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Scientific Session 19 — Efficacy/Administration/Informatics - Safety/Quality

Thursday, May 4, 2017

Abstracts 2298-3291

2298. Safety and Outcomes of Fiducial Placement for Radiosurgery in Patients With Abdominal Malignancies

Shah A*,  Cura M. Baylor University Medical Center, Dallas, TX

Address correspondence to A. Shah (

Objective: The purpose of this study was to evaluate the technical, safety, and treatment outcomes of multimodality approaches to percutaneous fiducial placement before CyberKnife (Accuray) stereotactic radiosurgery.

Materials and Methods: Retrospective analysis was performed of 111 patients (78 men, 33 women) who underwent percutaneous fiducial placement in 111 consecutive procedures from February 2006 to January 2014. Technical success was defined as fiducial marker location in the tumor or vicinity suitable for CyberKnife radiosurgery. Complications were classified according to the Society of Interventional Radiology system. Treatment outcomes were determined by utilizing modified Response Evaluation Criteria in Solid Tumors criteria.

Results: A total of 111 patients (mean age ± SD, 62.4 ± 12.4 years) with abdominal metastatic disease and hepatocellular carcinoma underwent percutaneous placement of 450 fiducial markers (mean per patient, 4.2 ± 1.2) in 47 patients with hepatocellular carcinoma and 64 hepatic metastases (39 colorectal, 25 other tumors). A variety of modalities were used for placement (83% fluoroscopy- and ultrasound-guided, 12% CT-guided, 2% ultrasound-guided, and 3% fluoroscopy-guided). Marker placement was technically successful in all cases. Six patients had complications related to placement (5.4%), including four migrations from the original placement bed, one self-limiting episode of hemoperitoneum, and one minor self-limiting pneumothorax. Scans were obtained after stereotactic radiosurgery in 110 of 111 of the patients. Of these, 16% showed complete response to treatment, 48% of patients showed partial response, 21% showed stable disease, and 15% showed progressive disease.

Conclusion: Fluoroscopic and ultrasound-guided placement was most commonly used to place fiducials for CyberKnife therapy at our institution. High technical success with few significant complications was achieved consistently. Treatment outcomes on scans obtained after stereotactic radiosurgery show varied results, but 64% of patients showed some response to therapy.