Deirdre E. Moran MBBCh, Presenter: Nothing to Disclose

Robert G. Sheiman MD, Abstract Co-Author: Nothing to Disclose

Olga Rachel Brook MD, Abstract Co-Author: Research Grant, Guerbet SA

Maryellen Ruth Morris Sun MD, Abstract Co-Author: Investigator, Bracco Group Investigator, Glaxo SmithKline plc

Anand Mahadevan MD, Abstract Co-Author: Nothing to Disclose

Bettina Siewert MD, Abstract Co-Author: Nothing to Disclose

To evaluate the technical success and safety of transbronchial (bronchoscopic) versus percutaneous (CT-guided) fiducial placement for CyberKnife radiotherapy of lung tumors.

From September 2005 to January 2013, we retrospectively reviewed 272 fiducial marker placements in 248 patients with lung tumors who subsequently underwent CyberKnife radiation therapy. The study was IRB-approved, HIPAA-compliant and was performed at a single tertiary institution. Procedure-related complications were documented. Technical success was defined as implantation enabling adequate treatment planning with computed tomographic simulation. Fisher exact probability test was used to compare proportions of complications and repeat procedures between two groups.

221/272 (81.2%) fiducial markers were placed percutaneously and 51/272 (18.8%) were placed using a transbronchial technique. 15/51 (29%) fiducial placements with transbronchial approach were unsuccessful, as discovered at radiotherapy planning session, and required a repeat procedure. 9/15 of repeat procedures were performed percutaneously, 5/15 were placed during repeat bronchoscopy, and 1/15 was placed at transesophageal endoscopic ultrasound. No repeat fiducial placements were required for patients who had the fiducials placed using a percutaneous technique (p<0.001), with a technical success rate of 100%. Pneumothorax was seen in 73/221 (33%) of percutaneously placed fiducials and in 4/51 (7.8%) in the transbronchial placements (p<0.001). Nevertheless, no significant difference was seen in the rate of thoracostomy tubes placements: 18/221 (8.1%) of percutaneously placed fiducials and 2/51 (3.9%) of transbronchially placed fiducials (p=0.39).

Transbronchial fiducial marker placement has a significantly higher rate of failed placements requiring repeat procedures in comparison to percutaneous placement, while the rate of pneumothorax requiring thoracostomy placement is similar between the two approaches.

Fiducial placements for lung tumors should be preferentially performed using a percutaneous approach, as it has a higher technical success rate with a similar clinically significant complication rate as compared to transbronchial fiducial placement.

Moran, D, Sheiman, R, Brook, O, Sun, M, Mahadevan, A, Siewert, B, Technical Success and Safety of Transbronchial versus Percutaneous Fiducial Placement for CyberKnife Radiotherapy of Lung Tumors.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004608.html