Electromagnetic navigation bronchoscopy-guided fiducial placement for robotic stereotactic radiosurgery of lung tumors

A feasibility study

Devanand Anantham, David Feller-Kopman, Lakshmi N. Shanmugham, Stuart M. Berman, Malcolm M. DeCamp, Sidhu P. Gangadharan, Ralf Eberhardt, Felix Herth, Armin Ernst*

*Corresponding author for this work

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

Background: Stereotactic radiosurgery (Cyberknife; Accuray Incorporated; Sunnyvale, CA) is a treatment option for patients who are medically unfit to undergo lung tumor resection. For precise tumor ablation, the Cyberknife requires fiducial marker placement in or near the target tumor. Fiducial placement under transthoracic CT guidance is associated with a high risk of iatrogenic pneumothorax. Electromagnetic navigation bronchoscopy (ENB) may offer a less morbid alternative to accurately deploy fiducials to bronchoscopically invisible peripheral lung lesions. Objective: Open-label, feasibility study to assess fiducial placement in peripheral lung tumors by ENB. Method: Consecutive patients with peripheral lung tumors and who were evaluated to be nonsurgical candidates underwent fiducial placement under ENB. This procedure was considered successful if fiducials were placed in or near the tumors and remained in place without migration for radiosurgery to proceed. The need for alternative or additional intrathoracic fiducial placement was documented as procedure failure. Results: A total of 39 fiducials markers were successfully deployed in eight of nine patients (89%). Of these eight successful cases, seven had fiducials placed directly within the tumor (88%). At Cyberknife planning, 7 to 10 days after fiducial placement, 35 of 39 fiducial markers (90%) were still in place and were adequate to allow radiosurgery to proceed. No immediate bronchoscopic complications were observed. One patient had a COPD exacerbation. Another patient returned within 1 day with transient, self-limiting fever. Conclusions: ENB can be used to deploy fiducial markers for Cyberknife radiosurgery of lung tumors safely and accurately without the complications associated with transthoracic placement.

Original languageEnglish (US)
Pages (from-to)930-935
Number of pages6
JournalChest
Volume132
Issue number3
DOIs
StatePublished - Jan 1 2007

Fingerprint

Radiosurgery
Electromagnetic Phenomena
Feasibility Studies
Robotics
Bronchoscopy
Lung
Fiducial Markers
Neoplasms
Pneumothorax
Chronic Obstructive Pulmonary Disease
Fever

Keywords

  • Cyberknife
  • Electromagnetic navigation bronchoscopy
  • Fiducial
  • Lung cancer
  • Robotic stereotactic radiosurgery

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Anantham, D., Feller-Kopman, D., Shanmugham, L. N., Berman, S. M., DeCamp, M. M., Gangadharan, S. P., ... Ernst, A. (2007). Electromagnetic navigation bronchoscopy-guided fiducial placement for robotic stereotactic radiosurgery of lung tumors: A feasibility study. Chest, 132(3), 930-935. https://doi.org/10.1378/chest.07-0522
Anantham, Devanand ; Feller-Kopman, David ; Shanmugham, Lakshmi N. ; Berman, Stuart M. ; DeCamp, Malcolm M. ; Gangadharan, Sidhu P. ; Eberhardt, Ralf ; Herth, Felix ; Ernst, Armin. / Electromagnetic navigation bronchoscopy-guided fiducial placement for robotic stereotactic radiosurgery of lung tumors : A feasibility study. In: Chest. 2007 ; Vol. 132, No. 3. pp. 930-935.
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abstract = "Background: Stereotactic radiosurgery (Cyberknife; Accuray Incorporated; Sunnyvale, CA) is a treatment option for patients who are medically unfit to undergo lung tumor resection. For precise tumor ablation, the Cyberknife requires fiducial marker placement in or near the target tumor. Fiducial placement under transthoracic CT guidance is associated with a high risk of iatrogenic pneumothorax. Electromagnetic navigation bronchoscopy (ENB) may offer a less morbid alternative to accurately deploy fiducials to bronchoscopically invisible peripheral lung lesions. Objective: Open-label, feasibility study to assess fiducial placement in peripheral lung tumors by ENB. Method: Consecutive patients with peripheral lung tumors and who were evaluated to be nonsurgical candidates underwent fiducial placement under ENB. This procedure was considered successful if fiducials were placed in or near the tumors and remained in place without migration for radiosurgery to proceed. The need for alternative or additional intrathoracic fiducial placement was documented as procedure failure. Results: A total of 39 fiducials markers were successfully deployed in eight of nine patients (89{\%}). Of these eight successful cases, seven had fiducials placed directly within the tumor (88{\%}). At Cyberknife planning, 7 to 10 days after fiducial placement, 35 of 39 fiducial markers (90{\%}) were still in place and were adequate to allow radiosurgery to proceed. No immediate bronchoscopic complications were observed. One patient had a COPD exacerbation. Another patient returned within 1 day with transient, self-limiting fever. Conclusions: ENB can be used to deploy fiducial markers for Cyberknife radiosurgery of lung tumors safely and accurately without the complications associated with transthoracic placement.",
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Anantham, D, Feller-Kopman, D, Shanmugham, LN, Berman, SM, DeCamp, MM, Gangadharan, SP, Eberhardt, R, Herth, F & Ernst, A 2007, 'Electromagnetic navigation bronchoscopy-guided fiducial placement for robotic stereotactic radiosurgery of lung tumors: A feasibility study', Chest, vol. 132, no. 3, pp. 930-935. https://doi.org/10.1378/chest.07-0522

Electromagnetic navigation bronchoscopy-guided fiducial placement for robotic stereotactic radiosurgery of lung tumors : A feasibility study. / Anantham, Devanand; Feller-Kopman, David; Shanmugham, Lakshmi N.; Berman, Stuart M.; DeCamp, Malcolm M.; Gangadharan, Sidhu P.; Eberhardt, Ralf; Herth, Felix; Ernst, Armin.

In: Chest, Vol. 132, No. 3, 01.01.2007, p. 930-935.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Electromagnetic navigation bronchoscopy-guided fiducial placement for robotic stereotactic radiosurgery of lung tumors

T2 - A feasibility study

AU - Anantham, Devanand

AU - Feller-Kopman, David

AU - Shanmugham, Lakshmi N.

AU - Berman, Stuart M.

AU - DeCamp, Malcolm M.

AU - Gangadharan, Sidhu P.

AU - Eberhardt, Ralf

AU - Herth, Felix

AU - Ernst, Armin

PY - 2007/1/1

Y1 - 2007/1/1

N2 - Background: Stereotactic radiosurgery (Cyberknife; Accuray Incorporated; Sunnyvale, CA) is a treatment option for patients who are medically unfit to undergo lung tumor resection. For precise tumor ablation, the Cyberknife requires fiducial marker placement in or near the target tumor. Fiducial placement under transthoracic CT guidance is associated with a high risk of iatrogenic pneumothorax. Electromagnetic navigation bronchoscopy (ENB) may offer a less morbid alternative to accurately deploy fiducials to bronchoscopically invisible peripheral lung lesions. Objective: Open-label, feasibility study to assess fiducial placement in peripheral lung tumors by ENB. Method: Consecutive patients with peripheral lung tumors and who were evaluated to be nonsurgical candidates underwent fiducial placement under ENB. This procedure was considered successful if fiducials were placed in or near the tumors and remained in place without migration for radiosurgery to proceed. The need for alternative or additional intrathoracic fiducial placement was documented as procedure failure. Results: A total of 39 fiducials markers were successfully deployed in eight of nine patients (89%). Of these eight successful cases, seven had fiducials placed directly within the tumor (88%). At Cyberknife planning, 7 to 10 days after fiducial placement, 35 of 39 fiducial markers (90%) were still in place and were adequate to allow radiosurgery to proceed. No immediate bronchoscopic complications were observed. One patient had a COPD exacerbation. Another patient returned within 1 day with transient, self-limiting fever. Conclusions: ENB can be used to deploy fiducial markers for Cyberknife radiosurgery of lung tumors safely and accurately without the complications associated with transthoracic placement.

AB - Background: Stereotactic radiosurgery (Cyberknife; Accuray Incorporated; Sunnyvale, CA) is a treatment option for patients who are medically unfit to undergo lung tumor resection. For precise tumor ablation, the Cyberknife requires fiducial marker placement in or near the target tumor. Fiducial placement under transthoracic CT guidance is associated with a high risk of iatrogenic pneumothorax. Electromagnetic navigation bronchoscopy (ENB) may offer a less morbid alternative to accurately deploy fiducials to bronchoscopically invisible peripheral lung lesions. Objective: Open-label, feasibility study to assess fiducial placement in peripheral lung tumors by ENB. Method: Consecutive patients with peripheral lung tumors and who were evaluated to be nonsurgical candidates underwent fiducial placement under ENB. This procedure was considered successful if fiducials were placed in or near the tumors and remained in place without migration for radiosurgery to proceed. The need for alternative or additional intrathoracic fiducial placement was documented as procedure failure. Results: A total of 39 fiducials markers were successfully deployed in eight of nine patients (89%). Of these eight successful cases, seven had fiducials placed directly within the tumor (88%). At Cyberknife planning, 7 to 10 days after fiducial placement, 35 of 39 fiducial markers (90%) were still in place and were adequate to allow radiosurgery to proceed. No immediate bronchoscopic complications were observed. One patient had a COPD exacerbation. Another patient returned within 1 day with transient, self-limiting fever. Conclusions: ENB can be used to deploy fiducial markers for Cyberknife radiosurgery of lung tumors safely and accurately without the complications associated with transthoracic placement.

KW - Cyberknife

KW - Electromagnetic navigation bronchoscopy

KW - Fiducial

KW - Lung cancer

KW - Robotic stereotactic radiosurgery

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U2 - 10.1378/chest.07-0522

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