用于早期肺癌射波刀立体定向放射治疗计划的血管内基准标记物插入的安全性和有效性

Safety and Efficacy of Endovascular Fiducial Marker Insertion for CyberKnife Stereotactic Radiation Therapy Planning in Early-Stage Lung Cancer.

作者信息

Mongeon Mikael, Thibault Florence, Chartrand-Lefebvre Carl, Gorgos Andrei-Bogdan, Soulez Gilles, Filion Edith, Therasse Eric

机构信息

Department of Radiology, Centre Hospitalier Pierre Le Gardeur, Terrebonne, Quebec, Canada.

Department of Radiology, Centre Hospitalier de l'Université de Montréal, 3840, rue Saint-Urbain, Montréal, Québec, Canada H2W 1T8.

出版信息

J Vasc Interv Radiol. 2017 Aug;28(8):1090-1097. doi: 10.1016/j.jvir.2017.05.010. Epub 2017 Jun 16.

DOI:10.1016/j.jvir.2017.05.010

PMID:28629928

Abstract

PURPOSE

To evaluate the safety and efficacy of endovascular fiducial markers (EVFMs) for CyberKnife stereotactic radiation therapy (RT) of malignant lung neoplasms in patients with contraindications to percutaneous fiducial marker (PTFM) placement.

MATERIALS AND METHODS

Between January 2011 and December 2013, 15 patients (7 men and 8 women) aged 59-87 years (mean, 73 y) underwent EVFM placement and 109 patients (54 men and 55 women) aged 55-92 years (mean, 73 y) underwent 114 PTFM placements. All patients who received EVFMs had contraindications to PTFM insertion. Complications were recorded for all 129 procedures. Proportions of markers used for CyberKnife stereotactic RT planning and distance between markers and tumor were assessed in all 15 patients in the EVFM group and in 15 randomly selected patients in the PTFM group.

RESULTS

Sixty-two EVFMs and 56 PTFMs were inserted in the groups of 15 patients. CyberKnife stereotactic RT was not performed in 2 EVFM recipients (8 EVFMs) and 1 PTFM recipient (4 PTFMs). CyberKnife stereotactic RT was planned with the use of 39 of 54 EVFMs (72%) in 13 patients and 37 of 52 PTFMs (71%) in 14 patients. Mean distances between the tumor and EVFMs and PTFMs were 5.5 mm and 2.7 mm, respectively (P = .0152). No complications occurred in the EVFM group. In the PTFM group, 60 of 114 patients (52.6%) had small or moderate pneumothoraxes, 13 (11.4%) had chest tubes inserted, and 5 (4.4%) had self-limiting hemoptysis.

CONCLUSIONS

EVFM is feasible and safe, and may therefore offer an alternative when patients are not candidates for percutaneous marker placement.

摘要

目的

评估血管内基准标记物（EVFM）在有经皮基准标记物（PTFM）放置禁忌证的恶性肺肿瘤患者的射波刀立体定向放射治疗（RT）中的安全性和有效性。

材料与方法

2011年1月至2013年12月期间，15例年龄在59 - 87岁（平均73岁）的患者（7例男性，8例女性）接受了EVFM放置，109例年龄在55 - 92岁（平均73岁）的患者（54例男性，55例女性）接受了114次PTFM放置。所有接受EVFM的患者均有PTFM插入的禁忌证。记录了所有129例手术的并发症。在EVFM组的所有15例患者以及PTFM组随机选择的15例患者中，评估了用于射波刀立体定向RT计划的标记物比例以及标记物与肿瘤之间的距离。

结果

在15例患者组中，分别插入了62个EVFM和56个PTFM。2例接受EVFM的患者（8个EVFM）和1例接受PTFM的患者（4个PTFM）未进行射波刀立体定向RT。13例患者中，54个EVFM中的39个（72%）用于射波刀立体定向RT计划，14例患者中52个PTFM中的37个（71%）用于该计划。肿瘤与EVFM和PTFM之间的平均距离分别为5.5毫米和2.7毫米（P = 0.0152）。EVFM组未发生并发症。在PTFM组中，114例患者中有60例（52.6%）发生轻度或中度气胸，13例（11.4%）插入了胸管，5例（4.4%）出现自限性咯血。