placement for stereotactic radiosurgery, were retrospectively reviewed. Fourteen patients (9 men, 5 women; mean age, 70 years) with a history of pneumonectomy (n = 3), lobectomy (n = 3) or with severe cardiopulmonary co-morbidity (n = 8) underwent coil (fiducial marker) placement. Pushable or detachable platinum micro coils (n = 49) 2–3 mm in size were inserted through coaxial microcatheters into a small distal pulmonary artery in the vicinity of the tumor under biplane angiography/fluoroscopy guidance.
Forty nine coils with a median number of 3 coils per tumor were placed with a mean tumor-coil distance of 2.7 cm. Forty three (87.7%) of 49 coils were successfully used as fiducial markers. Two coils could not be used due to a larger tumor-coil distance (> 50 mm). Four coils were in an acceptable position but their non-coiling shape precluded tumor tracking for CyberKnife treatment. No major complications needing further medication other than nominal therapy, hospitalization more than one night or permanent adverse sequale were observed.
Endovascular placement of coil as a fiducial marker is safe and feasible during CyberKnife therapy, and might be an option for the patients in which percutaneous transthoracic fiducial placement might be risky.

참고문헌 (Reference)

1 Adler JR Jr, "The Cyberknife: a frameless robotic system for radiosurgery" 69 (69): 124-128, 1997

2 Wulf J, "Stereotactic radiotherapy for primary lung cancer and pulmonary metastases : a noninvasive treatment approach in medically inoperable patients" 60 : 186-196, 2004

3 Whyte RI, "Stereotactic radiosurgery for lung tumors: preliminary report of a phase I trial" 75 : 1097-1101, 2003

4 Timmerman RD, "Stereotactic body radiation therapy in multiple organ sites" 25 : 947-952, 2007

5 Ginsberg RJ, "Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group" 60 : 615-622, 1995

6 Imura M, "Insertion and fixation of fiducial markers for setup and tracking of lung tumors in radiotherapy" 63 : 1442-1447, 2005

7 Hong JC, "High retention and safety of percutaneously implanted endovascular embolization coils as fiducial markers for image-guided stereotactic ablative radiotherapy of pulmonary tumors" 81 : 85-90, 2011

8 Uematsu M, "Focal, high dose, and fractionated modified stereotactic radiation therapy for lung carcinoma patients: a preliminary experience" 82 : 1062-1070, 1998

9 Shirato H, "Feasibility of insertion/implantation of 2.0-mmdiameter gold internal fiducial markers for precise setup and real-time tumor tracking in radiotherapy" 56 : 240-247, 2003

10 Prévost JB, "Endovascular coils as lung tumour markers in real-time tumour tracking stereotactic radiotherapy : preliminary results" 18 : 1569-1576, 2008

11 Mager JJ, "Embolotherapy of pulmonary arteriovenous malformations : long-term results in 112 patients" 15 : 451-456, 2004

12 Pump KK, "Distribution of bronchial arteries in the human lung" 62 : 447-451, 1972

13 Bhagat N, "Complications associated with the percutaneous insertion of fiducial markers in the thorax" 33 : 1186-1191, 2010

14 Schroeder C, "Coil spring fiducial markers placed safely using navigation bronchoscopy in inoperable patients allows accurate delivery of CyberKnife stereotactic radiosurgery" 140 : 1137-1142, 2010

15 Chang SD, "Clinical experience with image-guided robotic radiosurgery(the Cyberknife)in the treatment of brain and spinal cord tumors" 38 : 780-783, 1998