Department of Pulmonology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland.
Department of Pulmonology, Ospedale San Giovanni, Bellinzona, Switzerland.
Respirology. 2021 May;26(5):469-476. doi: 10.1111/resp.14006. Epub 2021 Jan 5.
SBRT is an alternative treatment for early-stage inoperable lung cancer. Metallic FM allow to increase tumour tracking precision by CyberKnife®. Currently used techniques for FM placement have many limitations; transthoracic insertion has a high risk for pneumothorax, endovascular insertion requires expertise and dedicated angiography infrastructure and endobronchial linear-gold FM dislocate frequently. This is the first study to assess the safety and efficacy of cs-FM endobronchial insertion under fluoroscopy with or without R-EBUS assessment.
We retrospectively evaluated all consecutive patients undergoing endobronchial cs-FM placement for at least one PPL <25 mm between 10.2015 and 12.2019. TBB of the PPL were performed in case of a typical R-EBUS signal. PPL tracking accuracy by CyberKnife, complications, cs-FM migration rate and procedure duration were analysed.
A total of 52 patients were treated during 55 procedures and 207 cs-FM were placed in 70 PPL. Tracking was successful for 65 of 70 (93%) PPL. R-EBUS was performed for 33 (47%) PPL and TBB for 9 (13%) PPL. Bronchospasm occurred once and any other complications were observed. Migration of cs-FM occurred in 16 of 207 (8%) cs-FM. Migration was more frequent when the target was in a previously irradiated area (P = 0.022). The median bronchoscopy duration was 31.5 min (n = 48 procedures).
Bronchoscopic cs-FM placement is a rapid and safe procedure. It is associated with a low migration rate and allows precise SBRT delivery. Previous irradiation of the PPL was associated with a higher migration rate.
SBRT 是一种治疗早期不可手术的肺癌的替代方法。金属 FM 可通过 CyberKnife®提高肿瘤跟踪精度。目前 FM 放置的技术有很多局限性；经胸插入有气胸的高风险，血管内插入需要专业知识和专用血管造影基础设施，而支气管内线性金 FM 经常脱位。这是第一项评估在透视下或联合 R-EBUS 评估下经支气管 cs-FM 插入的安全性和有效性的研究。
我们回顾性评估了 2015 年 10 月至 2019 年 12 月期间至少有一个 PPL <25mm 的患者进行的经支气管 cs-FM 放置。在典型的 R-EBUS 信号的情况下，对 PPL 进行 TBB。分析 CyberKnife 的 PPL 跟踪准确性、并发症、cs-FM 迁移率和手术时间。
共有 52 名患者在 55 次治疗中接受了治疗，70 个 PPL 中放置了 207 个 cs-FM。65 个 PPL 的跟踪成功。33 个 PPL 进行了 R-EBUS，9 个 PPL 进行了 TBB。发生了一次支气管痉挛，没有观察到其他任何并发症。207 个 cs-FM 中有 16 个发生了迁移。当靶区位于先前照射区域时，cs-FM 的迁移更为频繁（P = 0.022）。中位支气管镜检查时间为 31.5 分钟（n = 48 例手术）。
经支气管 cs-FM 放置是一种快速安全的操作。它具有较低的迁移率，并能精确地进行 SBRT 治疗。PPL 的先前照射与更高的迁移率相关。
