CT fluoroscopy-guided percutaneous fiducial marker placement for cyberknife stereotactic radiosurgery: Technical results and complications in 222 consecutive procedures

Christoph G. Trumm, Sophia M. Häußler, Alexander Muacevic, Robert Stahl, Sebastian Stintzing, Philipp M. Paprottka, Frederik Strobl, Tobias F. Jakobs, Maximilian F. Reiser, Ralf Thorsten Hoffmann

Research output: Contribution to journalArticlepeer-review

52 Scopus citations

Abstract

Purpose To evaluate technical outcome and safety of computed tomographic (CT) fluoroscopy-guided percutaneous fiducial marker placement before CyberKnife stereotactic radiosurgery. Materials and Methods Retrospective analysis was performed of 196 patients (106 men) undergoing CT fluoroscopy-guided fiducial marker placement in 222 consecutive procedures under local anesthesia from March 2006 to February 2012. Technical success was defined as fiducial marker location in the tumor or vicinity suitable for CyberKnife radiosurgery evaluated on postinterventional planning CT. Complications were classified per Society of Interventional Radiology (SIR). Results One hundred ninety-six patients (age, 61.5 y ± 13.1) underwent percutaneous placement of 321 fiducial markers (mean per tumor, 1.2 ± 0.5; range, 1-4) in 37 primary tumors and 227 metastases in the thorax (n = 121), abdomen (n = 122), and bone (n = 21). Fiducial marker placement was technically successful in all procedures: intratumoral localization in 193 (60.1%), at tumor margin in 50 (15.6%), and outside of tumor in 78 cases (24.3%; mean distance to marker, 0.4 cm ± 0.6; range, 0-2.9 cm). Complications were observed in 63 placement procedures (28.4%), including minor self-limiting pneumothorax (n = 21; SIR class B) and self-limiting pulmonary hemorrhage (n = 35; SIR class A), and major pneumothorax requiring thoracostomy/drainage insertion (n = 14; SIR class D) and systemic toxicity of local anesthetic drug (n = 1; SIR class D). Conclusions CT fluoroscopy-guided percutaneous fiducial marker placement can be performed with high technical success under local anesthesia in various anatomic regions. Although self-limiting in most cases, pneumothorax and pulmonary hemorrhage are frequently observed during fiducial marker implantation into lung tumors.

Original languageEnglish
Pages (from-to)760-768
Number of pages9
JournalJournal of Vascular and Interventional Radiology
Volume25
Issue number5
DOIs
StatePublished - May 2014
Externally publishedYes

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