Korean J Radiol.  2015 Jun;16(3):626-631. 10.3348/kjr.2015.16.3.626.

Intravascular Placement of Metallic Coils as Lung Tumor Markers for CyberKnife Stereotactic Radiation Therapy

• Karaman K
• Dokdok AM
• Karadeniz
• Ceylan C
• Engin K

• KMID: 2155533
• DOI: http://doi.org/10.3348/kjr.2015.16.3.626

Abstract

OBJECTIVE
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.
MATERIALS AND METHODS
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.
RESULTS
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.
CONCLUSION
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.

Keyword

Fiducial marker; Lung neoplasm; CyberKnife

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
*Fiducial Markers
Humans
Lung/surgery
Lung Neoplasms/*surgery
Male
Middle Aged
Platinum
Pneumonectomy
*Pulmonary Artery
Radiosurgery/*methods
Retrospective Studies
Platinum

Figure

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  Fig. 1 60-year-old male with non-small cell lung carcinoma (patient No. 10). Digital fluoroscopic image shows microcatheter placed in smaller pulmonary artery. Coil being pushed out of catheter is indicated by arrow.

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  Fig. 2 72-year-old male with metastatic adenocarcinoma (patient No. 5). A. Digital fluoroscopic image shows endovascular coils (arrows) which were placed into both lungs in single procedure. Tumors in both lungs were treated with CyberKnife. B. Coronal maximum intensity projection CT image shows two endovascular coils (arrows) in right lung, which were adequately placed in vicinity of tumor (star).

• 

  Fig. 3 71-year-old male with metastatic non-small cell lung carcinoma (patient No. 6). Digital fluoroscopic image shows endovascular coil, which has been deployed in non-coiling shape (arrow). Coils in such shape cannot be used for tumor tracking in CyberKnife radiosurgery.

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