 |
|
| The Novel Use of Coil Spring Fiducials Placed via Navigation Bronchoscopy in Inoperable Patients Allows for the Safe and Effective Delivery of Cyberknife Stereotactic Radiation |
|
Carsten Schroeder1, Rana Hejal2, Philip Linden1; 1Thoracic & Esophageal Surgery, Case Medical Center, Cleveland, OH; 2Pulmonary/Critical Care & Sleep Medicine, Case Medical Center, Cleveland, OH Objective: Stereotactic radiosurgery (Cyberknife) is a treatment option for patients who are medically unfit to undergo lung tumor resection. For precise tumor ablation, the Cyberknife requires fiducial marker placement in or near the target tumor. Fiducial placement under transthoracic CT guidance is associated with a high risk of iatrogenic pneumothorax. Electromagnetic navigation bronchoscopy (ENB) offers a less morbid alternative to accurately deploy fiducials to bronchoscopically invisible peripheral lung lesions. Prior studies, in which linear markers were used, showed at least a 10% dislocation rate and required general anesthesia for placement. We propose the use of coil-spring fiducials placed under moderate sedation in an outpatient bronchoscopy suite setting to decrease these complications. Methods: 27 Consecutive non-surgical patients with isolated lung tumors underwent fiducial placement using ENB under moderate sedation in an outpatient bronchoscopy suite. Four patients received 17 linear fiducials and 23 patients with 28 tumors received 104 coil-spring fiducials. The procedures were considered successful if fiducials were placed in or near the tumors and remained in place without migration allowing radiosurgery to proceed. The need for alternative or additional intrathoracic fiducial placement was documented as procedure failure. Results: A total of 121 fiducials markers were successfully deployed in 27 patients with 32 tumor locations (mean diameter 21.6mm). 17 tumors (53%) were adjacent to the pleura. 13 patients (48%) underwent concomitant transbronchial biopsy. At Cyberknife planning a week after placement, 8 of 17 linear fiducial markers (47%) and 100 of 104 coil-spring fiducials (96%) were still in place. 2/4 patients with linear fiducials required additional CT guided fiducials; none of the coil fiducial patients required additional procedures. Two pneumothoraces (6%) occurred after transbronchial biopsy (one treated with a pig-tail chest tube and one with observation only). Conclusion: ENB can be used to deploy fiducial markers for Cyberknife radiosurgery of lung tumors safely and accurately with fewer complications than via CT guided placement. Transbronchial biopsies can be performed in the same setting. Coil-spring fiducials rarely dislocate and therefore reduce the re-procedure rate and/or Cyberknife tracking errors. The procedure can be performed safely in an outpatient bronchoscopy suite setting under moderate sedation. Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
We Model Excellence |
|
Copyright © 2012 American Association for Thoracic Surgery
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.