Endoscopic placement of fiducial markers for real-time tumor-tracking radiotherapy in 50 patients with lung cancer: A feasibility study

Purpose: Fiducial markers can be used for real-time tumor-tracking radiotherapy in patients with lung cancer. CT-guided placement is associated with a substantial complication rate (15%-30% pneumothorax). In this retrospective study we examined the feasibility and safety of bronchoscopic placement of fiducial markers (gold coils) into/nearby solid lung lesions. Methods: We placed 137 gold coils (35 by needle: 0,5 x 5 mm, and 102 by brush: 1,2 x 3mm) in 50 consecutive patients with lung lesions. We used electromagnetic navigation bronchoscopy (ENB) and/or fluoroscopy for guidance. 74% of patients were male, mean age was 71,6a, mean FeV1 was 1,7l (60% of predicted). Anatomical distribution of lung lesions was mostly in the inner-third of the lung parenchyma (38%), followed by peripheral lesions (34%) and lesions located in the mid-third of the lungs (28%). Results: Migration rate of the fiducial markers was 20%. We did not observe any severe complications throughout bronchoscopy, e.g. pneumothorax or haemoptysis. Three (=8%) of the patients developed radiotherapy-associated pneumonitis. View this table: Migration of fiducial markers Conclusion: Placement of fiducial markers through ENB or fluoroscopy guided bronchoscopy is a safe and effective methode without complications. Real-time tumor-tracking radiotherapy with fiducial markers decreases the risk of pneumonitis.