Dutta Debnarayan, Kataki Kaushik Jagannath, George Shibu, Reddy Sruthi K, Sashidharan Ajay, Kannan Rajesh, Madhavan Ram, Nair Haridas, Tatineni Tushar, Holla Raghavendra
Department of Radiation Oncology, Amrita Institute of Medical Science, Kochi, India.
Department of Radiology, Amrita Institute of Medical Science, Kochi, India.
Radiat Oncol J. 2020 Dec;38(4):253-261. doi: 10.3857/roj.2020.00472. Epub 2020 Nov 30.
Evaluate morbidities and "quality" of fiducial marker placement in primary liver tumours (hepatocellular carcinoma [HCC]) for CyberKnife.
Thirty-six HCC with portal vein thrombosis(PVT) were evaluated for "quality" of fiducial placement, placement time, pain score, complications, recovery time and factors influencing placement.
One hundred eight fiducials were placed in 36 patients. Fiducial placement radiation oncologist score was "good" in 24(67%), "fair" in 4(11%), and "poor" in 3(8%) patients. Concordance with radiologist score in "poor", "fair", and "good" score was 2/2(100%), 4/5(80%), and 24/27(89%), respectively(p=0.001). Child-Pugh score(p=0.080), performance status(PS) (p=0.014) and accrued during "learning curve"(p=0.013) affected placement score. Mean placement time(p=0.055), recovery time(p=0.025) was longer and higher major complications(p=0.009) with poor PS. Liver segment involved(p=0.484) and the Barcelona Clinic Liver Cancer(BCLC) stage did not influence placement score. "Good" placement score was 30% in first cohort whereas 93% in last cohort(p=0.023). Time for placement was 42.2 and 14.3 minutes, respectively(p=0.069). Post-fiducial pain score 0-1 in 26 patients(72%) and pain score 3-4 was in 2(6%). Five patients (14%) admitted in "day-care"(2 mild pneumothorax, 3 pain). Mortality in 1 patient(3%) admitted for hemothorax.
Fiducial placement is safe and in experienced hands, "quality" of placement is "good" in majority. Major complications and admission after fiducial placement are rare. Complications, fiducial placement time, recovery time is more during the "learning curve". Poor Child-Pugh score, extensive liver involvement, poor PS have higher probability of complications.
评估射波刀治疗原发性肝癌（肝细胞癌[HCC]）时基准标记放置的发病率及“质量”。
对36例伴有门静脉血栓形成（PVT）的HCC患者进行基准标记放置“质量”、放置时间、疼痛评分、并发症、恢复时间及影响放置的因素评估。
36例患者共放置了108个基准标记。基准标记放置放射肿瘤学家评分为“良好”的患者有24例（67%），“中等”的有4例（11%），“差”的有3例（8%）。与放射科医生在“差”“中等”“良好”评分上的一致性分别为2/2（100%）、4/5（80%）和24/27（89%）（p=0.001）。Child-Pugh评分（p=0.080）、体能状态（PS）（p=0.014）及在“学习曲线”期间累积的情况（p=0.013）影响放置评分。PS差时，平均放置时间（p=0.055）、恢复时间（p=0.025）更长，主要并发症发生率更高（p=0.009）。肝段受累情况（p=0.484）及巴塞罗那临床肝癌（BCLC）分期不影响放置评分。第一组“良好”放置评分占比30%，而最后一组为93%（p=0.023）。放置时间分别为42.2分钟和14.3分钟（p=0.069）。26例患者（72%）基准标记放置后的疼痛评分为0 - 1分，疼痛评分为3 - 4分的有2例（6%）。5例患者（14%）需“日间护理”（2例轻度气胸，3例疼痛）。1例因血胸入院患者死亡（3%）。
基准标记放置是安全的，在经验丰富的医生操作下，大多数放置“质量”良好。基准标记放置后主要并发症及入院情况罕见。在“学习曲线”期间并发症、基准标记放置时间、恢复时间更多。Child-Pugh评分差、肝受累范围广、PS差时并发症发生概率更高。
