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01.12.2011 | Case report | Ausgabe 1/2011 Open Access

Journal of Medical Case Reports 1/2011

Successful treatment of a T4 lung tumor with vertebral body invasion using fiducial markers in the thoracic spine for image-guided radiation therapy: A case report

Zeitschrift:
Journal of Medical Case Reports > Ausgabe 1/2011
Autoren:
Anudh K Jain, John Handal, Lawrence J Solin
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1752-1947-5-470) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

AKJ supervised all aspects of radiation treatment planning and delivery, analyzed and interpreted the patient data, and performed literature review. JH performed the implantation of the fiducial markers. LJS analyzed and interpreted the patient data and conducted the literature review. All authors read and approved the final manuscript.

Abstract

Introduction

Paravertebral and paraspinal tumors pose a significant challenge in radiation therapy because of the radiation sensitivity of the spinal cord and the need for maximum treatment accuracy. Implantation of fiducial markers into vertebral bodies has been described as a method of increasing the accuracy of radiation treatment for single-dose stereotactic radiosurgery for spinal and paraspinal primary tumors and metastases. However, utilization of this technique has not been described for conventionally fractionated radiation therapy. This report is the first of its kind in the literature and describes successful treatment of a T4 primary lung tumor with vertebral body invasion with conventionally fractionated, image-guided radiotherapy using fiducial markers implanted in the thoracic spine.

Case presentation

Our patient was a 47-year-old African-American man who presented to our hospital with a history of several months of increasing left arm pain, chest pain, dyspnea on exertion, occasional dry cough, and weight loss. He was found to have stage IIIA T4, N0, M0 lung cancer with vertebral body invasion. He had fiducial markers placed in the thoracic spine for image-guided radiation treatment set-up. The patient received 74 Gy radiation therapy with concurrent chemotherapy, and daily matching of the fiducial markers on the treatment machine allowed for treatment of the tumor while sparing the dose to the adjacent spinal cord. With one year of clinical follow-up, the patient has had regression of the tumor with only asymmetric soft-tissue thickening seen on a computed tomographic scan and grade 1 dyspnea on exertion as the only side effects of the treatment.

Conclusion

Fiducial marker placement is a safe and effective technique for maximizing the accuracy and reproducibility for radiation treatment of lesions near the spinal cord. This technique may be used in conventionally fractionated radiation treatment regimens, such as those employed to treat a lung tumor with vertebral body invasion, to potentially improve clinical outcomes for patients.

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