TY - JOUR
T1 - Electromagnetic navigational bronchoscopy-guided fiducial markers for lung stereotactic body radiation therapy
T2 - Analysis of safety, feasibility, and interfraction stability
AU - Nabavizadeh, Nima
AU - Zhang, Junan
AU - Elliott, David A.
AU - Tanyi, James A.
AU - Thomas, Charles R.
AU - Fuss, Martin
AU - Deffebach, Mark
PY - 2014/4
Y1 - 2014/4
N2 - Background: Embolization coils as fiducial markers for pulmonary stereotactic body radiation therapy (SBRT) are perceived to be the optimal marker type, given their ability to conform and anchor within the small airways. The aim of our study was to assess retention, placement, migration, feasibility, and safety of electromagnetic navigational bronchoscopy (ENB)-guided embolization coil markers throughout courses of SBRT. Methods: Thirty-one patients with 34 nodules underwent ENB-guided fiducial placement of several 4mm fibered platinum embolization coils before SBRT. Patient and nodule positioning was confirmed with daily pretreatment cone-beam computed tomography (CBCT). Fiducial positional characteristics were analyzed utilizing radiation treatment-planning software comparing the simulation CT with daily CBCTs. Results: Of 105 fiducials placed, 103 were identifiable on simulation CT (retention rate: 98.1%). Incidence of asymptomatic pneumothoraces was 6%. One patient experienced hemoptysis requiring hospitalization. Eighty-six percent of fiducials were placed within 1 cm of the nodule, with 52% of fiducials placed directly on the nodule surface. Throughout a 5-fraction SBRT course, fiducial displacement was <7, 5, and 2mm in 98%, 96%, and 67% of pretreatment CBCTs. Conclusions: ENB placement of embolization coils as fiducials for lung SBRT image guidance is associated with a low rate of iatrogenic pneumothoraces, and resulted in reliable placement of the fiducials in close proximity to the lung nodule. Embolization coils retained their relative position to the nodule throughout the course of SBRT, and provide an excellent alternative to linear gold seeds.
AB - Background: Embolization coils as fiducial markers for pulmonary stereotactic body radiation therapy (SBRT) are perceived to be the optimal marker type, given their ability to conform and anchor within the small airways. The aim of our study was to assess retention, placement, migration, feasibility, and safety of electromagnetic navigational bronchoscopy (ENB)-guided embolization coil markers throughout courses of SBRT. Methods: Thirty-one patients with 34 nodules underwent ENB-guided fiducial placement of several 4mm fibered platinum embolization coils before SBRT. Patient and nodule positioning was confirmed with daily pretreatment cone-beam computed tomography (CBCT). Fiducial positional characteristics were analyzed utilizing radiation treatment-planning software comparing the simulation CT with daily CBCTs. Results: Of 105 fiducials placed, 103 were identifiable on simulation CT (retention rate: 98.1%). Incidence of asymptomatic pneumothoraces was 6%. One patient experienced hemoptysis requiring hospitalization. Eighty-six percent of fiducials were placed within 1 cm of the nodule, with 52% of fiducials placed directly on the nodule surface. Throughout a 5-fraction SBRT course, fiducial displacement was <7, 5, and 2mm in 98%, 96%, and 67% of pretreatment CBCTs. Conclusions: ENB placement of embolization coils as fiducials for lung SBRT image guidance is associated with a low rate of iatrogenic pneumothoraces, and resulted in reliable placement of the fiducials in close proximity to the lung nodule. Embolization coils retained their relative position to the nodule throughout the course of SBRT, and provide an excellent alternative to linear gold seeds.
KW - Fiducials
KW - Lung SBRT
KW - Navigational bronchoscopy
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U2 - 10.1097/LBR.0000000000000065
DO - 10.1097/LBR.0000000000000065
M3 - Article
C2 - 24739685
AN - SCOPUS:84905818038
SN - 1944-6586
VL - 21
SP - 123
EP - 130
JO - Journal of Bronchology and Interventional Pulmonology
JF - Journal of Bronchology and Interventional Pulmonology
IS - 2
ER -