Division of Thoracic and Esophageal Surgery, Case Medical Center University Hospitals, Cleveland, OH 44106-5011, USA.
J Thorac Cardiovasc Surg. 2010 Nov;140(5):1137-42. doi: 10.1016/j.jtcvs.2010.07.085. Epub 2010 Sep 20.
CyberKnife stereotactic body radiosurgery is a potentially curative option for medically inoperable Stage I lung cancer. Fiducial marker placement in or near the tumor is required. Transthoracic placement using computed tomography guidance has been associated with a high risk of iatrogenic pneumothorax. Electromagnetic navigation bronchoscopy offers a safer method of placing markers; however, previous studies using linear markers have shown at least a 10% dislocation rate. We describe the use of coil-spring fiducial markers placed under moderate sedation in an outpatient bronchoscopy suite.
A total of 52 consecutive nonoperative patients with isolated lung tumors underwent fiducial placement using electromagnetic navigation bronchoscopy. Of the 52 patients, 4 received 17 linear fiducial markers, and 49 patients with 56 tumors received 217 coil-spring fiducial markers. The procedures were considered successful if the fiducial markers had been placed in or near the tumors and had remained in place without migration, allowing radiosurgery without the need for additional fiducial markers.
A total of 234 fiducial markers were successfully deployed in 52 patients with 60 tumors (mean diameter 23.7 mm). Of these 60 tumors, 35 (58%) were adjacent to the pleura. At CyberKnife planning, 8 (47%) of 17 linear fiducial markers and 215 (99%) of 217 coil-spring fiducial markers (P = .0001) were still in place. Of the 4 patients with linear fiducial markers, 2 required additional fiducial placements; none of the patients with coil fiducial markers required additional procedures. Three pneumothoraces (5.8%) occurred in peripheral lesions (2 were treated with a pig-tail chest tube and 1 with observation only).
Deployment of coil spring fiducial markers using navigation bronchoscopy can safely be performed with the patient under moderate sedation with almost no migration and a 5.8% rate of pneumothorax.
CyberKnife 立体定向体放射外科治疗对于无法手术的 I 期肺癌是一种潜在的根治性选择。肿瘤内或附近需要放置基准标记物。经胸 CT 引导下的基准标记物放置与较高的医源性气胸风险相关。电磁导航支气管镜提供了一种更安全的放置标记物的方法；然而，之前使用线性标记物的研究显示，至少有 10%的脱位率。我们描述了在门诊支气管镜检查室中度镇静下使用螺旋弹簧基准标记物的使用情况。
52 例连续的孤立性肺肿瘤非手术患者接受了电磁导航支气管镜下的基准标记物放置。52 例患者中，4 例接受了 17 个线性基准标记物，49 例 56 个肿瘤接受了 217 个螺旋弹簧基准标记物。如果基准标记物已经放置在肿瘤内或附近，并且没有迁移，允许进行放射外科治疗而无需额外的基准标记物，则认为该程序是成功的。
52 例患者的 60 个肿瘤（平均直径 23.7 毫米）中成功植入了 234 个基准标记物。这些肿瘤中，35 个（58%）靠近胸膜。在 CyberKnife 计划中，17 个线性基准标记物中的 8 个（47%）和 217 个螺旋弹簧基准标记物中的 215 个（99%）仍在原处（P=0.0001）。4 例接受线性基准标记物的患者中，有 2 例需要额外的基准标记物放置；没有接受螺旋弹簧基准标记物的患者需要额外的手术。3 例（5.8%）发生在外周病变的气胸（2 例采用猪尾胸管治疗，1 例仅观察）。
在患者中度镇静下使用导航支气管镜安全地部署螺旋弹簧基准标记物，几乎没有迁移，气胸发生率为 5.8%。
