Approaches for Lung Fiducial Markers Insertion in Stereotactic Body Radiotherapy: A Systematic Review and...

Area of Science:

• Pulmonary oncology
• Radiation oncology
• Medical physics

Background:

• Pulmonary fiducial markers (FMs) are crucial for real-time tracking in CyberKnife stereotactic body radiotherapy (SBRT).
• SBRT serves as an alternative to surgery for early-stage inoperable non-small-cell lung cancer (NSCLC) and intrathoracic oligometastatic disease.
• Comparing transthoracic, endovascular, and endobronchial FMs insertion approaches is essential for optimizing SBRT delivery.

Purpose of the Study:

• To systematically review and compare the clinical performance and safety of three pulmonary fiducial marker (FM) insertion approaches for peripheral pulmonary lesions (PPL).
• To evaluate FM location accuracy, tracking rates, and per-procedural complications (pneumothorax, hemoptysis) across different insertion techniques.

Main Methods:

• A systematic review and meta-analysis of studies on FM implantation prior to SBRT was conducted.
• Databases searched include PubMed/MEDLINE and EMBASE.
• Included 27 studies with 2065 patients and 4149 FM insertions, analyzing clinical performance and safety outcomes.

Main Results:

• Endobronchial insertion of nonlinear FMs demonstrated the lowest inaccurate FM location rate (0.030).
• High and comparable tracking rates were observed for endobronchial (0.975), endovascular (0.999), and transthoracic (0.985) approaches.
• Transthoracic access was associated with the highest rates of pneumothorax (0.342) and hemoptysis (0.035).

Conclusions:

• Endobronchial insertion of nonlinear FMs is associated with superior location accuracy.
• All three FM implantation methods (endobronchial, endovascular, transthoracic) exhibit high tracking feasibility for CyberKnife SBRT.
• The choice of FM insertion approach impacts complication rates, with endobronchial and endovascular methods potentially offering improved safety profiles.