Clinical Trials Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 18, 2016; 8(17): 731-738
Published online Jun 18, 2016. doi: 10.4254/wjh.v8.i17.731
Therapeutic usability of two different fiducial gold markers for robotic stereotactic radiosurgery of liver malignancies: A pilot study
Maria Marsico, Tommaso Gabbani, Lorenzo Livi, Maria Rosa Biagini, Andrea Galli
Maria Marsico, Integrate Activity Department 1, Gastroenterology, AOU Modena University Hospital, 41121 Modena, Italy
Tommaso Gabbani, Maria Rosa Biagini, Andrea Galli, Oncology Department, Clinical Gastroenterology, AOU Careggi, Florence University Hospital, 50134 Florence, Italy
Lorenzo Livi, Oncology Department, Radiotherapy SOD, AOU Careggi, Florence University Hospital, 50134 Florence, Italy
Author contributions: Marsico M conceived the study, participated in the procedures for placement of the markers, wrote and reviewed the article; Gabbani T Participated in the procedures for placement of the markers, performed the statistical analysis, wrote and reviewed the article; Livi L and Galli A participated in the study design, coordinated and helped to draft the manuscript; Biagini MR participated in the study design, and in the procedures for placement of the markers and review of the article.
Institutional review board statement: The study was reviewed and approved by the Gastroenterology Unit, University of Florence review board.
Informed consent statement: All patients provided written informed consent for enrolment in the study, and inclusion in this article of information that could potentially lead to their identification.
Conflict-of-interest statement: The authors (Maria Marsico, MD, Tommaso Gabbani, MD, Andrea Galli, Professor, Maria Rosa Biagini, MD, Lorenzo Livi, Professor) have no conflicts to report.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at ma.marsico@libero.it. Participants gave informed consent for data sharing, however the data presented are anonymous and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Maria Marsico, MD, Integrate Activity Department 1, Gastroenterology, AOU Modena University Hospital, Via del Pozzo 71, 41121 Modena, Italy. ma.marsico@libero.it
Telephone: +39-32-98051908
Received: January 31, 2016
Peer-review started: January 31, 2016
First decision: March 31, 2016
Revised: May 2, 2016
Accepted: May 31, 2016
Article in press: June 2, 2016
Published online: June 18, 2016
Processing time: 135 Days and 13.8 Hours
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. A 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.

Keywords: Robotic radiosurgery, Fiducial markers, Liver malignancies, CyberKnife, Radiation therapy, Stereotactic radiosurgery

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.