Risks and Benefits of Fiducial Marker Placement in Tumor Lesions for Robotic Radiosurgery: Technical Outcomes of 357 Implantations
by
, , , and
Melina Kord
1,2
,
Anne Kluge
1,2,
Markus Kufeld
2,
Goda Kalinauskaite
1,2,
Franziska Loebel
2,3,
Carmen Stromberger
1,2,
Volker Budach
1,2,
Bernhard Gebauer
4,
Gueliz Acker
2,3,5,† and
Carolin Senger
1,2,*,† 1
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
2
Charité CyberKnife Center, Augustenburger Platz 1, 13353 Berlin, Germany
3
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
4
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
5
Berlin Institute of Health at Charité Universitätsmedizin Berlin, BIH Acadamy, Clinician Scientist Program, Charitéplatz 1, 10117 Berlin, Germany
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this study.
Cancers 2021, 13(19), 4838; https://doi.org/10.3390/cancers13194838
Submission received: 29 July 2021
/
Revised: 19 September 2021
/
Accepted: 22 September 2021
/
Published: 28 September 2021
(This article belongs to the Special Issue Advanced Image-Guided Robotic Technology Based Radiosurgery for Cancers)
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.
Keywords:
CyberKnife; robotic radiosurgery; fiducial marker; tumor tracking; target motion
