title: Fiducial marker placement via conventional or electromagnetic navigation bronchoscopy (ENB): an interdisciplinary approach to the curative management of lung cancer.
abstract: OBJECTIVE
  Conventional and electromagnetic navigation bronchoscopy (ENB) is generally used as a diagnostic tool in suspicious pulmonary nodules. The use of this technique for the placement of fiducial markers in patients with inoperable but early-stage lung cancer could present an innovative approach enabling risk-reduced therapy.
  
  
  METHODS
  We present seven clinical cases where conventional bronchoscopy and ENB were used as part of an experimental interdisciplinary approach to clinical management and therapy planning. In each case, we analyzed the clinical indication, endoscopic procedures and post-interventional outcome.
  
  
  RESULTS
  In six patients (three females, three males) with peripheral non-small cell lung cancer (NSCLC), stage cT1cN0cM0, surgery and conventional stereotactic radiation therapy was not possible because of end-stage chronic obstructive pulmonary disease. ENB was used for fiducial marker placement prior to cyberknife radiotherapy. No procedure-related complications were observed. Complete remission could be achieved in four cases, partial remission in two cases and no relevant complications induced by radiotherapy were observed. In one male patient, an endoluminal relapse in the right lower lobe was diagnosed following a right upper lobe resection for a NSCLC. The tumor could not be clearly identified by computerized tomography, so that the bronchoscopic placement of a fiducial marker in the tumor was performed in order to allow stereotactic radiochemotherapy, by which complete remission could be achieved.
  
  
  CONCLUSIONS
  Fiducial marker placement may be an interesting bronchoscopic technique in the interdisciplinary therapeutic approach to inoperable early-stage lung cancer. In the described cases, therapy planning was successful and no procedure-related complications were observed.
authors.affiliation: Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien, Solingen, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Hagmeyer
authors.affiliation: Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien, Solingen, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Priegnitz
authors.affiliation: Klinik und Poliklinik für Strahlentherapie, Universitätsklinik Köln, Köln, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Kocher
authors.affiliation: Klinik für Strahlentherapie und Radioonkologie, Klinikum Stadt Soest, Soest, Germany.
authors.forename: Burkhart
authors.initials: B
authors.lastname: Schilcher
authors.affiliation: Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
authors.forename: Wilfried
authors.initials: W
authors.lastname: Budach
authors.affiliation: Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien, Solingen, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Treml
authors.affiliation: Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien, Solingen, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Stieglitz
authors.affiliation: Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien, Solingen, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Randerath
mesh_terms: D000368:Aged; D001999:Bronchoscopy / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D055590:Electromagnetic Phenomena; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology; D016634:Radiosurgery; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: curative radiotherapy; cyberknife; electromagnetic navigation bronchoscopy; fiducial marker; inoperable tumor; lung cancer