KMID : 1038620200380040253
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Radiation Oncology Journal 2020 Volume.38 No. 4 p.253 ~ p.261
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Prospective evaluation of fiducial marker placement quality and toxicity in liver CyberKnife stereotactic body radiotherapy
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Dutta Debnarayan
Kataki Kaushik Jagannath George Shibu Reddy Sruthi K. Sashidharan Ajay Kannan Rajesh Ramaih Madhavan Ram Nair Haridas Tatineni Tushar Holla Raghavendra
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Abstract
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Background: Evaluate morbidities and ¡°quality¡± of fiducial marker placement in primary liver tumours (hepatocellular carcinoma [HCC]) for CyberKnife.
Materials and Methods: Thirty-six HCC with portal vein thrombosis (PVT) were evaluated for ¡°quality¡± of fiducial placement, placement time, pain score, complications, recovery time and factors influencing placement.
Results: One hundred eight fiducials were placed in 36 patients. Fiducial placement radiation oncologist score was ¡°good¡± in 24 (67%), ¡°fair¡± in 4 (11%), and ¡°poor¡± in 3(8%) patients. Concordance with radiologist score in ¡°poor¡±, ¡°fair¡±, and ¡°good¡± score was 2/2 (100%), 4/5 (80%), and 24/27 (89%), respectively (p=0.001). Child-Pugh score (p=0.080), performance status (PS) (p=0.014) and accrued during ¡°learning curve¡± (p=0.013) affected placement score. Mean placement time (p=0.055), recovery time (p=0.025) was longer and higher major complications (p=0.009) with poor PS. Liver segment involved (p=0.484) and the Barcelona Clinic Liver Cancer (BCLC) stage did not influence placement score. ¡°Good¡± placement score was 30% in first cohort whereas 93% in last cohort (p=0.023). Time for placement was 42.2 and 14.3 minutes, respectively (p=0.069). Post-fiducial pain score 0?1 in 26 patients (72%) and pain score 3?4 was in 2 (6%). Five patients (14%) admitted in ¡°day-care¡± (2 mild pneumothorax, 3 pain). Mortality in 1 patient (3%) admitted for hemothorax.
Conclusion: Fiducial placement is safe and in experienced hands, ¡°quality¡± of placement is ¡°good¡± in majority. Major complications and admission after fiducial placement are rare. Complications, fiducial placement time, recovery time is more during the ¡°learning curve¡±. Poor Child-Pugh score, extensive liver involvement, poor PS have higher probability of complications.
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KEYWORD
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Hepatocellular carcinoma, Stereotactic body radiotherapy, Fiducial marker
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