Image-guided marker placement in liver tumors for stereotactic radiotherapy: technique and safety

To evaluate the technique and safety of percutaneous radiopaque gold marker placement in the liver before external stereotactic radiotherapy for intrahepatic tumors. Thirteen patients were included in this study. One gold marker per patient was placed using a computed tomographic fluoroscopy procedure. Follow-up was carried out with a multislice computed tomographic scan. A marker was placed in the center (n = 6) or in the periphery (n = 7) of the target lesion. No immediate complications were noted. Long-term follow-up showed changes in coil position relative to liver anatomy in 4 cases; all 4 markers were placed in the center of the target lesion. No other long-term complications were seen. Radiopaque markers can be placed safely in liver lesions before external stereotactic radiotherapy. However, marker displacement can occur early, thereby compromising the precision of the planned treatment. The decreased size of the tumor as a response to therapy was responsible for late migration in this small series.