First‐in‐man case of non‐invasive proton radiotherapy for the treatment of refractory ventricular tachycardia in advanced heart failure

Dusi, Veronica; Vitolo, Viviana; Frigerio, Laura; Totaro, Rossana; Valentini, Adele; Barcellini, Amelia; Mirandola, A.; Perego, Giovanni Battista; Coccia, Michela; Greco, Alessandra; Ghio, Stefano; Valvo, Francesca; Ferrari, Gaetano Maria De; Gnecchi, Massimiliano; Visconti, Luigi Oltrona; Rordorf, Roberto

doi:10.1002/ejhf.2056

Cited by 22 publications

(16 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Limited data are available on malfunctions during proton and carbon ion therapy 26,27 . In fact, the first use of proton therapy in a patient with ventricular tachycardia at the Centro Nazionale di Adroterapia Oncologica in Pavia/Italy was reported recently 28 . Thus, no consensus may have been reached because two complex issues were combined in one statement.…”

Section: Discussionmentioning

confidence: 99%

Recommendations regarding cardiac stereotactic body radiotherapy for treatment refractory ventricular tachycardia

et al. 2021

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

Section: Discussionmentioning

confidence: 99%

Recommendations regarding cardiac stereotactic body radiotherapy for treatment refractory ventricular tachycardia

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In addition, a precise gating or tracking could be done without the need and limitations of a fiducial marker. This could further reduce the safety margins to be applied and perhaps reduce treatment times, particularly in case of respiratory gated delivery for radiotherapy with heavy particles such as protons and carbon ions ( 9 , 10 , 12 , 20 ). A further usefulness of this system could consist in increasing the safety in the treatment phase, by controlling in real time the cardiac cycle and heart movements and allowing to interrupt the delivery of the radiant beam in case of anomalies on each of these two factors with extremely short reaction times.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of an Automatic Ultrasonographic Image Acquisition System Associated With an Artificial Intelligence Algorithm for Real-Time Monitoring of Cardiac Motion During Cardiac Radio-Ablation

Casula

Dusi

Camps³

et al. 2022

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

BackgroundThe management of the cardio-respiratory motion of the target and the reduction of the uncertainties related to patient's positioning are two of the main challenges that stereotactic arrhythmia radio-ablation (STAR) has to overcome. A prototype of a system was developed that can automatically acquire and interpret echocardiographic images using an artificial intelligence (AI) algorithm to calculate cardiac displacement in real-time.MethodsWe conducted a single center study enrolling consecutive patients with a history of ventricular arrhythmias (VA) in order to evaluate the feasibility of this automatic acquisition system. Echocardiographic images were automatically acquired from the parasternal and apical views with a dedicated probe. The system was designed to hold the probe fixed to the chest in the supine position during both free-breathing and short expiratory breath-hold sequences, to simulate STAR treatment. The primary endpoint was the percentage of patients reaching a score ≥2 in a multi-parametric assessment evaluating the quality of automatically acquired images. Moreover, we investigated the potential impact of clinical and demographic characteristics on achieving the primary endpoint.ResultsWe enrolled 24 patients (63 ± 14 years, 21% females). All of them had a history of VA and 21 (88%) had an ICD. Eight patients (33%) had coronary artery disease, 12 (50%) had non-ischemic cardiomyopathy, and 3 had idiopathic VA. Parasternal, as well as apical images were obtained from all patients except from one, in whom parasternal view could not be collected due to the patient's inability to maintain the supine position. The primary endpoint was achieved in 23 patients (96%) for the apical view, in 20 patients (87%) for the parasternal view, and in all patients in at least one of the two views. The images' quality was maximal (i.e., score = 4) in at least one of the two windows in 19 patients (79%). Atrial fibrillation arrhythmia was the only clinical characteristics associated with a poor score outcome in both imaging windows (apical p = 0.022, parasternal p = 0.014).ConclusionsThese results provide the proof-of-concept for the feasibility of an automatic ultrasonographic image acquisition system associated with an AI algorithm for real-time monitoring of cardiac motion in patients with a history of VA.

show abstract

“…To achieve this, the plan was normalized so that PTV D92% = 25 CGyE. Also, in order to arrive at a satisfactory treatment plan ( 26 , 27 ), robust optimization with 2 mm set-up error in all directions and 2% range uncertainty was used during planning.…”

Section: Case Descriptionmentioning

confidence: 99%

Case Report: Treatment Planning Study to Demonstrate Feasibility of Transthoracic Ultrasound Guidance to Facilitate Ventricular Tachycardia Ablation With Protons

Perrin¹,

Maguire

Garonna³

et al. 2022

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

BackgroundCardiac arrhythmias, such as ventricular tachycardia, are disruptions in the normal cardiac function that originate from problems in the electrical conduction of signals inside the heart. Recently, a non-invasive treatment option based on external photon or proton beam irradiation has been used to ablate the arrhythmogenic structures. Especially in proton therapy, based on its steep dose gradient, it is crucial to monitor the motion of the heart in order to ensure that the radiation dose is delivered to the correct location. Transthoracic ultrasound imaging has the potential to provide guidance during this treatment delivery. However, it has to be noted that the presence of an ultrasound probe on the chest of the patient introduces constraints on usable beam angles for both protons and photon treatments. This case report investigates the possibility to generate a clinically acceptable proton treatment plan while the ultrasound probe is present on the chest of the patient.CaseA treatment plan study was performed based on a 4D cardiac-gated computed tomography scan of a 55 year-old male patient suffering from refractory ventricular tachycardia who underwent cardiac radioablation. A proton therapy treatment plan was generated for the actual treatment target in presence of an ultrasound probe on the chest of this patient. The clinical acceptability of the generated plan was confirmed by evaluating standard target dose-volume metrics, dose to organs-at-risk and target dose conformity and homogeneity.ConclusionThe generation of a clinically acceptable proton therapy treatment plan for cardiac radioablation of ventricular tachycardia could be performed in the presence of an ultrasound probe on the chest of the patient. These results establish a basis and justification for continued research and product development for ultrasound-guided cardiac radioablation.

show abstract

First‐in‐man case of non‐invasive proton radiotherapy for the treatment of refractory ventricular tachycardia in advanced heart failure

Cited by 22 publications

References 6 publications

Recommendations regarding cardiac stereotactic body radiotherapy for treatment refractory ventricular tachycardia

Recommendations regarding cardiac stereotactic body radiotherapy for treatment refractory ventricular tachycardia

Feasibility of an Automatic Ultrasonographic Image Acquisition System Associated With an Artificial Intelligence Algorithm for Real-Time Monitoring of Cardiac Motion During Cardiac Radio-Ablation

Case Report: Treatment Planning Study to Demonstrate Feasibility of Transthoracic Ultrasound Guidance to Facilitate Ventricular Tachycardia Ablation With Protons

Contact Info

Product

Resources

About