Treatment of lung lesions by stereotactic body radiation therapy after computed tomography guided placement of a Visicoil® marker: Initial experience

Abstract

ObjectiveTo describe the technique of stereotactic body radiation therapy (SBRT) of lung lesions after the computed tomography (CT) guided placement of an internal fiducial marker and to assess the results, complications and secondary effects of these procedures. Materials and methodsA series of 39 lesions (8 primary and 31 metastases) in 25 patients treated using this procedure were analyzed. A CT-guided percutaneous transthoracic puncture was performed for placing the internal marker in the lesion or near to it. The procedure did not require sedation.The marker serves as a guide for the treatment of the lesion using SBRT with respiratory synchronism, which allows the movement of the tumor to be controlled and to decrease the radiation volume, giving high doses with precision to the tumor, and minimal to the surrounding healthy tissue. ResultsThe only complication of the percutaneous fiducial placement was a pneumothorax in 6 (24%) patients. A pleural drain had to be placed in 3 patients. Local control was achieved in 96.7% of the lesions. The radiation produced a Grade 1 asthenia in 1 patient, a Grade 2 pneumonitis in one patient and a Grade 1 pneumonitis in the remainder. ConclusionsThe CT-guided placement of internal markers in lung lesions is a safe technique that may be performed as ambulatory procedure. SBRT with respiratory synchronism allows the dose to the tumor to be increased, and reduces the volume of healthy lung treated, with few secondary effects.