Karaman Kutlay, Dokdok A Murat, Karadeniz Oktay, Ceylan Cemile, Engin Kayıhan
Department of Radiology, Anadolu Medical Center, Kocaeli 41400, Turkey.
Department of Radiation Oncology, Anadolu Medical Center, Kocaeli 41400, Turkey.
Korean J Radiol. 2015 May-Jun;16(3):626-31. doi: 10.3348/kjr.2015.16.3.626. Epub 2015 May 13.
To present our experience with placing endovascular coils in pulmonary arteries used as a fiducial marker for CyberKnife therapy and to describe the technical details and complications of the procedure.
Between June 2005 and September 2013, 163 patients with primary or secondary lung malignancies, referred for fiducial placement for stereotactic radiosurgery, were retrospectively reviewed. Fourteen patients (9 men, 5 women; mean age, 70 years) with a history of pneumonectomy (n = 3), lobectomy (n = 3) or with severe cardiopulmonary co-morbidity (n = 8) underwent coil (fiducial marker) placement. Pushable or detachable platinum micro coils (n = 49) 2-3 mm in size were inserted through coaxial microcatheters into a small distal pulmonary artery in the vicinity of the tumor under biplane angiography/fluoroscopy guidance.
Forty nine coils with a median number of 3 coils per tumor were placed with a mean tumor-coil distance of 2.7 cm. Forty three (87.7%) of 49 coils were successfully used as fiducial markers. Two coils could not be used due to a larger tumor-coil distance (> 50 mm). Four coils were in an acceptable position but their non-coiling shape precluded tumor tracking for CyberKnife treatment. No major complications needing further medication other than nominal therapy, hospitalization more than one night or permanent adverse sequale were observed.
Endovascular placement of coil as a fiducial marker is safe and feasible during CyberKnife therapy, and might be an option for the patients in which percutaneous transthoracic fiducial placement might be risky.
介绍我们在肺动脉中放置血管内线圈作为射波刀治疗的基准标记物的经验，并描述该操作的技术细节和并发症。
回顾性分析2005年6月至2013年9月期间163例因立体定向放射外科手术需要放置基准标记物而转诊的原发性或继发性肺恶性肿瘤患者。14例患者（9例男性，5例女性；平均年龄70岁）有肺叶切除术（n = 3）、肺段切除术（n = 3）病史或患有严重心肺合并症（n = 8），接受了线圈（基准标记物）放置。在双平面血管造影/荧光透视引导下，将尺寸为2 - 3毫米的可推送或可分离铂微线圈（n = 49）通过同轴微导管插入肿瘤附近的小的远端肺动脉。
共放置49个线圈，每个肿瘤平均放置3个线圈，肿瘤与线圈的平均距离为2.7厘米。49个线圈中有43个（87.7%）成功用作基准标记物。2个线圈因肿瘤与线圈距离较大（> 50毫米）而无法使用。4个线圈位置可接受，但未卷曲的形状妨碍了射波刀治疗对肿瘤的追踪。未观察到除名义治疗外需要进一步药物治疗、住院超过一晚或永久性不良后遗症的重大并发症。
在射波刀治疗期间，血管内放置线圈作为基准标记物是安全可行的，对于经皮经胸放置基准标记物可能有风险的患者可能是一种选择。
