Implantation of fiducial markers in the liver for stereotactic body radiation therapy: Feasibility and results

Purpose: Robotic stereotactic body radiation therapy (SBRT) for the treatment of hepatocellular carcinoma requires the perilesional implant of gold fiducial markers for detection by scopy. The purpose of this study is to determine whether the implant of gold fiducial markers is still possible and, if so, with which imaging technique and with what results. Materials and methods: This is a prospective study based on the implant of fiducial markers in the liver in our department for a treatment by SBRT for a hepatocellular carcinoma in 38 patients (49 lesions to treat) over a period of one year. As the first choice, it consisted of sonographic guidance and, if not possible, CT-scan guidance was used. Results: The mean number of fiducial markers implanted per procedure was 2.68(+/- 0.61) with almost exclusive sonographic guidance (36 out of 38 patients or 95% of the patients). The mean distance between the markers and the lesion was 32 mm (+/- 11 mm) and that between the markers was 17 mm (+/- 7 mm). Conclusion: SBRT is being evaluated for the treatment of liver lesions. The radiologist has an important role to play since the implant of fiducial markers in the liver is indispensable. It is almost always possible with sonographic guidance, including for lesions not accessible to microbiopsies, a treatment by radiofrequency or for lesions poorly individualisable by sonography or CT-scan. (C) 2014 Editions francaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.