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This Article Full Text (PDF) Free All Versions of this Article: chest.07-0522v1 132/3/930    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Anantham, D. Articles by Ernst, A. Search for Related Content PubMed PubMed Citation Articles by Anantham, D. Articles by Ernst, A.

Electromagnetic navigation bronchoscopy guided fiducial placement for robotic stereotactic radiosurgery of lung tumors -- a feasibility study

¹Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA ²Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA ³Thoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA ⁴Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Germany

aernst{at}bidmc.harvard.edu

Abstract

BackgroundCyberknife^® stereotactic radiosurgery is a treatment option for patients who are medically unfit to undergo lung tumor resection. For precise tumor ablation, Cyberknife^® requires fiducial marker placement in or near the target tumor. Fiducial placement under transthoracic CT guidance is associated with a high risk of iatrogenic pneumothorax. Electromagnetic navigation bronchoscopy may offer a less morbid alternative to accurately deploy fiducials to bronchoscopically invisible peripheral lung lesions.

ObjectivesOpen-label, feasibility study to assess fiducial placement in peripheral lung tumors by electromagnetic navigation bronchoscopy.

MethodConsecutive patients with peripheral lung tumors, and who were evaluated to be non-surgical candidates, underwent fiducial placement under electromagnetic navigation bronchoscopy. This procedure was considered successful if fiducials were placed in or near the tumors and remained in place without migration for radiosurgery to proceed. The need for alternative or additional intra-thoracic fiducial placement was documented as procedure failure.

ResultsA total of 39 fiducials markers were successfully deployed in 8 of 9 patients (89%). Of these 8 successful cases, 7 had fiducials placed directly within the tumor (88%). At Cyberknife^® planning, 7-10 days after fiducial placement, 35/39 (90%) of fiducial markers were still in place and were adequate to allow radiosurgery to proceed. No immediate bronchoscopic complications were observed. One patient experienced a COPD exacerbation. Another patient returned within one day with transient, self-limiting fever.

ConclusionsElectromagnetic navigation bronchoscopy can be used to deploy fiducial markers for Cyberknife^® radiosurgery of lung tumors safely and accurately without the complications associated with transthoracic placement.

Key Words: Cyberknife^® • Electromagnetic navigation bronchoscopy • Fiducial • Lung cancer • Robotic stereotactic radiosurgery