Safety and Efficacy of Endovascular Fiducial Marker Insertion for CyberKnife Stereotactic Radiation Therapy Planning in Early-Stage Lung Cancer.

PURPOSE: To evaluate the safety and efficacy of endovascular fiducial markers (EVFMs) for CyberKnife stereotactic radiation therapy (RT) of malignant lung neoplasms in patients with contraindications to percutaneous fiducial marker (PTFM) placement. MATERIALS AND METHODS: Between January 2011 and December 2013, 15 patients (7 men and 8 women) aged 59-87 years (mean, 73 y) underwent EVFM placement and 109 patients (54 men and 55 women) aged 55-92 years (mean, 73 y) underwent 114 PTFM placements. All patients who received EVFMs had contraindications to PTFM insertion. Complications were recorded for all 129 procedures. Proportions of markers used for CyberKnife stereotactic RT planning and distance between markers and tumor were assessed in all 15 patients in the EVFM group and in 15 randomly selected patients in the PTFM group. RESULTS: Sixty-two EVFMs and 56 PTFMs were inserted in the groups of 15 patients. CyberKnife stereotactic RT was not performed in 2 EVFM recipients (8 EVFMs) and 1 PTFM recipient (4 PTFMs). CyberKnife stereotactic RT was planned with the use of 39 of 54 EVFMs (72%) in 13 patients and 37 of 52 PTFMs (71%) in 14 patients. Mean distances between the tumor and EVFMs and PTFMs were 5.5 mm and 2.7 mm, respectively (P = .0152). No complications occurred in the EVFM group. In the PTFM group, 60 of 114 patients (52.6%) had small or moderate pneumothoraxes, 13 (11.4%) had chest tubes inserted, and 5 (4.4%) had self-limiting hemoptysis. CONCLUSIONS: EVFM is feasible and safe, and may therefore offer an alternative when patients are not candidates for percutaneous marker placement.

Anomalous right vertebral artery arising from the arch of aorta: report of three cases.

The right vertebral artery most commonly originates as the first branch of the right subclavian artery. Although anatomical variants of the aortic arch are commonly encountered on cross-sectional imaging, certain variants of the right vertebral artery are exceedingly rare. In this report, we present 3 cases of aberrant right vertebral artery arising as the last branch of the aortic arch, a very rare variant.

Assessing the Need for Adjuvant Chemotherapy After Stereotactic Body Radiation Therapy in Early-stage Non-small Cell Lung Carcinoma.

PURPOSE: Surgery remains the standard treatment for medically operable patients with early-stage non-small cell lung carcinoma (NSCLC). Following surgical resection, adjuvant chemotherapy is recommended for large tumors >4 cm. For unfit patients, stereotactic body radiation therapy (SBRT) has emerged as an excellent alternative to surgery. This study aims to assess patterns of recurrence and discuss the role of chemotherapy after SBRT for NSCLC. METHODS: We reviewed patients treated with SBRT for primary early-stage NSCLC between 2009 and 2015. Total target doses were between 50 and 60 Gy administered in three to eight fractions. All patients had a staging fluorodeoxyglucose (FDG) positron emission tomography (PET) integrated with computed tomography (CT) scan, and histologic confirmation was obtained whenever possible. Mediastinal staging was performed if lymph node involvement was suspected on CT or PET/CT. Survival outcomes were estimated using the Kaplan-Meier method. RESULTS: Among the 559 early-stage NSCLC patients treated with SBRT, 121 patients were stage T2N0. The one-year and three-year overall survival rates were 88% and 70%, respectively, for patients with T2 disease, compared to 95% and 81%, respectively, for the T1 patients (p<0.05). The one-year and three-year local control rates were equal in both groups (98% and 91%, respectively). In T2 patients, 25 (21%) presented a relapse, among which 21 (84%) were nodal or distant. The median survival of T2N0 patients following a relapse was 11 months. CONCLUSION: Lung SBRT provides high local control rates, even for larger tumors. When patients relapse, the majority of them do so at regional or distant sites. These results raise the question as to whether adjuvant treatment should be considered following SBRT for larger tumors.

Percutaneous CT-guided lung interventions-local pleural anesthesia.

Local pleural anesthesia during percutaneous lung interventions is an important part of the procedure that has not been standardized in the literature. Significant pain can be experienced during lung biopsies, which may affect the outcome of intervention. We describe a step-by-step method of anesthesia targeting the most sensitive anatomical structure involved: the parietal pleura.

Nonmassive acute pulmonary embolism: evaluation of the impact of pulmonary arterial wall distensibility on the assessment of the CT obstruction score.

PURPOSE: To evaluate the impact of pulmonary arterial wall distensibility on the assessment of a computed tomography (CT) score in patients with nonmassive pulmonary embolism (PE) (ie, Mastora score). MATERIALS AND METHODS: The arterial wall distensibility of five central pulmonary arteries (pulmonary artery trunk, right and left main pulmonary arteries, right and left interlobar pulmonary arteries) was studied on ECG-gated CT angiographic studies of the chest in 15 patients with no pulmonary arterial hypertension (group 1; mean pulmonary artery pressure: 17.2 mm Hg) and 9 patients with nonmassive PE (group 2), using 2D reconstructions at every 10% of the R-R interval. RESULTS: The systolic and diastolic reconstruction time windows of the examined arteries were identical in the 2 groups, obtained at 20% and 80% of the R-R interval, respectively. No statistically significant difference was observed between the mean values of the pulmonary arterial wall distensibility between the 2 groups, varying between 20.5% and 24% in group 1 and between 23.3% and 25.9% in group 2. The coefficients of variation of the average arterial surfaces were found to vary between 4.30% and 6.50% in group 1 and 4.2% and 8.4% in group 2. Except the pulmonary artery trunk in group 2, all the intraclass correlation coefficients were around 0.8 or greater than 0.8, that is the cutoff for good homogeneity of measurements. CONCLUSION: The pulmonary arterial wall systolic-diastolic distensibility does not interfere with the assessment of a CT obstruction score in the setting of nonmassive PE.