CT-guided fiducial marker placement for Stereotactic Ablative Radiotherapy in Lung malignancy: safety and efficacy from a single center experience

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Abstract Summary
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Authors (including presenting author) :
Chu CM(1), Poon DMC(2), Yu SCH(1)
Affiliation :
(1) Department of Imaging and Interventional Radiology, Prince of Wales Hospital,(2) Department of Clinical Oncology, Prince of Wales Hospital
Introduction :
Usage of fiducial markers to guide accurate lung tumor localization during Stereotactic Ablative Radiotherapy (SABR) is in upward trend. We aim to evaluate efficacy and safety of CT-guided percutaneous lung tumor fiducial marker placement at our institution.
Objectives :
This was assessment of efficacy and safety involving total 26 patients with lung malignancy underwent CT-guided percutaneous lung tumor fiducial marker placement (2009-2014).
Methodology :
Gold markers (IZI Medical) were placed inside or at the periphery of the lesion. Primary endpoint was satisfactory marker positioning. Post-procedure CT was available to confirm markers and detect subsequent complications.
Result & Outcome :
RESULTS: There were 18 males and 8 females patients with mean age 71.4 years (range 42-86). One patient had two separate sessions of fiducial markers placement for two different lung lesions. All procedures performed under local anesthesia. No malposition of markers detected in immediate post procedural CT. All interventions met primary endpoint of satisfactory marker positioning. Technical success rate (defined as successful fiducial marker placement) was 27/27 (100%). 25 patients received subsequent SABR. One patient had two SABR for two different lesions. One patient was excluded from subsequent SABR as reduction in size of tumor in planning CT. Clinical success rate (defined as completion of SABR) was 26/27 (96.3%). No patients required additional fiducial markers localization during the period of SABR. 26 cases consisted of 10 adenocarcinoma (38.5%), 10 squamous cell carcinoma (38.5%), 1 poorly differentiated NSCLC (3.8%), 3 lung metastases from primary colonic tumor (11.5%), 1 nasopharyngeal carcinoma (3.8%) and 1 sacral chordoma (3.8%). Mean lung tumor size was 2.62cm (range 0.9-7.8). The target tumor site in RUL/RML/RLL/LUL/LLL was 14/1/5/3/4 respectively. Average markers inserted was 1.78 (range 1-3). No pneumothorax (12) or trace pneumothorax (9) were in total 21 cases that were not required chest tube (77.8%), small to moderate pneumothorax required chest tube in 6 cases (22.2%) The average hospital stay was 1.7days (range 1-4). COMMENTS: CT guided lung fiducial marker placement is safe and effective procedure which can facilitate accurate lung localization for SABR in treatment of lung cancer.

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