Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115, United States.
Department of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115, United States.
J Med Imaging Radiat Sci. 2021 Sep;52(3):409-416. doi: 10.1016/j.jmir.2021.06.004. Epub 2021 Jul 3.
To evaluate the technical success and safety of transbronchial (bronchoscopic) fiducial placement compared to percutaneous CT-guided fiducial placement for stereotactic body radiotherapy (SBRT) of lung tumors.
This IRB-approved, HIPAA-compliant retrospective study was performed at a single tertiary institution. Consecutive patients undergoing lung fiducial placement for purposes of guiding SBRT (CyberKnife®, Accuray, Inc.) between September 2005 to January 2013 were included in the study. Fiducial seeds were placed percutaneously with CT guidance or transbronchially with bronchoscopic guidance. We compared procedure-related complications (pneumothorax, chest tube placement), technical success (defined as implantation enabling adequate treatment planning with CT simulation) and migration rate. The need for repeat procedures and their mode was noted. Statistical analysis was performed using Fisher exact and Chi square probability tests.
Two hundred and forty-four patients with lung tumors and 272 fiducial seed placements were included in the study. Two hundred and twenty-one of the 272 (81.2%) fiducial markers were placed percutaneously and 51/272 (18.8%) were placed transbronchially. Pneumothorax was seen in 73/221 (33%) of percutaneously-placed fiducials and in 4/51 (7.8%) of transbronchial placements (p<0.001). No significant difference was seen in the rate of chest tube placement between the two groups: 20/221 (9%) of percutaneously placed fiducials and 2/51 (3.9%) of transbronchially placed fiducials (p=0.39). Fifteen of the 51 (29%) of fiducial placements with transbronchial approach were unsuccessful, as discovered at radiotherapy planning session, and required a repeat procedure. Nine of the 15 (60%) of repeat procedures were performed percutaneously, 5/15 (33%) were placed during repeat bronchoscopy, and 1/15 (7%) was placed at transesophageal endoscopic ultrasound. No repeat fiducial placements were required for patients who had the fiducials placed percutaneously (p<0.001), with a technical success rate of 100%.
Transbronchial fiducial marker placement has a significantly higher rate of failed seed placements requiring repeat procedures in comparison to percutaneous placement. Complication rate of pneumothorax requiring chest drain placement is similar between the two approaches.
评估经支气管（支气管镜）与经皮 CT 引导下肺肿瘤立体定向体放射治疗（SBRT）置钉术的技术成功率和安全性。
本研究经机构审查委员会批准并符合 HIPAA 规定，回顾性分析了 2005 年 9 月至 2013 年 1 月在单一的三级机构中接受 SBRT（CyberKnife，Accuray，Inc.）治疗的患者。所有患者均为肺内植入放射性粒子以引导 SBRT 治疗。纳入研究的患者接受经皮 CT 引导或经支气管镜引导下植入放射性粒子。我们比较了两组患者的并发症（气胸、胸腔引流管置入）、技术成功率（定义为植入后能进行充分的 CT 模拟治疗计划）和迁移率。记录了重复置钉的需要和方式。采用 Fisher 确切概率检验和卡方检验进行统计学分析。
本研究共纳入 244 例肺肿瘤患者和 272 枚放射性粒子。272 枚粒子中，221 枚（81.2%）经皮植入，51 枚（18.8%）经支气管镜植入。经皮植入的 221 枚放射性粒子中有 73 枚（33%）发生气胸，而经支气管镜植入的 51 枚中仅 4 枚（7.8%）发生气胸（p<0.001）。两组患者的胸腔引流管置入率无显著差异：经皮植入的 221 枚放射性粒子中有 20 枚（9%），经支气管镜植入的 51 枚中有 2 枚（3.9%）（p=0.39）。在放疗计划阶段发现，经支气管镜植入的 51 枚放射性粒子中有 15 枚（29%）植入失败，需要重复置钉。15 例中有 13 例（87%）接受了重复经皮置钉，5 例（33%）在重复支气管镜检查时植入，1 例（7%）在经食管内镜超声引导下植入。而经皮植入的患者无需重复置钉（p<0.001），技术成功率为 100%。
与经皮植入相比，经支气管镜植入放射性粒子标记物的种子植入失败率更高，需要重复植入。两种方法导致气胸需要放置胸腔引流管的并发症发生率相似。
