CT Fluoroscopy-Guided Percutaneous Fiducial Marker Placement for CyberKnife Stereotactic Radiosurgery: Technical Results and Complications in 222 Consecutive Procedures
CT Fluoroscopy-Guided Percutaneous Fiducial Marker Placement for CyberKnife Stereotactic Radiosurgery: Technical Results and Complications in 222 Consecutive Procedures
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DOI：
10.1016/j.jvir.2014.01.004
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发表时间：
2014-05-01
影响因子：
2.9
通讯作者：
Hoffmann, Ralf-Thorsten
中科院分区：
文献类型：
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作者：
Trumm, Christoph G.;Haeussbler, Sophia M.;Hoffmann, Ralf-Thorsten
目的：评估射波刀立体定向放射外科手术前计算机断层扫描（CT）透视引导经皮基准标记放置的技术、结果和安全性。材料和方法：对222例接受CT透视引导基准标记放置的196名患者（106名男性）进行了回顾性分析。2006年3月至2012年2月在局部麻醉下进行的连续性手术。技术成功定义为在介入后计划CT上评价的肿瘤或附近的基准标记位置适合射波刀放射外科手术。根据介入放射学会（SIR）对并发症进行分类。（年龄，61.5岁+/- 13.1）接受了321个基准标记的经皮放置（平均每个肿瘤，1.2 +/- 0.5;范围，1-4）在37原发性肿瘤和227转移在胸部（n = 121），腹部（n = 122），和骨（n = 21）。在所有手术中，基准标记物放置在技术上都是成功的：193例（60.1%）在肿瘤边缘进行了肿瘤内定位。50例（15.6%），78例（24.3%;距标记物的平均距离为0.4 cm +/- 0.6;范围为0-2.9 cm）位于肿瘤外。在63例置入手术（28.4%）中观察到并发症，包括轻微自限性气胸（n = 21; SIR B类）和自限性肺出血（n = 35; SIR A类），以及需要胸廓造口术/引流插入的严重气胸（n = 14; SIR类）。结论：在局部麻醉下，在各种解剖区域，CT透视引导下经皮基准标记物放置可以以高技术成功率进行。尽管在大多数情况下是自限性的，但在基准标记植入肺肿瘤期间经常观察到气胸和肺出血。
Purpose: To evaluate technical, outcome and safety of computed tomographic (CT) fluoroscopy guided percutaneous fiducial marker placement before CyberKnife stereotactic radiosurgery.Materials And Methods: Retrospective analysis was performed of 196 patients,(106 men) undergoing CT fluoroscopy guided fiducial Marker placement in 222. Consecutive procedures under local anesthesia from March 2006 to February 2012. Technical success was defined as fiducial marker location in the tumor or vicinity suitable for CyberKnife radiosurgery evaluated on postinterventional planning CT. Complications were classified per Society of Interventional Radiology (SIR).Results: One hundred ninety-six patients (age, 61.5 y +/- 13.1) underwent percutaneous placement of 321 fiducial markers (mean per tumor, 1.2 +/- 0.5; range, 1-4) in 37 primary tumors and 227 metastases in the thorax (n = 121), abdomen (n = 122), and bone (n = 21). Fiducial marker placement was technically successful in all procedures: intratumoral localization in 193 (60.1%), at tumor margin. in 50 (15.6%), and outside of tumor in 78 cases (24.3%; mean distance to marker, 0.4 cm +/- 0.6; range, 0-2.9 cm). Complications were observed in 63 placement procedures (28.4%), including minor self-limiting pneumothorax (n = 21; SIR class B) and self-limiting pulmonary hemorrhage (n = 35; SIR class A), and major pneumothorax requiring thoracostomy/drainage insertion (n = 14; SIR class. D) and systemic toxicity of local anesthetic drug (n = 1; SIR class D).Conclusions: CT fluoroscopy guided percutaneous fiducial Marker placement can be performed with high technical success under local anesthesia in Various anatomic regions. Although self-limiting in most cases, pneumothorax: and pulmonary hemorrhage ate frequently observed during fiducial marker implantation into lung tumors.