Ultrasound-Guided Placement of Gold Fiducial Markers for Stereotactic Partial-Breast Irradiation

Seiler, Stephen; Rahimi, Asal; Choudhery, Sadia; Garwood, Dan; Spangler, Ann; Cherian, Solomon; Goudreau, Sally

doi:10.2214/ajr.15.14771

Cited by 14 publications

(11 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Prior to the treatment, three to four gold fiducials were placed near the surgical bed with ultrasound guidance by a certified radiologist together with the treating radiation oncologist, in local anaesthesia. For optimal tracking, the maximum and minimum distances between fiducial markers were less than 10 cm and more than 2 cm, and the markers were placed at least 1-2 cm away from the seroma cavity, as recommended by Seiler et al [38]. One week after gold marker placement, a new simulation CT was performed in a supine position with both arms next to the body with 1.25 mm axial slice spacing.…”

Section: Methodsmentioning

confidence: 99%

Implementation of Stereotactic Accelerated Partial Breast Irradiation Using Cyber-Knife – Technical Considerations and Early Experiences of a Phase II Clinical Study

Mészáros

Smanykó

Major

et al. 2020

Pathol. Oncol. Res.

View full text Add to dashboard Cite

To report the implementation, dosimetric results of and early experiences with stereotactic accelerated partial breast irradiation (SAPBI) following breast conserving surgery (BCS) for postmenopausal low-risk St I-II invasive breast cancer (IBC) patients. Between November 2018 and August 2019, 27 patients were registered in our phase II prospective study. SAPBI was performed with Cyber-Knife (CK) M6 machine, in 4 daily fractions of 6.25 Gy to a total dose of 25 Gy. Respiratory movements were followed with implanted gold markers and Synchrony system. Corrections for patient displacement and respiratory movement during treatment were performed with the robotic arm. Early side effects, cosmetic results, and dosimetric parameters were assessed. The average volume of the surgical cavity, clinical target volume (CTV), and planning target volume (PTV_EVAL) were 8.1 cm 3 (range: 1.75-27.3 cm 3), 55.3 cm 3 (range: 26.2-103.5 cm 3), and 75.7 cm 3 (range: 40-135.4 cm 3), respectively. The mean value of the PTV_eval/whole breast volume ratio was 0.09 (range: 0.04-0.19). No grade 2 or worst acute side-effect was detected. Grade 1 (G1) erythema occurred in 6 (22.2%) patients, while G1 oedema was reported by 3 (11.1%) cases. G1 pain was observed in 1 (3.4%) patient. Cosmetic result were excellent in 17 (62.9%) and good in 10 (37.1%) patients. SAPBI with CK is a suitable and practicable technique for the delivery of APBI after BCS for low-risk, St. I-II. IBC. Our early findings are encouraging, CK-SAPBI performed with four daily fractions is convenient and perfectly tolerated by the patients.

show abstract

Section: Methodsmentioning

confidence: 99%

Implementation of Stereotactic Accelerated Partial Breast Irradiation Using Cyber-Knife – Technical Considerations and Early Experiences of a Phase II Clinical Study

Mészáros

Smanykó

Major

et al. 2020

Pathol. Oncol. Res.

View full text Add to dashboard Cite

show abstract

“…Forty-three patients were randomly selected from the cohort enrolled at our institutional clinical trial, which is a single-arm, prospective 5-fraction dose escalation stereotactic radiotherapy study conducted on Cyberknife system. For each enrolled patient, four to five gold fiducial markers (CIVCO Medical Solutions, Orange City, IA) were systematically implanted at least 2-cm apart at the edge of the lumpectomy cavity [ 15 ]. Each gold fiducial marker was 3-mm in length and 1.2-mm in diameter.…”

Section: Methodsmentioning

confidence: 99%

Comprehensive target geometric errors and margin assessment in stereotactic partial breast irradiation

et al. 2017

Self Cite

View full text Add to dashboard Cite

BackgroundRecently developed stereotactic partial breast irradiation (S-PBI) allows delivery of a high biologically potent dose to the target while sparing adjacent critical organs and normal tissue. With S-PBI tumoricidal doses, accurate and precise dose delivery is critical to achieve high treatment quality. This study is to investigate both rigid and non-rigid components of target geometric error and their corresponding margins in S-PBI and identify correlated clinical factors.MethodsForty-three early-stage breast cancer patients with implanted gold fiducial markers were enrolled in the study. Fiducial positions recorded on the orthogonal kV images on a Cyberknife system during treatment were used to estimate intra-fraction errors and composite errors (including intra-fraction errors and residual errors after patient setup). Both rigid and non-rigid components of intra-fraction and composite errors were analyzed and used to estimate rigid and non-rigid margins, respectively. Univariate and multivariate linear regressions were conducted to evaluate correlations between clinical factors and errors.ResultsFor the study group, the intra-fraction rigid and non-rigid errors are 2.0 ± 0.6 mm and 0.3 ± 0.2 mm, respectively. The composite rigid and non-rigid errors are 2.3 ± 0.5 mm and 1.3 ± 0.8 mm, respectively. The rigid margins in the left-right, anterior-posterior, and superior-inferior directions are estimated as 2.1, 2.4, and 2.3 mm, respectively. The estimated non-rigid margin, assumed to be isotropic, is 1.7 mm. The outer breast quadrants are more susceptible to composite errors occurrence than the inner breast quadrants. The target to chest wall distance is the clinical factor correlated with target geometric errors.ConclusionsThis is the first comprehensive analysis of breast target geometric rigid and non-rigid errors in S-PBI. Upon the estimation, the non-rigid margin is comparable to rigid margin, and therefore should be included in planning target volume as it cannot be accounted for by the Cyberknife system. Treatment margins selection also need to consider the impact of relevant clinical factor.Electronic supplementary materialThe online version of this article (10.1186/s13014-017-0889-6) contains supplementary material, which is available to authorized users.

show abstract

“…Three to four of these markers were placed internally before simulation at surgery or under ultrasound guidance by a radiologist in conjunction with the treating radiation oncologist, around the lumpectomy cavity. We have previously published an article providing details of ultrasound-guided fiducial placement in the breast (12). Daily localization and fiducial tracking was achieved using the Synchrony Respiratory Tracking System associated with the Cyberknife radiosurgery system per established system standards (Cyberknife, Accuray, Sunnyvale, CA).…”

Section: Planningmentioning

confidence: 99%

Preliminary Results of a Phase 1 Dose-Escalation Trial for Early-Stage Breast Cancer Using 5-Fraction Stereotactic Body Radiation Therapy for Partial-Breast Irradiation

Rahimi

Thomas

Spangler

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

Self Cite

View full text Add to dashboard Cite

Dose was escalated to the target dose of 40 Gy in 5 fractions, with the occurrence of only 1 dose-limiting toxicity. Patients felt cosmetic results improved within the first year after surgery and stereotactic body radiation therapy. Our results show minimal toxicity with excellent cosmesis; however, further follow-up is warranted in future studies. This study is the first to show the safety, tolerability, feasibility, and cosmesis results of a 5-fraction dose-escalated S-PBI treatment for early-stage breast cancer in the adjuvant setting.

show abstract

Ultrasound-Guided Placement of Gold Fiducial Markers for Stereotactic Partial-Breast Irradiation

Abstract: All 51 postoperative patients underwent successful fiducial placement without complications. Our technique of placing gold fiducial markers in proximity to the seroma cavity is considered safe and effective for breast cancer patients being treated with APBI using robotic-based SBRT.

Cited by 14 publications

References 8 publications

Implementation of Stereotactic Accelerated Partial Breast Irradiation Using Cyber-Knife – Technical Considerations and Early Experiences of a Phase II Clinical Study

Implementation of Stereotactic Accelerated Partial Breast Irradiation Using Cyber-Knife – Technical Considerations and Early Experiences of a Phase II Clinical Study

Comprehensive target geometric errors and margin assessment in stereotactic partial breast irradiation

Preliminary Results of a Phase 1 Dose-Escalation Trial for Early-Stage Breast Cancer Using 5-Fraction Stereotactic Body Radiation Therapy for Partial-Breast Irradiation

Contact Info

Product

Resources

About