Refining Treatment Planning in STereotactic Arrhythmia Radioablation: Benchmark Results and Consensus Statement From the STOPSTORM.eu Consortium

Trojani, Valeria; Grehn, Melanie; Botti, Andrea; Balgobind, Brian; Savini, Alessandro; Boda-Heggemann, Judit; Miszczyk, Marcin; Elicin, Olgun; Krug, David; Andratschke, Nicolaus; Schmidhalter, Daniel; van Elmpt, Wouter; Bogowicz, Marta; de Areba Iglesias, Javier; Dolla, Lukasz; Ehrbar, Stefanie; Fernandez-Velilla, Enric; Fleckenstein, Jens; Granero, Domingo; Henzen, Dominik; Hurkmans, Coen; Kluge, Anne; Knybel, Lukas; Loopeker, Sandy; Mirandola, Alfredo; Richetto, Veronica; Sicignano, Gianluisa; Vallet, Veronique; van Asselen, Bram; Worm, Esben; Pruvot, Etienne; Verhoeff, Joost; Fast, Martin; Iori, Mauro; Blanck, Oliver

doi:10.1016/j.ijrobp.2024.07.2331

International Journal of Radiation Oncology*Biology*Physics

2025

DOI: 10.1016/j.ijrobp.2024.07.2331

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Refining Treatment Planning in STereotactic Arrhythmia Radioablation: Benchmark Results and Consensus Statement From the STOPSTORM.eu Consortium

Valeria Trojani,

Melanie Grehn,

Andrea Botti

et al.

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Cited by 3 publications

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Implementing stereotactic arrhythmia radioablation with STOPSTORM.eu consortium support: intermediate results of a prospective Israeli single-institutional trial

Borzov,

Efraim,

Suleiman

et al. 2024

Strahlenther Onkol

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Background Ventricular tachycardia (VT) is a life-threatening arrhythmia originating from the heart’s ventricles. Traditional treatments include antiarrhythmic medications, implantable cardioverter-defibrillators (ICDs), and catheter ablation. Stereotactic body radiation therapy (SBRT) targeting the arrhythmogenic focus in the left ventricle—stereotactic arrhythmia radioablation (STAR)—is an emerging treatment and may offer a potential solution for patients with refractory VT. Objective We designed an interventional prospective clinical trial in Israel aligned with the STOPSTORM.eu consortium’s benchmarks, recommendations, and directives to assess the safety and efficacy of STAR in patients with refractory VT. Methods Our phase I/II single-institutional trial was approved by the Ministry of Health of Israel for 10 patients, initially assessing safety in the first 3 patients. We included patients with ICDs experiencing symptomatic monomorphic VT after an inadequate response to previous therapies. The primary endpoints were treatment-related serious adverse events and a reduction in VT burden as assessed by ICD interrogation. Secondary outcomes included a reduction in antiarrhythmic medications and changes in quality of life. Results From August 2023 to August 2024, 3 patients underwent STAR treatment. The prescription dose was a single fraction of 25 Gy. Planning target volumes were 47.8, 49.7, and 91.8 cc, and treatment was successfully delivered with no grade 3 or higher adverse events reported. Over a follow-up period of 12 months for the first patient and 8 months for the second one, no VT events were recorded after treatment. The third patient died from progressive heart failure 3 months after treatment. Left ventricular ejection fraction remained stable, and no significant radiation-induced inflammatory changes were noted. Conclusion The initial results of this trial suggest that STAR can reduce VT episodes in patients with refractory VT without severe adverse effects. The study highlights the importance of international collaboration and standardization in pioneering new treatments. Further follow-up and additional patient data will be necessary to confirm these findings and evaluate long-term outcomes, including potential adjustments to antiarrhythmic medication regimens.

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Implementing stereotactic arrhythmia radioablation with STOPSTORM.eu consortium support: intermediate results of a prospective Israeli single-institutional trial

Borzov,

Efraim,

Suleiman

et al. 2024

Strahlenther Onkol

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Stereotactic arrhythmia radioablation for ventricular tachycardia: a review of clinical trials and emerging roles of imaging

Kawamura,

Shimojo,

Tatsugami

et al. 2024

Journal of Radiation Research

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Ventricular tachycardia (VT) is a severe arrhythmia commonly treated with implantable cardioverter defibrillators, antiarrhythmic drugs and catheter ablation (CA). Although CA is effective in reducing recurrent VT, its impact on survival remains uncertain, especially in patients with extensive scarring. Stereotactic arrhythmia radioablation (STAR) has emerged as a novel treatment for VT in patients unresponsive to CA, leveraging techniques from stereotactic body radiation therapy used in cancer treatments. Recent clinical trials and case series have demonstrated the short-term efficacy and safety of STAR, although long-term outcomes remain unclear. Imaging techniques, such as electroanatomical mapping, contrast-enhanced magnetic resonance imaging and nuclear imaging, play a crucial role in treatment planning by identifying VT substrates and guiding target delineation. However, challenges persist owing to the complex anatomy and variability in target volume definitions. Advances in imaging and artificial intelligence are expected to improve the precision and efficacy of STAR. The exact mechanisms underlying the antiarrhythmic effects of STAR, including potential fibrosis and improvement in cardiac conduction, are still being explored. Despite its potential, STAR should be cautiously applied in prospective clinical trials, with a focus on optimizing dose delivery and understanding long-term outcomes. Collaborative efforts are necessary to standardize treatment strategies and enhance the quality of life for patients with refractory VT.

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Stereotactic arrhythmia radioablation (STAR) opens a new era in the treatment of arrhythmias?

Zhang,

Hu,

Tang

et al. 2024

Front. Cardiovasc. Med.

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Tachyarrhythmias are common cardiovascular emergencies encountered in clinical practice. Among these, atrial fibrillation (AF) and ventricular tachycardia (VT) pose significant hazards due to their prevalence and severity. Initially, non-invasive pharmacological antiarrhythmic interventions were the primary treatment modality; however, due to their limited control rates and side effects, invasive therapies have been introduced in recent years. These include catheter ablation, alcohol ablation, cardiac implantable electronic devices, and heart transplantation. Nonetheless, for some patients, invasive treatments do not offer a definitive cure for arrhythmias and carry the risk of recurrence, especially with AF and VT, where the relapse rates are high and the treatment for VT is correlated with the type of tachycardia present. Currently, novel non-invasive treatment methods are emerging, with stereotactic radioablation therapy becoming an effective alternative for the management of refractory tachyarrhythmias. This review provides an overview of the application background of Stereotactic Arrhythmia Radioablation (STAR) therapy and promising results from its use in animal models and clinical applications.

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Refining Treatment Planning in STereotactic Arrhythmia Radioablation: Benchmark Results and Consensus Statement From the STOPSTORM.eu Consortium

Cited by 3 publications

References 68 publications

Implementing stereotactic arrhythmia radioablation with STOPSTORM.eu consortium support: intermediate results of a prospective Israeli single-institutional trial

Implementing stereotactic arrhythmia radioablation with STOPSTORM.eu consortium support: intermediate results of a prospective Israeli single-institutional trial

Stereotactic arrhythmia radioablation for ventricular tachycardia: a review of clinical trials and emerging roles of imaging

Stereotactic arrhythmia radioablation (STAR) opens a new era in the treatment of arrhythmias?

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