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Sidhu C, Tang C, Scott A, Yamini Ramamurty H, Yagnik L, Morey S, Phillips M, Jacques A, Thomas R. Feasibility, safety and outcomes of stereotactic radiotherapy for ultra-central thoracic oligometastatic disease guided by linear endobronchial ultrasound-inserted fiducials. Radiother Oncol 2024:110547. [PMID: 39332638 DOI: 10.1016/j.radonc.2024.110547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 09/09/2024] [Accepted: 09/13/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND & PURPOSE Local treatment of oligometastases has been found to improve survival and prognosis. Stereotactic body radiotherapy (SBRT) has emerged as a treatment option for oligometastases but its use in ultra-central (UC) areas can cause significant toxicity and mortality. Fiducial markers (FM) can be used to improve SBRT accuracy, and can be inserted in the central thorax using linear endobronchial ultrasound (EBUS) bronchoscopy. Outcomes of FM-guided SBRT for UC thoracic oligometastases is unknown. METHODS A single-centre retrospective study investigating the feasibility, safety and outcomes of both linear EBUS-inserted FMs and subsequent FM-guided SBRT for UC-oligometastatic disease. Motion analyses of FMs were also performed. RESULTS Thirty outpatients underwent 32 EBUS-FM insertion procedures with 100 % success, and no major procedural mortality or morbidity. Minor complications were 4.8 % incidence of delayed FM-displacement. UC FM-guided SBRT was completed in 20 patients with 99.9 % fractions delivered. Median SBRT dose delivered was 40 Gy over a median of 8 fractions. Majority of adverse events were Grade 1 and there was no SBRT-related mortality. Local control with SBRT was 95 %, with overall survival at 1-year and 3-years of 90 % and 56.3 % respectively. Median overall survival after SBRT was 43.6 months. FM movements in UC areas were recorded being greatest in the superior-inferior axis. CONCLUSION Combined linear EBUS sampling and FM-insertion in UC thoracic oligometastatic disease is feasible and safe. UC-SBRT to oligometastases using FM guidance was found to have minimal complications and associated with moderate survival up to 3 years post-treatment.
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Affiliation(s)
- Calvin Sidhu
- School of Health Sciences, Edith Cowan University, Joondalup, Australia; Institute for Respiratory Health, Perth, Australia.
| | - Colin Tang
- School of Health Sciences, Edith Cowan University, Joondalup, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia; Institute for Respiratory Health, Perth, Australia
| | - Alison Scott
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia; Institute for Respiratory Health, Perth, Australia
| | - Hema Yamini Ramamurty
- Department of Respiratory Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia; Institute for Respiratory Health, Perth, Australia
| | - Lokesh Yagnik
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, Australia; Institute for Respiratory Health, Perth, Australia
| | - Sue Morey
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia; Institute for Respiratory Health, Perth, Australia
| | - Martin Phillips
- Macquarie University Hospital, Sydney, Australia; Institute for Respiratory Health, Perth, Australia
| | - Angela Jacques
- Institute of Health Research, University of Notre Dame, Fremantle, Australia; Institute for Respiratory Health, Perth, Australia
| | - Rajesh Thomas
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia; Institute of Health Research, University of Notre Dame, Fremantle, Australia; School of Medicine, University of Western Australia, Perth, Australia; Institute for Respiratory Health, Perth, Australia
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Horibe A, Ohta K, Shoji J, Hatano M, Shiotani Y, Anan K, Nomura K, Iwata H, Ogino H. CT-Guided Fiducial Marker Implantation with Ultra-fine 25-Gauge Needle Prior to Proton Therapy for Liver Malignancies. Cardiovasc Intervent Radiol 2024; 47:1287-1293. [PMID: 39174792 DOI: 10.1007/s00270-024-03808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/02/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE Proton therapy is highly effective for liver malignancies, and to increase its accuracy, placement of fiducial markers in the liver is preferred. We retrospectively evaluated the safety and feasibility of CT-guided fiducial marker implantation using ultra-fine 25-gauge needles before proton therapy for liver malignancies. MATERIALS AND METHODS Between May 2016 and April 2021, 334 cases were investigated. All of procedures were performed without anesthesia. Technical success was defined as the completion of implantation at the intended site. Tumor-marker distance and possibility of synchronization between tumors and markers were evaluated and compared with Mann-Whitney U test. Complications were evaluated using the Common Terminology Criteria for Adverse Events, version 4.0. RESULTS Technical success rate was 97.3%. Tumor-marker distance was 19.1 mm (median, range 0-96) in the group in which the implanted marker was synchronized with tumor (n = 315), while it was 34.5 mm (median, range 6-94) in the group in which the implanted marker was not synchronized (n = 13) (p value = 0.011 < 0.05). The complication rate was 2.4%, 2 were classified as grade 4 and 5 as grade 1, and 1 as grade 2. There were no grade 3 or higher complications that seemed to be related to the procedure. CONCLUSION CT-guided marker implantation using a 25-gauge needle achieved a satisfactory success rate with few complications and was useful for the image-guided and respiratory-synchronized proton therapy. LEVEL OF EVIDENCE 3: Local non-random sample.
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Affiliation(s)
- Akihiro Horibe
- Department of Diagnostic Radiology, Nagoya City University West Medical Center, Nagoya, Japan
| | - Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan.
| | - Jumpei Shoji
- Department of Diagnostic Radiology, Nagoya City University West Medical Center, Nagoya, Japan
| | - Mototaka Hatano
- Department of Diagnostic Radiology, Nagoya City University West Medical Center, Nagoya, Japan
| | - Yujiro Shiotani
- Department of Radiology, Toyokawa City Hospital, Toyokawa, Japan
| | - Kumiko Anan
- Department of Proton Therapy Technology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Kento Nomura
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
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Chau M, Saluja M, Anderson J. Computed Tomography-Guided Prostate Sampling and Fiducial Marker Insertion in Patients With Absent Rectums. J Comput Assist Tomogr 2024; 48:72-76. [PMID: 37531637 DOI: 10.1097/rct.0000000000001514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
OBJECTIVES We aimed to present our experience and the outcomes of a novel technique, computed tomography (CT)-guided prostate biopsy and fiducial marker insertion in patients with absent rectums. METHODS Patients who underwent CT-guided prostate biopsy at a single institution from November 2010 to November 2022 were retrospectively reviewed. Patients were included if they had a clinical suspicion of prostate cancer and had absent rectums from previous surgical resection. Contrast-enhanced CT scan was used to perform transgluteal prostate biopsy. Patient demographics, multiparametric magnetic resonance imaging, and biopsy details were recorded. RESULTS Thirteen biopsy procedures and 1 CT-guided fiducial marker insertion were performed on 12 unique patients. The reasons for the absence of rectums included surgical resection for rectal cancer (n = 10) and surgical resection for inflammatory bowel disease (n = 2). Clinically significant cancer was found in 7 of 13 biopsy results (52.8%), clinically insignificant cancer in 3 of 13 (23.1%), and benign cancer in 3 of 13 (23.1%). No complications were recorded. CONCLUSIONS Our data support CT-guided prostate biopsy as an accurate and effective technique for investigating prostate cancer that requires tissue sampling in patients with absent rectums.
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Nemoto H, Saito M, Suzuki T, Suzuki H, Sano N, Mochizuki Z, Mochizuki K, Ueda K, Komiyama T, Marino K, Aoki S, Oguri M, Takahashi H, Onishi H. Evaluation of computed tomography metal artifact and CyberKnife fiducial recognition for novel size fiducial markers. J Appl Clin Med Phys 2023; 24:e14142. [PMID: 37672211 PMCID: PMC10691645 DOI: 10.1002/acm2.14142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/28/2023] [Accepted: 08/19/2023] [Indexed: 09/07/2023] Open
Abstract
PURPOSE This study aimed to compare fiducial markers used in CyberKnife treatment in terms of metal artifact intensity observed in CT images and fiducial recognition in the CyberKnife system affected by patient body thickness and type of marker. METHODS Five markers, ACCULOC 0.9 mm × 3 mm, Ball type Gold Anchor (GA) 0.28 mm × 10 mm, 0.28 mm × 20 mm, and novel size GA 0.4 mm × 10 mm, 0.4 mm × 20 mm were evaluated. To evaluate metal artifacts of CT images, two types of CT images of water-equivalent gels with each marker were acquired using Aquilion LB CT scanner, one applied SEMAR (SEMAR-on) and the other did not apply this technique (SEMAR-off). The evaluation metric of artifact intensity (MSD ) which represents a variation of CT values were compared for each marker. Next, 5, 15, and 20 cm thickness of Tough Water (TW) was placed on the gel under the condition of overlapping the vertebral phantom in the Target Locating System, and the live image of each marker was acquired to compare fiducial recognition. RESULTS The mean MSD of SEMAR-off was 78.80, 74.50, 97.25, 83.29, and 149.64 HU for ACCULOC, GA0.28 mm × 10 mm, 20 mm, and 0.40 mm × 10 mm, 20 mm, respectively. In the same manner, that of SEMAR-on was 23.52, 20.26, 26.76, 24.89, and 33.96 HU, respectively. Fiducial recognition decreased in the order of 5, 15, and 20 cm thickness, and GA 0.4 × 20 mm showed the best recognition at thickness of 20 cm TW. CONCLUSIONS We demonstrated the potential to reduce metal artifacts in the CT image to the same level for all the markers we evaluated by applying SEMAR. Additionally, the fiducial recognition of each marker may vary depending on the thickness of the patient's body. Particularly, we showed that GA 0.40 × 20 mm may have more optimal recognition for CyberKnife treatment in cases of high bodily thickness in comparison to the other markers.
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Affiliation(s)
- Hikaru Nemoto
- Department of Advanced Biomedical ImagingUniversity of YamanashiYamanashiJapan
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Masahide Saito
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Hidekazu Suzuki
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Naoki Sano
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Koji Mochizuki
- Kasugai CyberKnife Rehabilitation HospitalYamanashiJapan
| | - Koji Ueda
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Kan Marino
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Shinichi Aoki
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Mitsuhiko Oguri
- Department of RadiologyShizuoka General HospitalShizuokaJapan
| | | | - Hiroshi Onishi
- Department of RadiologyUniversity of YamanashiYamanashiJapan
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Kord M, Kluge A, Kufeld M, Kalinauskaite G, Loebel F, Stromberger C, Budach V, Gebauer B, Acker G, Senger C. Risks and Benefits of Fiducial Marker Placement in Tumor Lesions for Robotic Radiosurgery: Technical Outcomes of 357 Implantations. Cancers (Basel) 2021; 13:cancers13194838. [PMID: 34638321 PMCID: PMC8508340 DOI: 10.3390/cancers13194838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Robotic radiosurgery (RRS) allows for the accurate treatment of primary tumors or metastases with high single doses. However, organ motion during or between fractions can lead to imprecise irradiation. We sought to evaluate the risks and advantages of fiducial marker (FM) implantation regarding clinical complications, marker migration, and motion amplitude. Complications were most common in Synchrony®-tracked lesions affected by respiratory motion, particularly lung lesions. Pneumothoraces and pulmonary bleeding were the most common complications. An increased complication rate was associated with concomitant biopsy sampling and FM implantation. Most FM migration observed in this study occurred after CT-guided placements and clinical FM insertions. The largest motion amplitudes were observed in hepatic and lower lung lobe lesions. This study highlights the benefits of marker implantation, especially in lesions with a large motion amplitude, including hepatic lesions and lesions of the lower lobe of the lung located >100.0 mm from the spine. Abstract Fiducial markers (FM) inserted into tumors increase the precision of irradiation during robotic radiosurgery (RRS). This retrospective study evaluated the clinical complications, marker migration, and motion amplitude of FM implantations by analyzing 288 cancer patients (58% men; 63.1 ± 13.0 years) who underwent 357 FM implantations prior to RRS with CyberKnife, between 2011 and 2019. Complications were classified according to the Society of Interventional Radiology (SIR) guidelines. The radial motion amplitude was calculated for tumors that moved with respiration. A total of 725 gold FM was inserted. SIR-rated complications occurred in 17.9% of all procedures. Most complications (32.0%, 62/194 implantations) were observed in Synchrony®-tracked lesions affected by respiratory motion, particularly in pulmonary lesions (46.9% 52/111 implantations). Concurrent biopsy sampling was associated with a higher complication rate (p = 0.001). FM migration occurred in 3.6% after CT-guided and clinical FM implantations. The largest motion amplitudes were observed in hepatic (20.5 ± 11.0 mm) and lower lung lobe (15.4 ± 10.5 mm) lesions. This study increases the awareness of the risks of FM placement, especially in thoracic lesions affected by respiratory motion. Considering the maximum motion amplitude, FM placement remains essential in hepatic and lower lung lobe lesions located >100.0 mm from the spine.
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Affiliation(s)
- Melina Kord
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (A.K.); (G.K.); (C.S.); (V.B.)
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (G.A.)
| | - Anne Kluge
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (A.K.); (G.K.); (C.S.); (V.B.)
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (G.A.)
| | - Markus Kufeld
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (G.A.)
| | - Goda Kalinauskaite
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (A.K.); (G.K.); (C.S.); (V.B.)
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (G.A.)
| | - Franziska Loebel
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (G.A.)
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Carmen Stromberger
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (A.K.); (G.K.); (C.S.); (V.B.)
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (G.A.)
| | - Volker Budach
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (A.K.); (G.K.); (C.S.); (V.B.)
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (G.A.)
| | - Bernhard Gebauer
- Department of Radiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany;
| | - Gueliz Acker
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (G.A.)
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health at Charité Universitätsmedizin Berlin, BIH Acadamy, Clinician Scientist Program, Charitéplatz 1, 10117 Berlin, Germany
| | - Carolin Senger
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (A.K.); (G.K.); (C.S.); (V.B.)
- Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany; (M.K.); (F.L.); (G.A.)
- Correspondence: ; Tel.: +49-30-450-557221
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Gaspard D, Boujaoude Z, Kubicek G, Abouzgheib W. Transthoracic placement of fiducials with ultrasound or electronic navigational bronchoscopy needle guidance by the interventional pulmonologist: A case series. Respirol Case Rep 2021; 9:e0818. [PMID: 34336221 PMCID: PMC8319654 DOI: 10.1002/rcr2.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/10/2021] [Accepted: 07/08/2021] [Indexed: 11/11/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) has become one of the main options for treatment of thoracic malignancies, leading to the need for more fiducial marker placement. We report cases where these fiducials were placed transthoracically by interventional pulmonologists using ultrasound (US) and electronic navigational bronchoscopy (ENB) needle guidance. Six cases were identified in the Cooper University Hospital medical records where such procedures were performed, alone or in combination with other interventions. All six patients underwent successful placement of fiducials. Concomitant bronchoscopic procedures were performed in four cases. All patients proceeded to SBRT without the need for further interventions. The overall retention rate of fiducials was 80%. No complications were noted. Fiducials' placement by interventional pulmonologists using US or ENB needle guidance is safe and effective, and may be combined with other procedures in a single setting.
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Affiliation(s)
- Dany Gaspard
- Division of Pulmonary and Critical Care MedicineCooper University HospitalCamdenNew JerseyUSA
| | - Ziad Boujaoude
- Division of Pulmonary and Critical Care MedicineCooper University HospitalCamdenNew JerseyUSA
| | - Gregory Kubicek
- Division of Radiation OncologyCooper University HospitalCamdenNew JerseyUSA
| | - Wissam Abouzgheib
- Division of Pulmonary and Critical Care MedicineCooper University HospitalCamdenNew JerseyUSA
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Comparison of technical success and safety of transbronchial versus percutaneous CT-guided fiducial placement for SBRT of lung tumors. J Med Imaging Radiat Sci 2021; 52:409-416. [PMID: 34229986 DOI: 10.1016/j.jmir.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/29/2021] [Accepted: 06/09/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the technical success and safety of transbronchial (bronchoscopic) fiducial placement compared to percutaneous CT-guided fiducial placement for stereotactic body radiotherapy (SBRT) of lung tumors. MATERIALS AND METHODS This IRB-approved, HIPAA-compliant retrospective study was performed at a single tertiary institution. Consecutive patients undergoing lung fiducial placement for purposes of guiding SBRT (CyberKnife®, Accuray, Inc.) between September 2005 to January 2013 were included in the study. Fiducial seeds were placed percutaneously with CT guidance or transbronchially with bronchoscopic guidance. We compared procedure-related complications (pneumothorax, chest tube placement), technical success (defined as implantation enabling adequate treatment planning with CT simulation) and migration rate. The need for repeat procedures and their mode was noted. Statistical analysis was performed using Fisher exact and Chi square probability tests. RESULTS Two hundred and forty-four patients with lung tumors and 272 fiducial seed placements were included in the study. Two hundred and twenty-one of the 272 (81.2%) fiducial markers were placed percutaneously and 51/272 (18.8%) were placed transbronchially. Pneumothorax was seen in 73/221 (33%) of percutaneously-placed fiducials and in 4/51 (7.8%) of transbronchial placements (p<0.001). No significant difference was seen in the rate of chest tube placement between the two groups: 20/221 (9%) of percutaneously placed fiducials and 2/51 (3.9%) of transbronchially placed fiducials (p=0.39). Fifteen of the 51 (29%) of fiducial placements with transbronchial approach were unsuccessful, as discovered at radiotherapy planning session, and required a repeat procedure. Nine of the 15 (60%) of repeat procedures were performed percutaneously, 5/15 (33%) were placed during repeat bronchoscopy, and 1/15 (7%) was placed at transesophageal endoscopic ultrasound. No repeat fiducial placements were required for patients who had the fiducials placed percutaneously (p<0.001), with a technical success rate of 100%. CONCLUSION Transbronchial fiducial marker placement has a significantly higher rate of failed seed placements requiring repeat procedures in comparison to percutaneous placement. Complication rate of pneumothorax requiring chest drain placement is similar between the two approaches.
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Respiratory gating in patients with lung carcinoma undergoing radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim:
This study aims to compare the gating signals of patients with lung cancer recorded during the planning computed tomography scan with the ones recorded during treatment fractions. The results provide insights into how representative the respiratory signals from the planning scan are for radiation dose partitioning.
Materials and methods:
The amplitude and frequency of the respiratory signals of 29 patients with lung carcinoma were analysed and compared with the amplitude and frequency of those recorded during their planning scans. Moreover, a cross-correlation analysis was performed between the difference between the planning scan and fractions and features from the planning scan.
Results:
Two patients showed significantly different amplitude and frequency during treatment fractions compared to those from the planning scan. These patients showed low variances in frequency and amplitude during the different fractions. The difference between planning scan and fractions is correlated with the variances within the planning scan.
Findings:
Respiratory signals can differ between the planning scan and the fractions. In this case, a new planning scan may be beneficial. The respiratory signals from the planning scan may be predictive of whether the planning scan will be representative and usable as a control measure during radiotherapy fractions.
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A Miniaturized Platform for Multiplexed Drug Response Imaging in Live Tumors. Cancers (Basel) 2021; 13:cancers13040653. [PMID: 33562152 PMCID: PMC7915324 DOI: 10.3390/cancers13040653] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary We have developed an implantable microdevice that is placed into a live tumor, and can directly image how effective various chemotherapy drugs are at inducing cell death, without having to remove or process the tumor tissue. Currently drug optimization is performed by assessing tumor shrinkage after treating a patient with systemic doses of a chemotherapy agent; this only evaluates a single treatment at a time and typically takes weeks-months before an optimal treatment strategy is found (if found at all) for a specific patient. In contrast, using the technology presented here, a personalized cancer treatment strategy can potentially be optimized and tailored to a specific patient’s tumor characteristics within several hours, without requiring surgical tissue removal or prolonged trials of potentially ineffective chemotherapies. Abstract By observing the activity of anti-cancer agents directly in tumors, there is potential to greatly expand our understanding of drug response and develop more personalized cancer treatments. Implantable microdevices (IMD) have been recently developed to deliver microdoses of chemotherapeutic agents locally into confined regions of live tumors; the tissue can be subsequently removed and analyzed to evaluate drug response. This method has the potential to rapidly screen multiple drugs, but requires surgical tissue removal and only evaluates drug response at a single timepoint when the tissue is excised. Here, we describe a “lab-in-a-tumor” implantable microdevice (LIT-IMD) platform to image cell-death drug response within a live tumor, without requiring surgical resection or tissue processing. The LIT-IMD is inserted into a live tumor and delivers multiple drug microdoses into spatially discrete locations. In parallel, it locally delivers microdose levels of a fluorescent cell-death assay, which diffuses into drug-exposed tissues and accumulates at sites of cell death. An integrated miniaturized fluorescence imaging probe images each region to evaluate drug-induced cell death. We demonstrate ability to evaluate multi-drug response over 8 h using murine tumor models and show correlation with gold-standard conventional fluorescence microscopy and histopathology. This is the first demonstration of a fully integrated platform for evaluating multiple chemotherapy responses in situ. This approach could enable a more complete understanding of drug activity in live tumors, and could expand the utility of drug-response measurements to a wide range of settings where surgery is not feasible.
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Patel M, Colvin T, Kirkland RS, Marcrom S, Dobelbower M, Spencer SA, Boggs DH, Popple R, Shen S, Wei B, McDonald A. Reduced Margin Stereotactic Body Radiation Therapy for Early Stage Non-Small Cell Lung Cancers. Cureus 2020; 12:e8618. [PMID: 32676253 PMCID: PMC7362592 DOI: 10.7759/cureus.8618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose Our study reports the clinical outcomes of patients treated with 5-mm isotropic margin, fiducial-guided stereotactic body radiation therapy (SBRT) for early stage non-small cell lung cancer (NSCLC). We also sought to assess the effect of histological subtype on local control. Methods We retrospectively reviewed the charts of all patients treated with SBRT for NSCLC between 2007 and 2017 at our institution. All patients who had implanted fiducial markers, planning target volume (PTV) margins of 5 mm or less, early stage disease (T1-T2, N0), and at least one follow-up CT were included in this analysis. Estimates of local control were generated using the Kaplan-Meier method, and differences between survival curves were assessed using the log-rank test. Results A total of 152 patients met the inclusion criteria for this analysis, with a median follow-up of 27.9 months. Patients received 54 Gy in three fractions for peripheral tumors and 48-52.5 Gy in four to five fractions for central tumors. NSCLC histology was adenocarcinoma in 69 (45.4%) cases, squamous cell carcinoma in 65 (42.8%) cases, and other or non-subtyped in 18 (11.8%) cases. Across the entire cohort, the two-year estimate of local control was 95.1%. When histology was considered, the two-year estimate of local control among patients with adenocarcinoma was 95.6% as compared with 85.0% for patients with other subtypes (p=0.044). Conclusions Fiducial-guided, isotropic 5-mm PTV margin for thoracic SBRT did not compromise local control compared with historical standards. In this series, patients with adenocarcinoma experienced improved local control compared with squamous cell carcinoma.
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Affiliation(s)
- Mayank Patel
- Radiation Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Tyler Colvin
- Internal Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | | | - Samuel Marcrom
- Radiation Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Michael Dobelbower
- Radiation Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Sharon A Spencer
- Radiation Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Drexell H Boggs
- Radiation Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Richard Popple
- Radiation Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Sui Shen
- Radiation Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Benjamin Wei
- Cardiothoracic Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Andrew McDonald
- Radiation Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, USA
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11
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Boateng F, Ngwa W. Delivery of Nanoparticle-Based Radiosensitizers for Radiotherapy Applications. Int J Mol Sci 2019; 21:ijms21010273. [PMID: 31906108 PMCID: PMC6981554 DOI: 10.3390/ijms21010273] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/21/2019] [Accepted: 12/16/2019] [Indexed: 02/06/2023] Open
Abstract
Nanoparticle-based radiosensitization of cancerous cells is evolving as a favorable modality for enhancing radiotherapeutic ratio, and as an effective tool for increasing the outcome of concomitant chemoradiotherapy. Nevertheless, delivery of sufficient concentrations of nanoparticles (NPs) or nanoparticle-based radiosensitizers (NBRs) to the targeted tumor without or with limited systemic side effects on healthy tissues/organs remains a challenge that many investigators continue to explore. With current systemic intravenous delivery of a drug, even targeted nanoparticles with great prospect of reaching targeted distant tumor sites, only a portion of the administered NPs/drug dosage can reach the tumor, despite the enhanced permeability and retention (EPR) effect. The rest of the targeted NPs/drug remain in systemic circulation, resulting in systemic toxicity, which can decrease the general health of patients. However, the dose from ionizing radiation is generally delivered across normal tissues to the tumor cells (especially external beam radiotherapy), which limits dose escalation, making radiotherapy (RT) somewhat unsafe for some diseased sites despite the emerging development in RT equipment and technologies. Since radiation cannot discriminate healthy tissue from diseased tissue, the radiation doses delivered across healthy tissues (even with nanoparticles delivered via systemic administration) are likely to increase injury to normal tissues by accelerating DNA damage, thereby creating free radicals that can result in secondary tumors. As a result, other delivery routes, such as inhalation of nanoparticles (for lung cancers), localized delivery via intratumoral injection, and implants loaded with nanoparticles for local radiosensitization, have been studied. Herein, we review the current NP delivery techniques; precise systemic delivery (injection/infusion and inhalation), and localized delivery (intratumoral injection and local implants) of NBRs/NPs. The current challenges, opportunities, and future prospects for delivery of nanoparticle-based radiosensitizers are also discussed.
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Affiliation(s)
- Francis Boateng
- TIDTAC LLC, Orlando, FL 32828, USA
- Correspondence: ; Tel.: +1-7745264723
| | - Wilfred Ngwa
- TIDTAC LLC, Orlando, FL 32828, USA
- Department of Physics and Applied Physics, University of Massachusetts Lowell Lowell, MA 01854, USA
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Radiation Oncology, Harvard Medical School, Boston, MA 02115, USA
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12
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Baker S, Sharma A, Antonisse I, Cornelissen R, Moelker A, Nuyttens JJ. Endovascular Coils as Lung Tumor Fiducial Markers for Real-Time Tumor Tracking in Stereotactic Body Radiotherapy: Comparison of Complication Rates with Transthoracic Fiducial Marker Placement. J Vasc Interv Radiol 2019; 30:1901-1907. [PMID: 31530487 DOI: 10.1016/j.jvir.2019.04.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/11/2019] [Accepted: 04/22/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate safety of endovascular coil fiducial placement and compare complication rates with transthoracic fiducial placement in patients with peripheral early-stage lung cancer receiving fiducial markers for stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS This retrospective study included consecutive patients who received endovascular coils (n = 416 patients, n = 1,335 coils) or transthoracic fiducials (n = 30 patients, n = 80 fiducials) for SBRT between August 2005 and January 2017. During the first 3 years of the study period, patients preferentially received cylindrical platinum fiducial markers by percutaneous transthoracic placement; only patients with contraindications received endovascular coils. Thereafter, patients received endovascular fiducials as the first-line procedure. Endovascular embolization coils were placed via the femoral vein into subsegmental pulmonary artery branches near the tumor. Complications were scored by SIR criteria. RESULTS The success rate of endovascular coil placement was 99.8%. One patient developed grade 2 hemoptysis requiring procedure discontinuation. Following placement, 1 patient (0.2%) developed grade 3 cardiac arrhythmia. A total of 36 patients (9%) developed grade 1 complications: mild hemoptysis (n = 4; 1%), small asymptomatic pulmonary infarction or hemorrhage (n = 30; 7%), hypoglycemia (n = 1; 0.2%), and vasovagal episode (n = 1; 0.2%). Following transthoracic marker placement, 4 patients (13%) developed a pneumothorax requiring hospital admission and chest tube (grade 2), 6 patients (20%) developed pneumothorax requiring no intervention (grade 1), 2 patients (7%) experienced asymptomatic pulmonary bleeding, and 1 patient (3%) developed persistent pain. CONCLUSIONS Endovascular coil fiducial placement for lung SBRT is associated with high procedural success rates and lower rates of clinically relevant complications than transthoracic marker placement.
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Affiliation(s)
- Sarah Baker
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Dr. Molenwaterplein 40, Rotterdam 3015 GD, The Netherlands.
| | - Aman Sharma
- Department of Radiotherapy and Oncology, Regional Cancer Centre, Indira Gandhi Medical College, Shimla, India
| | - Imogeen Antonisse
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Dr. Molenwaterplein 40, Rotterdam 3015 GD, The Netherlands
| | - Robin Cornelissen
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Adriaan Moelker
- Department of Radiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joost Jan Nuyttens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Dr. Molenwaterplein 40, Rotterdam 3015 GD, The Netherlands
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13
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Local control rates in stereotactic body radiotherapy (SBRT) of lung metastases associated with the biologically effective dose. Rep Pract Oncol Radiother 2019; 24:142-150. [PMID: 30723385 DOI: 10.1016/j.rpor.2019.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 01/02/2019] [Indexed: 12/20/2022] Open
Abstract
Aim To evaluate dose differences in lung metastases treated with stereotactic body radiotherapy (SBRT), and the correlation with local control, regarding the dose algorithm, target volume and tissue density. Background Several studies showed excellent local control rates in SBRT for lung metastases, with different fractionation schemes depending on the tumour location or size. These results depend on the dose distributions received by the lesions in terms of the tissue heterogeneity corrections performed by the dose algorithms. Materials and methods Forty-seven lung metastases treated with SBRT, using intrafraction control and respiratory gating with internal fiducial markers as surrogates (ExacTrac, BrainLAB AG), were calculated using Pencil Beam (PB) and Monte Carlo (MC) (iPlan, BrainLAB AG).Dose differences between both algorithms were obtained for the dose received by 99% (D 99%) and 50% (D 50%) of the planning treatment volume (PTV). The biologically effective dose delivered to 99% (BED99%) and 50% (BED50%) of the PTV were estimated from the MC results. Local control was evaluated after 24 months of median follow-up (range: 3-52 months). Results The greatest variations (40.0% in ΔD 99% and 38.4% in ΔD 50%) were found for the lower volume and density cases. The BED99% and BED50% were strongly correlated with observed local control rates: 100% and 61.5% for BED99% > 85 Gy and <85 Gy (p < 0.0001), respectively, and 100% and 58.3% for BED50% > 100 Gy and <100 Gy (p < 0.0001), respectively. Conclusions Lung metastases treated with SBRT, with delivered BED99% > 85 Gy and BED50% > 100 Gy, present better local control rates than those treated with lower BED values (p = 0.001).
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14
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Vogel L, Sihono DSK, Weiss C, Lohr F, Stieler F, Wertz H, von Swietochowski S, Simeonova-Chergou A, Wenz F, Blessing M, Boda-Heggemann J. Intra-breath-hold residual motion of image-guided DIBH liver-SBRT: An estimation by ultrasound-based monitoring correlated with diaphragm position in CBCT. Radiother Oncol 2018; 129:441-448. [DOI: 10.1016/j.radonc.2018.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
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15
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Khadige M, Salleron J, Marchesi V, Oldrini G, Peiffert D, Beckendorf V. Cyberknife ® stereotactic radiation therapy for stage I lung cancer and pulmonary metastases: evaluation of local control at 24 months. J Thorac Dis 2018; 10:4976-4984. [PMID: 30233872 DOI: 10.21037/jtd.2018.07.26] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background CyberKnife® stereotactic radiotherapy allows for minimally invasive treatment with satisfactory results in patients with inoperable primary or metastatic lung cancer. The objective of this study was to identify factors influencing the probability of local control. Methods Ninety-five patients (100 lung tumors) treated between January and December 2013 at our department by SBRT (stereotactic body radiation therapy) using CyberKnife® were included in the study. There were 71 stage T1 or T2 primary tumors and 29 secondary tumors. The tracking methods were as follow: fiducial markers with Synchrony® in 50 cases (gold seeds in 35, coils in 15 cases), spine with 4D-CT and Xsight® Spine in 43 cases, and direct viewing by Xsight® Lung in 7 cases. The methods were allocated according to the characteristics of each target. Results With a median follow-up of 24 months, the probability of local control at 24 months was 88%. The probability of local control differed according to the size of the target (92% for tumors ≤35 mm and 54% for tumors >35 mm: P=0.013) and according to the distance of the fiducial markers in relation to the target (95% when <50 mm and 69% when ≥50 mm: P=0.011). Conclusions The best results were obtained with small lesions. With Synchrony®, the distance of the target relative to the fiducial markers should be less than 50 mm. Gold seeds are recommended, although coils may be used instead of gold seeds. The number of fiducial markers did not have a significant impact on the probability of local control. With an appropriate tracking method, stereotactic radiotherapy is an efficient treatment for stage I lung cancer and lung oligometastases.
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Affiliation(s)
- Myriam Khadige
- Department of Radiotherapy, Institut de Cancérologie de Lorraine, Nancy, France
| | - Julia Salleron
- Data Biostatistics Unit, Institut de Cancérologie de Lorraine, Nancy, France
| | - Vincent Marchesi
- Department of Medical physics, Institut de Cancérologie de Lorraine, Nancy, France
| | - Guillaume Oldrini
- Department of Radiology, Institut de Cancérologie de Lorraine, Nancy, France.,CRAN, UMR 7039, Université de Lorraine, CNRS, Vandoeuvre-lès-Nancy, France
| | - Didier Peiffert
- Department of Radiotherapy, Institut de Cancérologie de Lorraine, Nancy, France
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16
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de Blanck SR, Rydhög JS, Larsen KR, Clementsen PF, Josipovic M, Aznar MC, Af Rosenschöld PM, Jølck RI, Specht L, Andresen TL, Persson GF. Long term safety and visibility of a novel liquid fiducial marker for use in image guided radiotherapy of non-small cell lung cancer. Clin Transl Radiat Oncol 2018; 13:24-28. [PMID: 30258990 PMCID: PMC6154396 DOI: 10.1016/j.ctro.2018.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 11/16/2022] Open
Abstract
Safety and clinical feasibility of injecting a novel liquid fiducial marker for use in image guided radiotherapy in 15 patients with non-small cell lung cancer are reported. No major safety or toxicity issues were encountered. Markers present at start of radiotherapy remained visible in cone beam computed tomography and fluoroscopy images throughout the treatment course and on computed tomography images during follow-up (0-38 months). Marker volume reduction was seen until 9 months after treatment, after which no further marker breakdown was found. No post-treatment migration or marker related complications were found.
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Affiliation(s)
- Steen Riisgaard de Blanck
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jonas Scherman Rydhög
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark
| | - Klaus Richter Larsen
- Department of Respiratory Medicine, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 København, NV, Denmark
| | - Paul Frost Clementsen
- Department of Respiratory Medicine, Gentofte University Hospital and Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Mirjana Josipovic
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark
| | - Marianne Camille Aznar
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark
| | - Per Munck Af Rosenschöld
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark
| | - Rasmus Irming Jølck
- DTU Nanotech, Department of Micro-and Nanotechnology, Center for Nanomedicine and Theranostics, Technical University of Denmark, Building 345E, Ørsteds Plads, 2800 Kgs. Lyngby, Denmark.,Nanovi Radiotherapy A/S, Diplomvej 373N, 2800 Kgs. Lyngby, Denmark
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Thomas Lars Andresen
- DTU Nanotech, Department of Micro-and Nanotechnology, Center for Nanomedicine and Theranostics, Technical University of Denmark, Building 345E, Ørsteds Plads, 2800 Kgs. Lyngby, Denmark
| | - Gitte Fredberg Persson
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
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17
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Seides BJ, Egan JP, French KD, Kovitz KL, Desai NR. Fiducial marker placement for stereotactic body radiation therapy via convex probe endobronchial ultrasound: a case series and review of literature. J Thorac Dis 2018; 10:1972-1983. [PMID: 29707354 DOI: 10.21037/jtd.2018.03.49] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Convex probe endobronchial ultrasound (CP-EBUS) and stereotactic body radiotherapy (SBRT) are valuable tools in the diagnosis, staging, and treatment of thoracic malignancies. With widespread clinical adoption, novel uses of CP-EBUS beyond mediastinal diagnosis and staging continue to be discovered. SBRT is an attractive treatment strategy in early-stage lung cancer and oligo-metastatic disease of the chest when a surgical approach is either not feasible or desirable. Accurate application of SBRT is aided by the placement of radio-opaque fiducial markers (FM) to compensate for respiratory cycle movements. We describe eight patients with central thoracic lesions, either known or suspected to be malignant, who underwent EBUS bronchoscopy with lesion sampling and successful intralesional placement of modified FM via our technique, review the existing literature on this topic, and discuss the nuances of coding and billing aspects of FM placement.
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Affiliation(s)
- Benjamin J Seides
- Division of Pulmonary, Critical Care, and Allergy, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - John P Egan
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA.,Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Kim D French
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA
| | - Kevin L Kovitz
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA.,Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Neeraj R Desai
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA.,Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
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18
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Mizuhata M, Takamatsu S, Shibata S, Bou S, Sato Y, Kawamura M, Asahi S, Tameshige Y, Maeda Y, Sasaki M, Kumano T, Kobayashi S, Yamamoto K, Tamamura H, Gabata T. Respiratory-gated Proton Beam Therapy for Hepatocellular Carcinoma Adjacent to the Gastrointestinal Tract without Fiducial Markers. Cancers (Basel) 2018; 10:cancers10020058. [PMID: 29466294 PMCID: PMC5836090 DOI: 10.3390/cancers10020058] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 12/14/2022] Open
Abstract
The efficacy of proton beam therapy (PBT) for hepatocellular carcinoma (HCC) has been reported, but insertion of fiducial markers in the liver is usually required. We evaluated the efficacy and toxicity of respiratory-gated PBT without fiducial markers for HCC located within 2 cm of the gastrointestinal tract. From March 2011 to December 2015 at our institution, 40 patients were evaluated (median age, 72 years; range, 38-87 years). All patients underwent PBT at a dose of 60 to 80 cobalt gray equivalents (CGE) in 20 to 38 fractions. The median follow-up period was 19.9 months (range, 1.2-72.3 months). The median tumor size was 36.5 mm (range, 11-124 mm). Kaplan-Meier estimates of the 2-year overall survival, progression-free survival, and local tumor control rates were 76%, 60%, and 94%, respectively. One patient (2.5%) developed a grade 3 gastric ulcer and one (2.5%) developed grade 3 ascites retention; none of the remaining patients developed grade >3 toxicities (National Cancer Institute Common Terminology Criteria for Adverse Events ver. 4.0.). This study indicates that PBT without fiducial markers achieves good local control without severe treatment-related toxicity of the gastrointestinal tract for HCC located within 2 cm of the gastrointestinal tract.
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Affiliation(s)
- Miu Mizuhata
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui city, Fukui 910-8526, Japan.
| | - Shigeyuki Takamatsu
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui city, Fukui 910-8526, Japan.
- Department of Radiotherapy, Kanazawa University Hospital, Kanazawa city, Ishikawa 920-8641, Japan.
| | - Satoshi Shibata
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui city, Fukui 910-8526, Japan.
| | - Sayuri Bou
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui city, Fukui 910-8526, Japan.
| | - Yoshitaka Sato
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui city, Fukui 910-8526, Japan.
| | - Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya city, Aichi 466-8560, Japan.
| | - Satoko Asahi
- Department of Radiology, University of Fukui, Fukui City 910-1193, Fukui, Japan.
| | - Yuji Tameshige
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui city, Fukui 910-8526, Japan.
| | - Yoshikazu Maeda
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui city, Fukui 910-8526, Japan.
| | - Makoto Sasaki
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui city, Fukui 910-8526, Japan.
| | - Tomoyasu Kumano
- Department of Radiotherapy, Kanazawa University Hospital, Kanazawa city, Ishikawa 920-8641, Japan.
| | - Satoshi Kobayashi
- Department of Radiology, Kanazawa University, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Kazutaka Yamamoto
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui city, Fukui 910-8526, Japan.
| | - Hiroyasu Tamamura
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui city, Fukui 910-8526, Japan.
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University, Kanazawa City, Ishikawa 920-8641, Japan.
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19
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Doi H, Harui S, Nakajima H, Ando A, Kamino K, Fujiwara M, Nakajima T, Ikura S, Aihara T, Yamanaka N. Clinical Implications of a Novel, Iron-containing Fiducial Marker in Radiotherapy for Liver Tumors: An Initial Experience. Cureus 2017; 9:e1902. [PMID: 29404229 PMCID: PMC5794412 DOI: 10.7759/cureus.1902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A 0.5%-iron-containing fiducial marker, Gold AnchorTM (Naslund Medical AB, Huddinge, Sweden), has been recently developed. Herein, we report our initial experiences with the clinical use of the Gold AnchorTM (GA) in radiotherapy for liver tumors. Data of four consecutive patients with liver tumors, including two liver metastases and two hepatocellular carcinomas, were retrospectively analyzed. The GA was percutaneously placed under local anesthesia, close to the tumor. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (MRI) was performed after the placement of the GA. Radiotherapy was designed using the volumetric modulated arc therapy technique. All procedures for placement of the GA were successfully performed with no complications. The GA exhibited various forms in the liver in the four patients. All of the GAs were well-detected on MRI, planned computed tomography (CT), and cone-beam CT. Additionally, the tadpole-like shape of the GA showed better detectability than the uptake of lipiodol emulsion and could be used for three-dimensional correlation during setup in daily image-guided radiotherapy. GA was a useful tool in image registration of radiotherapy with a high applicability. Additionally, the tadpole-like shape can be recommended for liver radiotherapy. Our findings suggest that the GA will indeed be useful in clinical practice.
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Affiliation(s)
- Hiroshi Doi
- Department of Radiology, Hyogo College of Medicine
| | - Shogo Harui
- Department of Radiation Oncology, Meiwa Cancer Clinic
| | | | - Akira Ando
- Department of Radiation Oncology, Meiwa Cancer Clinic
| | - Keiji Kamino
- Department of Radiation Oncology, Meiwa Cancer Clinic
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20
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Bainbridge H, Salem A, Tijssen RHN, Dubec M, Wetscherek A, Van Es C, Belderbos J, Faivre-Finn C, McDonald F. Magnetic resonance imaging in precision radiation therapy for lung cancer. Transl Lung Cancer Res 2017; 6:689-707. [PMID: 29218271 PMCID: PMC5709138 DOI: 10.21037/tlcr.2017.09.02] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/08/2017] [Indexed: 12/25/2022]
Abstract
Radiotherapy remains the cornerstone of curative treatment for inoperable locally advanced lung cancer, given concomitantly with platinum-based chemotherapy. With poor overall survival, research efforts continue to explore whether integration of advanced radiation techniques will assist safe treatment intensification with the potential for improving outcomes. One advance is the integration of magnetic resonance imaging (MRI) in the treatment pathway, providing anatomical and functional information with excellent soft tissue contrast without exposure of the patient to radiation. MRI may complement or improve the diagnostic staging accuracy of F-18 fluorodeoxyglucose position emission tomography and computerized tomography imaging, particularly in assessing local tumour invasion and is also effective for identification of nodal and distant metastatic disease. Incorporating anatomical MRI sequences into lung radiotherapy treatment planning is a novel application and may improve target volume and organs at risk delineation reproducibility. Furthermore, functional MRI may facilitate dose painting for heterogeneous target volumes and prediction of normal tissue toxicity to guide adaptive strategies. MRI sequences are rapidly developing and although the issue of intra-thoracic motion has historically hindered the quality of MRI due to the effect of motion, progress is being made in this field. Four-dimensional MRI has the potential to complement or supersede 4D CT and 4D F-18-FDG PET, by providing superior spatial resolution. A number of MR-guided radiotherapy delivery units are now available, combining a radiotherapy delivery machine (linear accelerator or cobalt-60 unit) with MRI at varying magnetic field strengths. This novel hybrid technology is evolving with many technical challenges to overcome. It is anticipated that the clinical benefits of MR-guided radiotherapy will be derived from the ability to adapt treatment on the fly for each fraction and in real-time, using 'beam-on' imaging. The lung tumour site group of the Atlantic MR-Linac consortium is working to generate a challenging MR-guided adaptive workflow for multi-institution treatment intensification trials in this patient group.
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Affiliation(s)
- Hannah Bainbridge
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Ahmed Salem
- The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | | | - Michael Dubec
- The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Andreas Wetscherek
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Corinne Van Es
- The University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jose Belderbos
- The Netherlands Cancer Institute and The Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Corinne Faivre-Finn
- The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Fiona McDonald
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK
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21
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Shepard AJ, Wang B, Foo TKF, Bednarz BP. A block matching based approach with multiple simultaneous templates for the real-time 2D ultrasound tracking of liver vessels. Med Phys 2017; 44:5889-5900. [PMID: 28898419 DOI: 10.1002/mp.12574] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 08/15/2017] [Accepted: 08/20/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The implementation of motion management techniques in radiation therapy can aid in mitigating uncertainties and reducing margins. For motion management to be effective, it is necessary to track key structures both accurately and at a real-time speed. Therefore, the focus of this work was to develop a 2D algorithm for the real-time tracking of ultrasound features to aid in radiation therapy motion management. MATERIALS AND METHODS The developed algorithm utilized a similarity measure-based block matching algorithm incorporating training methods and multiple simultaneous templates. The algorithm is broken down into three primary components, all of which use normalized cross-correlation (NCC) as a similarity metric. First, a global feature shift to account for gross displacements from the previous frame is determined using large block sizes which encompass the entirety of the feature. Second, the most similar reference frame is chosen from a series of training images that are accumulated during the first K frames of tracking to aid in contour consistency and provide a starting point for the localized template initialization. Finally, localized block matching is performed through the simultaneous use of both a training frame and the previous frame. The localized block matching utilizes a series of templates positioned at the boundary points of the training and previous contours. The weighted final boundary points from both the previous and the training frame are ultimately combined and used to determine an affine transformation from the previous frame to the current frame. RESULTS A mean tracking error of 0.72 ± 1.25 mm was observed for 85 point-landmarks across 39 ultrasound sequences relative to manual ground truth annotations. The image processing speed per landmark with the GPU implementation was between 41 and 165 frames per second (fps) during the training set accumulation, and between 73 and 234 fps after training set accumulation. Relative to a comparable multithreaded CPU approach using OpenMP, the GPU implementation resulted in speedups between -30% and 355% during training set accumulation, and between -37% and 639% postaccumulation. CONCLUSIONS Initial implementations indicated an accuracy that was comparable to or exceeding those achieved by alternative 2D tracking methods, with a computational speed that is more than sufficient for real-time applications in a radiation therapy environment. While the overall performance reached levels suitable for implementation in radiation therapy, the observed increase in failures for smaller features, as well as the algorithm's inability to be applied to nonconvex features warrants additional investigation to address the shortcomings observed.
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Affiliation(s)
- Andrew J Shepard
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, USA
| | - Bo Wang
- GE Global Research, 1 Research Cir, Niskayuna, NY, 12309, USA
| | - Thomas K F Foo
- GE Global Research, 1 Research Cir, Niskayuna, NY, 12309, USA
| | - Bryan P Bednarz
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, USA
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Marsico M, Gabbani T, Lunardi S, Galli A, Biagini MR, Annese V. Percutaneous ultrasound-guided fiducial marker placement for liver cancer robotic stereotactic radio-surgery treatment: A comparative analysis of three types of markers and needles. Arab J Gastroenterol 2017; 18:83-86. [PMID: 28579341 DOI: 10.1016/j.ajg.2017.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/08/2017] [Accepted: 05/07/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Maria Marsico
- Gastroenterology UO, Bellaria-Maggiore Hospital, Bologna, Italy.
| | - Tommaso Gabbani
- Gastroenterology Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Sarah Lunardi
- Division of Internal Medicine 4, AOU Careggi University Hospital, Florence, Italy
| | - Andrea Galli
- Clinical Gastroenterology Unit, AOU Careggi University Hospital, Florence, Italy
| | - Maria Rosa Biagini
- Clinical Gastroenterology Unit, AOU Careggi University Hospital, Florence, Italy
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic, Dubai, United Arab Emirates
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23
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Abstract
The efficacy of low-dose computed tomography screening is likely to increase the number of early-stage lung cancers identified. The aging population, as well as increase in number of patients with multiple comorbidities, suggests that nonsurgical techniques such as stereotactic body radiotherapy will be vital in treating such malignancies. Convex probe endobronchial ultrasound facilitates the identification of mediastinal and hilar lymph nodes, in addition to central lung tumors. Using a simple modification of the transbronchial needle aspiration technique, we describe a method for placing fiducial markers into isolated central tumors that ensures appropriate localization for definitive radiotherapy.
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Marsico M, Gabbani T, Livi L, Biagini MR, Galli A. Therapeutic usability of two different fiducial gold markers for robotic stereotactic radiosurgery of liver malignancies: A pilot study. World J Hepatol 2016; 8:731-738. [PMID: 27330682 PMCID: PMC4911507 DOI: 10.4254/wjh.v8.i17.731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 05/02/2016] [Accepted: 06/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess how the application of different types of markers affects the tracking accuracy of CyberKnife’s.
METHODS: Fifteen patients were recruited and subjected to the ultrasound-guided placement of markers. Two different type of needles 25 gauge (G) and 17 G containing two different fiducial marker, gold notched flexible anchor wire 0.28 mm × 10 mm (25 G needle) and gold cylindrical grain 1 mm × 4 mm (17 G), were used. Seven days after the procedure, a CyberKnife planning computed tomography (CT) for the simulation of radiation treatment was performed on all patients. A binary CT score was assigned to the fiducial markers visualization. Also, the CT number was calculated for each fiducial and the values compared with a specific threshold.
RESULTS: For each patient from 1 to 5, intra-hepatic markers were placed (one in 2 patients, three in 8 patients, four in 3 patients, and five in 2 patients). A total of 48 needles were used (thirty-two 17 G and sixteen 25 G) and 48 gold markers were placed (32 Grain shaped markers and 16 Gold Anchor). The result showed that the CT visualization of the grain markers was better than the anchor markers (P = 5 × 10-9). Furthermore, the grain markers were shown to present minor late complications (P = 3 × 10-6), and the best CT threshold number (P = 0.0005).
CONCLUSION: The study revealed that the Gold Anchor fiducial marker is correlated with a greater number of late minor complications and low visualization by the CT.
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Ohta K, Shimohira M, Murai T, Nishimura J, Iwata H, Ogino H, Hashizume T, Shibamoto Y. Percutaneous fiducial marker placement prior to stereotactic body radiotherapy for malignant liver tumors: an initial experience. JOURNAL OF RADIATION RESEARCH 2016; 57:174-7. [PMID: 26826200 PMCID: PMC4795956 DOI: 10.1093/jrr/rrv099] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/30/2015] [Indexed: 05/03/2023]
Abstract
The aim of this study was to describe our initial experience with a gold flexible linear fiducial marker and to evaluate the safety and technical and clinical efficacy of stereotactic body radiotherapy using this marker for malignant liver tumors. Between July 2012 and February 2015, 18 patients underwent percutaneous fiducial marker placement before stereotactic body radiotherapy for malignant liver tumors. We evaluated the technical and clinical success rates of the procedure and the associated complications. Technical success was defined as successful placement of the fiducial marker at the target site, and clinical success was defined as the completion of stereotactic body radiotherapy without the marker dropping out of position. All 18 fiducial markers were placed successfully, so the technical success rate was 100% (18/18). All 18 patients were able to undergo stereotactic body radiotherapy without marker migration. Thus, the clinical success rate was 100% (18/18). Slight pneumothorax occurred as a minor complication in one case. No major complications such as coil migration or bleeding were observed. The examined percutaneous fiducial marker was safely placed in the liver and appeared to be useful for stereotactic body radiotherapy for malignant liver tumors.
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Affiliation(s)
- Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 467-8601, Japan
| | - Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 467-8601, Japan
| | - Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 467-8601, Japan Department of Radiation Oncology, Yokohama CyberKnife Center
| | | | - Hiromitsu Iwata
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 467-8601, Japan Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center
| | - Hiroyuki Ogino
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 467-8601, Japan Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center
| | - Takuya Hashizume
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 467-8601, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 467-8601, Japan
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Lipiodol injections for optimization of target volume delineation in a patient with a second tumor of the oropharynx: A case report. Strahlenther Onkol 2015; 191:681-6. [PMID: 26040498 DOI: 10.1007/s00066-015-0856-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 05/13/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Lipiodol injections were administered in the head and neck area to improve gross tumor volume (GTV) definition for small-volume re-irradiation of a 63-year-old previously irradiated patient with a second tumor of the oropharynx in the posterior wall with longitudinal ligament infiltration (cT4cN0cM0). METHODS The patient had dialysis-depending renal failure. On diagnostic computed tomography (CT), which was performed with intravenous contrast agent, the tumor in the oropharynx was not detectable. Because of dialysis-depending renal failure comorbidity, no contrast agent was applied in the planning CT and in the diagnostic magnetic resonance imaging (MRI) study. In each cross-sectional imaging study performed, the GTV, especially in craniocaudal extensions, was not safely delineable. Therefore, craniocaudal tumor margins were pharyngoscopically marked with Lipiodol injections, an iodine-containing contrast agent. RESULTS In a second planning CT, the GTV could be defined with the help of the Lipiodol marks and small-volume re-irradiation was performed. No Lipiodol-associated side effects occurred in the patient. CONCLUSION In the present case, the use of Lipiodol injections at the tumor margins facilitated the definition of the GTV.
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Abstract
In this review, image guidance and motion management in radiotherapy for lung cancer is discussed. Motion characteristics of lung tumours and image guidance techniques to obtain motion information are elaborated. Possibilities for management of image guidance and motion in the various steps of the treatment chain are explained, including imaging techniques and beam delivery techniques. Clinical studies using different motion management techniques are reviewed, and finally future directions for image guidance and motion management are outlined.
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Affiliation(s)
- S S Korreman
- Department of Science, Systems and Models, Roskilde University, Roskilde, Denmark
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CT-Guided Implantation of Intrahepatic Fiducial Markers for Proton Beam Therapy of Liver Lesions: Assessment of Success Rate and Complications. AJR Am J Roentgenol 2015; 204:W207-13. [DOI: 10.2214/ajr.14.12901] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Ohta K, Shimohira M, Sasaki S, Iwata H, Nishikawa H, Ogino H, Hara M, Hashizume T, Shibamoto Y. Transarterial Fiducial Marker Placement for Image-guided Proton Therapy for Malignant Liver Tumors. Cardiovasc Intervent Radiol 2014; 38:1288-93. [PMID: 25366091 DOI: 10.1007/s00270-014-1013-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 08/31/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study is to analyze the technical and clinical success rates and safety of transarterial fiducial marker placement for image-guided proton therapy for malignant liver tumors. METHODS AND MATERIALS Fifty-five patients underwent this procedure as an interventional treatment. Five patients had 2 tumors, and 4 tumors required 2 markers each, so the total number of procedures was 64. The 60 tumors consisted of 46 hepatocellular carcinomas and 14 liver metastases. Five-mm-long straight microcoils of 0.018 inches in diameter were used as fiducial markers and placed in appropriate positions for each tumor. We assessed the technical and clinical success rates of transarterial fiducial marker placement, as well as the complications associated with it. Technical success was defined as the successful delivery and placement of the fiducial coil, and clinical success was defined as the completion of proton therapy. RESULTS All 64 fiducial coils were successfully installed, so the technical success rate was 100 % (64/64). Fifty-four patients underwent proton therapy without coil migration. In one patient, proton therapy was not performed because of obstructive jaundice due to bile duct invasion by hepatocellular carcinoma. Thus, the clinical success rate was 98 % (54/55). Slight bleeding was observed in one case, but it was stopped immediately and then observed. None of the patients developed hepatic infarctions due to fiducial marker migration. CONCLUSION Transarterial fiducial marker placement appears to be a useful and safe procedure for proton therapy for malignant liver tumors.
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Affiliation(s)
- Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan.
| | - Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan.
| | - Shigeru Sasaki
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, 462-8508, Japan.
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, 462-8508, Japan.
| | - Hiroko Nishikawa
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, 462-8508, Japan.
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, 462-8508, Japan.
| | - Masaki Hara
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, 462-8508, Japan.
| | - Takuya Hashizume
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan.
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan.
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31
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CT Fluoroscopy–Guided Percutaneous Fiducial Marker Placement for CyberKnife Stereotactic Radiosurgery: Technical Results and Complications in 222 Consecutive Procedures. J Vasc Interv Radiol 2014; 25:760-8. [DOI: 10.1016/j.jvir.2014.01.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/22/2013] [Accepted: 01/07/2014] [Indexed: 11/18/2022] Open
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