title: Transarterial Fiducial Marker Placement for Image-guided Proton Therapy for Malignant Liver Tumors.
abstract: OBJECTIVE
  The aim of this study is to analyze the technical and clinical success rates and safety of transarterial fiducial marker placement for image-guided proton therapy for malignant liver tumors.
  
  
  METHODS
  Fifty-five patients underwent this procedure as an interventional treatment. Five patients had 2 tumors, and 4 tumors required 2 markers each, so the total number of procedures was 64. The 60 tumors consisted of 46 hepatocellular carcinomas and 14 liver metastases. Five-mm-long straight microcoils of 0.018 inches in diameter were used as fiducial markers and placed in appropriate positions for each tumor. We assessed the technical and clinical success rates of transarterial fiducial marker placement, as well as the complications associated with it. Technical success was defined as the successful delivery and placement of the fiducial coil, and clinical success was defined as the completion of proton therapy.
  
  
  RESULTS
  All 64 fiducial coils were successfully installed, so the technical success rate was 100 % (64/64). Fifty-four patients underwent proton therapy without coil migration. In one patient, proton therapy was not performed because of obstructive jaundice due to bile duct invasion by hepatocellular carcinoma. Thus, the clinical success rate was 98 % (54/55). Slight bleeding was observed in one case, but it was stopped immediately and then observed. None of the patients developed hepatic infarctions due to fiducial marker migration.
  
  
  CONCLUSIONS
  Transarterial fiducial marker placement appears to be a useful and safe procedure for proton therapy for malignant liver tumors.
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan. yesterday.is.yesterday@gmail.com.
authors.forename: Kengo
authors.initials: K
authors.lastname: Ohta
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan. mshimohira@gmail.com.
authors.forename: Masashi
authors.initials: M
authors.lastname: Shimohira
authors.affiliation: Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, 462-8508, Japan. ssasaki916@yahoo.co.jp.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Sasaki
authors.affiliation: Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, 462-8508, Japan. h-iwa-ncu@nifty.com.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Iwata
authors.affiliation: Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, 462-8508, Japan. piroko1018@gmail.com.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Nishikawa
authors.affiliation: Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, 462-8508, Japan. oginogio@gmail.com.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ogino
authors.affiliation: Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, 462-8508, Japan. mhara@med.nagoya-cu.ac.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Hara
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan. tky300@gmail.com.
authors.forename: Takuya
authors.initials: T
authors.lastname: Hashizume
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan. yshiba@med.nagoya-cu.ac.jp.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Shibamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D005240:Feasibility Studies; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D061766:Proton Therapy; D015641:Radiography, Interventional; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Fiducial marker; Proton therapy; Transarterial