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Original Article Assessment of Real-Time US-CT/MR-guided Percutaneous Gold Fiducial Marker Implementation in Malignant Hepatic Tumors for Stereotactic Body Radiation Therapy
Sungjun Hwang1orcid , Seok-Joo Chun2orcid , Eui Kyu Chie3,4orcid , Jeong Min Lee4,5orcid

DOI: https://doi.org/10.17998/jlc.2024.06.03 [Accepted]
Published online: June 10, 2024
1Department of Radiology, Inje University Ilsan Paik Hospital, Republic of Korea
2Department of Radiation Oncology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Republic of Korea
3Department of Radiation Oncology, Seoul National University Hospital, Republic of Korea
4Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
5Department of Radiology, Seoul National University Hospital, Republic of Korea
Corresponding author:  Jeong Min Lee,
Email: jmsh@snu.ac.kr
Received: 20 March 2024   • Revised: 18 May 2024   • Accepted: 2 June 2024
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Background/Aims
This study explored the initial institutional experience of using gold fiducial markers for stereotactic body radiotherapy (SBRT) in treating malignant hepatic tumors using real-time ultrasound-computed tomography (CT)/magnetic resonance (MR) imaging fusion-guided percutaneous placement.
Methods
From May 2021 to August 2023, 19 patients with 25 liver tumors that were invisible on pre-contrast CT received fiducial markers following these guidelines. Postprocedural scans were used to confirm their placement. We assessed technical and clinical success rates and monitored complications. The implantation of fiducial markers facilitating adequate treatment prior to SBRT, which was achieved in 96% of the cases (24 of 25 tumors), was considered technical success. Clinical success was the successful completion of SBRT without evidence of marker displacement and was achieved in 88% of cases (22 of 25 tumors). Complications included one major subcapsular hematoma and marker migration into the right atrium in two cases, which prevented SBRT.
Results
Among the treated tumors, 83.3% (20 of 24) showed a complete response, 12.5% (3 of 24) remained stable, and 4.2% (1 of 24) progressed during an average 11.7-month follow-up (range, 2–32 months).
Conclusions
This study confirms that percutaneous gold fiducial marker placement using real-time CT/MR guidance is effective and safe for SBRT in hepatic tumors, but warns of marker migration risks, especially near the hepatic veins and in subcapsular locations. Using fewer markers than traditionally recommended—typically two per patient), the outcomes were still satisfactory, particularly given the increased risk of migration when markers were placed near major hepatic veins.

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JLC : Journal of Liver Cancer