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Original Articles: General Thoracic

Fiducial Marker Placement Using Endobronchial Ultrasound and Navigational Bronchoscopy for Stereotactic Radiosurgery: An Alternative Strategy

^a Division of Thoracic Surgery, Franklin Square Hospital, Baltimore, Maryland
^d Division of Radiation Oncology, Franklin Square Hospital, Baltimore, Maryland
^b Division of Pulmonary Medicine, Baltimore, Maryland
^c Pulmonary and Critical Care Associates of Baltimore (PCCAB), Baltimore, Maryland

Accepted for publication September 17, 2009.

^_* Address correspondence to Dr Krimsky, 9103 Franklin Square Dr, Ste 300, Baltimore, MD 21237 (Email: william.krimsky{at}medstar.net).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: Stereotactic radiosurgery is being increasingly used to treat patients with early-stage non-small cell lung cancers (NSCLC) who are not candidates for surgical resection. Stereotactic radiosurgery usually needs fiducial markers (FMs) for the tracking process. FMs have generally been placed using percutaneous computed axial tomography scan guidance. We report the results of FM placement using endobronchial ultrasound (EBUS) in 43 patients.

Methods: A multidisciplinary tumor board evaluates NSCLC patients before they are offered stereotactic radiosurgery. In patients selected for stereotactic radiosurgery, FMs were inserted into peripheral, central, and mediastinal tumors using EBUS and, in selected patients, navigational bronchoscopy. Patients underwent repeat computed axial tomography chest scans 2 weeks later to ensure stability of the FMs before beginning stereotactic radiosurgery.

Results: Included were 43 consecutive patients (21 men, 22 women; mean age, 74.4 years). Forty-two (98%) had NSC carcinomas (5 recurrences); 1 had a carcinoid tumor. Twenty-two tumors were located in the left lung, 19 in the right lung, 1 at the carina, and 1 pretracheal. Two to 5 FMs were placed in and around all tumor masses using EBUS and, for peripheral lesions, EBUS combined with navigational bronchoscopy. Thirty patients had no displacement of FMs. In the 13 who had displaced 1 or more FMs, the ability to use the remaining FMs for stereotactic radiosurgery was unimpaired.

Conclusions: EBUS and navigational bronchoscopy are safe and effective methods to position FMs for preparing patients with both central and peripheral lung cancers for stereotactic radiosurgery.

This article has been cited by other articles:

				S. Senan and D. Palma Stereotactic Lung Radiotherapy: Do We Need Fiducial Markers? Ann. Thorac. Surg., January 1, 2011; 91(1): 335 - 336. [Full Text] [PDF]

				C. Aygun, J. Rodgers, W. Krimsky, D. Highfield, B. Gurses, S. Sarkar, and D. Harley Reply. Ann. Thorac. Surg., January 1, 2011; 91(1): 336 - 336. [Full Text] [PDF]

				C. Schroeder, R. Hejal, and P. A. Linden Coil spring fiducial markers placed safely using navigation bronchoscopy in inoperable patients allows accurate delivery of CyberKnife stereotactic radiosurgery J. Thorac. Cardiovasc. Surg., November 1, 2010; 140(5): 1137 - 1142. [Abstract] [Full Text] [PDF]