We examined the complications of transbronchial fluoroscopic-guided fiducial placement via flexible fiberoptic bronchoscopy in 40 patients with primary lung cancer or metastatic cancer to the lungs to facilitate delivery of stereotactic radiation therapy.
We retrospectively examined complications in 40 patients that were considered non-surgical candidates who underwent transbroncial fluoroscopic-guided fiducial placement via flexible fiberoptic bronchoscopy between 5/2006 and 8/2008.
A total of 161 gold fiducial markers were successfully deployed in 40 patients. One patient developed hypoxemia following placement of the first fiducial as a result of upper airway obstruction from sleep apnea and conscious sedation. Hypoxemia resolved with reversal of conscious sedation and jaw thrust maneuver. A small right apical pneumothorax was noted in another patient following placement of 3 fiducials. Review of chest radiographs prior to fiducial placement revealed the presence of a persistent right apical pneumothorax. Following fiducial placement the appearance of the pneumothorax was smaller. In this instance we do not feel the pneumothorax was a result of fiducial placement. All other patients tolerated the procedure well without any complications.
Transbronchial fluoroscopic-guided placement of gold fiducials via flexible fiberoptic bronchoscopy to facilitate delivery of stereotactic radiotherapy can be done safely with few complications.
This method may be a safer alternative to CT-guided placement of fiducials, which has a relatively high rate of pneumothorax. This might also represent a cost effective alternative to electromagnetic navigation bronchoscopy (ENB) for fiducial placement.
Elizabeth Ziner, No Financial Disclosure Information; No Product/Research Disclosure Information