Therapeutic usability of two different fiducial gold markers for robotic stereotactic radiosurgery of liver malignancies: A pilot study

Abstract

AIM:To assess how the application of different types of markers affects the tracking accuracy of CyberKnife's. METHODS:Fifteen patients were recruited and subjected to the ultrasound-guided placement of markers. Two different type of needles 25 gauge (G) and 17 G containing two different fiducial marker, gold notched flexible anchor wire 0.28 mm × 10 mm (25 G needle) and gold cylindrical grain 1 mm × 4 mm (17 G), were used. Seven days after the procedure, a CyberKnife planning computed tomography (CT) for the simulation of radiation treatment was performed on all patients. Therapeutic usability of two different fiducial gold markers for robotic stereotactic radiosurgery of liver malignancies: A pilot study Clinical Trials Study ORIGINAL ARTICLEA binary CT score was assigned to the fiducial markers visualization. Also, the CT number was calculated for each fiducial and the values compared with a specific threshold. RESULTS:For each patient from 1 to 5, intra-hepatic markers were placed (one in 2 patients, three in 8 patients, four in 3 patients, and five in 2 patients). A total of 48 needles were used (thirty-two 17 G and sixteen 25 G) and 48 gold markers were placed (32 Grain shaped markers and 16 Gold Anchor). The result showed that the CT visualization of the grain markers was better than the anchor markers (P = 5 × 10 -9 ). Furthermore, the grain markers were shown to present minor late complications (P = 3 × 10 -6 ), and the best CT threshold number (P = 0.0005). CONCLUSION:The study revealed that the Gold Anchor fiducial marker is correlated with a greater number of late minor complications and low visualization by the CT. Core tip: Robotic radiosurgery can employ different systems for the localization of the neoplastic targets to treat. The purpose of this study is to assess how the application of different types of markers affects the tracking accuracy of CyberKnife's. Fifteen patients have been recruited and analyzed for the study and two types of markers were used for the procedure. The computed tomography (CT) visualization of grain markers was better than anchor markers P = 5 × 10 -9. Grain markers presented minor late complications of P = 3 × 10 -6, and the best CT threshold number. The study revealed that the Gold Anchor fiducial marker is correlated with a greater number of late minor complication.Marsico M, Gabbani T, Livi L, Biagini MR, Galli A. Therapeutic usability of two different fiducial gold markers for robotic stereotactic radiosurgery of liver malignancies: A pilot study.

Percutaneous ultrasound-guided fiducial marker placement for liver cancer robotic stereotactic radio-surgery treatment: A comparative analysis of three types of markers and needles

“…Moreover, the 22 G needle is optimal for good placement because of its adequate diameter, which leads to a reduced complication rate. Furthermore, in accordance with the existing literature, our study suggests that US-guided fiducial placement is safe and effective and might represent a valuable and reliable alternative to CT-guided placement [21][22][23][24]. However, our study has limitations such as being a single-centre experience, etherogeneity of the patient population, and the lack of a randomized design.…”

Evaluation of computed tomography metal artifact and CyberKnife fiducial recognition for novel size fiducial markers

“…For fiducial recognition in TLS, Marsico et al. performed a subjective visual evaluation of CT images, 22 and our previous study evaluated fiducial recognition under the conditions of difficult‐to‐track markers in the CyberKnife system 5 . However, no study has evaluated fiducial recognition of the novel‐sized fiducial marker newly available for CyberKnife treatment.…”

Computed tomography or contrast‐enhanced ultrasonography for follow‐up of liver metastases after Cyberknife therapy?: A prospective pilot study

“…Stereotaxic body radiotherapy is an emerging treatment modality frequently adopted to treat primary and secondary tumors that are not amenable to surgical treatment and after failure or relapse following chemotherapy . The evaluation of the efficacy or disease progression is usually performed with CECT, which is considered the reference standard.…”

“…Stereotaxic body radiotherapy is an emerging treatment modality frequently adopted to treat primary and secondary tumors that are not amenable to surgical treatment and after failure or relapse following chemotherapy. 15 The evaluation of the efficacy or disease progression is usually performed with CECT, which is considered the reference standard. In this pilot prospective study, we compared the concordance of CEUS with CECT as an alternative imaging modality in patients with liver metastasis, and we found an excellent agreement (Cohen κ = 1.00).…”