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Stereotactic Radiation Therapy With Fiducial Markers – A Safety Study

February 7, 2009
Written by: , Filed in: Nuclear Medicine
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Background
Stereotactic radiation therapy (aka the CyberKnife) involves treatment of tumors in the body with high doses of local radiation, while limiting the dose of radiation to the rest of the body using multiple angles to aim the beam of radiation.

In extracranial and extraspinal regions, the ability to accurately aim at tumors is complicated by normal respiratory movement. To counter this, advances in tumor tracking have been made.

Fiducial markers made of gold that are implanted in the vicinity of the tumor act as an internal radiologic landmark and help the machine track the tumor throughout the respiratory cycle.

The objective of a recent study was to determine the success and safely rates of the percutaneous placement of fiducial markers in the authors’ institution.

Placement of fiducial markers for stereotactic radiation is safe, with complication rates well within the range of what has been reported for percutaneous biopsy.

Design
Retrospective study.

Methodology
Over five years, 132 patients underwent 139 procedures to place markers in unresectable tumors. Lung markers were placed in 44 cases, pancreatic markers in 66 cases, and liver markers were 34. Mean diameter of tumors was 3.4 cm.

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Results
Approximately three to seven fiducial markers were implanted for each tumor. There were no deaths. There were seven major complications (for a rate of 5%) and a minor complication rate of 17%. There was migration of fiducial markers in 4.3% of cases. The technical success rate was 95.7%.

Lung Implantation – All major complications were pneumothoraces, necessitating the need for chest tube placement. This led to a major complication rate of 16% in lungs.

Pancreatic Implantation – There was a minor complication rate of 3.3%. There was a migration rate of 3%.

Liver Implantation – There was no fiducial marker migration. There was a 2.9% minor complication rate.

Reviewer’s Comments
Stereotactic radiation has been used for >50 years, mainly in the areas of the body that can be immobilized successfully, such as the brain and spine. Newer systems combine tracking and robotics to deliver precise therapy without immobilization. Placement of fiducial markers is key to this new technology, but not much was known as to its complications.

This study showed an overall major complication rate of 5%, which was acceptable. These were pneumothoraces that needed to be treated, which at 16% was higher than the 10% threshold seen in the literature, mainly because of a high incidence of chronic obstructive pulmonary disease.

Overall technical success was 96%. Migration occurred usually in the lungs, and studies must be done to see if other objects such as coils may migrate less.

In conclusion, according to this study, placement of fiducial markers for stereotactic radiation is safe, with complication rates well within the range of what has been reported for percutaneous biopsy.

Author: Sharon Gonzales, MD

Reference:
Kothary N, Heit JJ, et al. Safety and Efficacy of Percutaneous Fiducial Marker Implantation for Image-Guided Radiation Therapy. J Vasc Interv Radiol; 2009;20 (February): 235-239.

CME Courses Available:

 

PET/CT and SPECT/CT To Plan and Monitor the Treatment of Cancer The precise tailoring of treatment for patients with cancer is an unmet challenge. The goal is to only administer treatments that have a high probability of being effective. Imaging with PET/CT and SPECT/CT provides methods that will help achieve this goal. The program covers the current clinical challenges, the new emerging answers from imaging, and how these methods can be applied to patient care. Read more: Nuclear Medicine: PET/CT and SPECT/CT

 

-- Diagnostic Imaging Review: For Residents, Fellows and Radiologists UCSF’s Department of Radiology and Biomedical Imaging recently conducted its annual radiology review course. It will soon be available in two video formats to meet your needs— DVD and MP4. Order now to get your special pre-publication discount. Read more or order: Diagnostic Imaging Review
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