Peroperative fiducial placement for postoperative stereotactic Cyberknife radiosurgery

Radiotherapy is often the treatment used for inoperable early-stage lung cancer as well as pulmonary metastases. In the last decade, efforts were done to increase local control with high-dose radiation without excessive collateral damage. Initially used for cranial lesions, stereotactic radiosurgery enlarged extracranial indications; the Cyberknife radiosurgery system needs metal (gold) markers for image guidance. For lung tumours, fiducials are inserted computed tomography (CT)-guided or bronchoscopy-guided. We describe four patients where fiducial placement was done during surgery.