Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Intravascular Placement of Metallic Coils as Lung Tumor Markers for CyberKnife Stereotactic Radiation Therapy

  • Karaman, Kutlay (Department of Radiology, Anadolu Medical Center) ;
  • Dokdok, A. Murat (Department of Radiology, Anadolu Medical Center) ;
  • Karadeniz, Oktay (Department of Radiology, Anadolu Medical Center) ;
  • Ceylan, Cemile (Department of Radiation Oncology, Anadolu Medical Center) ;
  • Engin, Kayihan (Department of Radiation Oncology, Anadolu Medical Center)
  • Received : 2014.01.08
  • Accepted : 2015.02.04
  • Published : 2015.06.01
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Abstract

Objective: To present our experience with placing endovascular coils in pulmonary arteries used as a fiducial marker for CyberKnife therapy and to describe the technical details and complications of the procedure. Materials and Methods: Between June 2005 and September 2013, 163 patients with primary or secondary lung malignancies, referred for fiducial placement for stereotactic radiosurgery, were retrospectively reviewed. Fourteen patients (9 men, 5 women; mean age, 70 years) with a history of pneumonectomy (n = 3), lobectomy (n = 3) or with severe cardiopulmonary co-morbidity (n = 8) underwent coil (fiducial marker) placement. Pushable or detachable platinum micro coils (n = 49) 2-3 mm in size were inserted through coaxial microcatheters into a small distal pulmonary artery in the vicinity of the tumor under biplane angiography/fluoroscopy guidance. Results: Forty nine coils with a median number of 3 coils per tumor were placed with a mean tumor-coil distance of 2.7 cm. Forty three (87.7%) of 49 coils were successfully used as fiducial markers. Two coils could not be used due to a larger tumor-coil distance (> 50 mm). Four coils were in an acceptable position but their non-coiling shape precluded tumor tracking for CyberKnife treatment. No major complications needing further medication other than nominal therapy, hospitalization more than one night or permanent adverse sequale were observed. Conclusion: Endovascular placement of coil as a fiducial marker is safe and feasible during CyberKnife therapy, and might be an option for the patients in which percutaneous transthoracic fiducial placement might be risky.

Keywords

References

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