Improved respiratory motion tracking through a novel fiducial marker placement guidance system during electromagnetic navigational bronchoscopy (ENB)

Stereotactic ablative radiotherapy (SABR) is a treatment option for patients with early stage non-small cell lung cancer (NSCLC) and recurrent or oligometastatic disease who are not surgical candidates. Due to the continuous motion of tumors within the lungs, implementing a strategy to track the tar...

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Bibliographic Details
Published in:	Radiation oncology (London, England) Vol. 14; no. 1; p. 124
Main Authors:	Stowe, Hayley, Ogake, Stella, Sharma, Sunil, Kelly, Suzanne, McDonald, Morgan, Stanley, Kayla, Walker, Paul, Arastu, Hyder, Granadillo, Carlos Anciano, Bowling, Mark, Ju, Andrew
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 11-07-2019 BioMed Central BMC
Subjects:	Abdomen Ablation Analysis Biopsy Bronchoscopy Bronchoscopy - methods Cancer Cancer therapies Carcinoma, Non-Small-Cell Lung - surgery Care and treatment Clinical trials CyberKnife Electromagnetic navigational bronchoscopy Electromagnetic Phenomena Electromagnetism Feasibility studies Fiducial Fiducial Markers Humans Lesions Light emitting diodes Lung cancer Lung diseases Lung Neoplasms - surgery Lung tumors Lungs Markers Metastasis Monitoring, Physiologic Movement Non-small cell lung cancer Non-small cell lung carcinoma Novels Patients Placement Radiation therapy Radiosurgery - methods Radiotherapy Radiotherapy Planning, Computer-Assisted - methods Recurrence (Disease) Respiratory Mechanics Respiratory-Gated Imaging Techniques Retrospective Studies Robotic surgery Robotics SABR Small cell lung cancer Stereotactic ablative radiotherapy Tracking Treatment outcome Tumors Ultrasonic imaging X-rays Fiducial Electromagnetic navigational bronchoscopy Lung cancer Stereotactic ablative radiotherapy SBRT SABR CyberKnife
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Summary:	Stereotactic ablative radiotherapy (SABR) is a treatment option for patients with early stage non-small cell lung cancer (NSCLC) and recurrent or oligometastatic disease who are not surgical candidates. Due to the continuous motion of tumors within the lungs, implementing a strategy to track the target lesion is crucial. One method is to place fiducial markers which the robotic SABR system is able to track during treatment. However, placing these markers in a manner that maximizes tracking efficacy can be challenging. Using a novel fiducial placement guidance system (FPGS) during fiducial deployment may offer a way to improve the quantity of fiducials tracked by the robotic SABR system. This was an institutional, retrospective review identifying all patients who received robotic SABR for lung tumors from May 2015 until January 2017. The FPGS was instituted in May 2016. The median number of fiducials tracked and the rate of complication was compared between patients whose fiducials were placed using FPGS versus those that were not. A total of 128 patients with 147 treated lung lesions were identified. Of the lesions that utilized FPGS (n = 44), 28 had 2 tracked fiducials (63.6%), 14 had 3 (31.8%) and 2 had 4 (4.6%). Of the lesions treated without FPGS (n = 103), 5 had 1 tracked fiducial (4.9%), 91 had 2 (88.4%), 6 had 3 (5.8%), and 2 had 4 (1.9%). A significant improvement in the median number of fiducials tracked per fraction was observed for the lesions with fiducials placed using FPGS on Wilcoxon rank sum test (p < 0.001). The rate of complication was low and not statistically different between cohorts (p = 0.44). The FPGS can be used during the deployment of fiducial markers and may increase the number of fiducials tracked. An exemption for this retrospective review was granted by the East Carolina University IRB under UMCIRB 15-001726.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1748-717X 1748-717X
DOI:	10.1186/s13014-019-1306-0