Endobronchial coil spring fiducial markers for CyberKnife® stereotactic body radiation therapy. Issue 5 (5th January 2021)

• Record Type: Journal Article
• Authors: Casutt, Alessio; Noirez, Leslie; Bernasconi, Maurizio; Koutsokera, Angela; Beigelman‐Aubry, Catherine; Kinj, Rémy; Ozsahin, Esat‐Mahmut; Durham, André‐Dante; von Garnier, Christophe; Lovis, Alban
• Is Part Of: Respirology. Volume 26:Issue 5(2021)
• Page Start: 469
• Page End: 476
• Publication Date: 2021-01-05
• Subjects: airway markers -- bronchoscopy and interventional techniques -- lung cancer -- metallic fiducial marker -- stereotactic body radiation therapy; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 612.2
• DOI: 10.1111/resp.14006
• Languages: English
• ISSNs: 1323-7799

Abstract

Abstract : We assessed for the first time the safety and efficacy of bronchoscopically inserted cs‐FM for CyberKnife® SBRT delivery. We show that this technique is safe and resulted in a very high PPL tracking rate enabling optimal SBRT delivery. See Cover Image See related Editorial ABSTRACT: Background and objective: SBRT is an alternative treatment for early‐stage inoperable lung cancer. Metallic FM allow to increase tumour tracking precision by CyberKnife®. Currently used techniques for FM placement have many limitations; transthoracic insertion has a high risk for pneumothorax, endovascular insertion requires expertise and dedicated angiography infrastructure and endobronchial linear‐gold FM dislocate frequently. This is the first study to assess the safety and efficacy of cs‐FM endobronchial insertion under fluoroscopy with or without R‐EBUS assessment. Methods: We retrospectively evaluated all consecutive patients undergoing endobronchial cs‐FM placement for at least one PPL <25 mm between 10.2015 and 12.2019. TBB of the PPL were performed in case of a typical R‐EBUS signal. PPL tracking accuracy by CyberKnife, complications, cs‐FM migration rate and procedure duration were analysed. Results: A total of 52 patients were treated during 55 procedures and 207 cs‐FM were placed in 70 PPL. Tracking was successful for 65 of 70 (93%) PPL. R‐EBUS was performed for 33 (47%) PPL and TBB for 9 (13%) PPL. Bronchospasm occurred once and any other complications were observed. Migration of cs‐FM occurred in 16 of 207 (8%) cs‐FM. Migration was more frequent when the target was in a previously irradiated area ( P = 0.022). The median bronchoscopy duration was 31.5 min ( n = 48 procedures). Conclusion: Bronchoscopic cs‐FM placement is a rapid and safe procedure. It is associated with a low migration rate and allows precise SBRT delivery. Previous irradiation of the PPL was associated with a higher migration rate.