Standardizing the Cardiac Radioablation Targeting Workflow: Enabling Semi-Automated Angulation and Segmentation of the Heart According to the American Heart Association Segmented Model

Ree, Martijn H. van der; Visser, Jelle; Planken, R. Nils; Dieleman, Edith; Boekholdt, S. Matthijs; Balgobind, Brian V.; Postema, Pieter G.

doi:10.1016/j.adro.2022.100928

Cited by 20 publications

(21 citation statements)

References 12 publications

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“…Concerning GTV contouring, manual transfer of the target volume to the RT treatment planning system by visual matching, as we did for our patient, is still the most used method. Yet, the use of a combination of manual transport and software-aided data review tools including semi-automated angulation and segmentation of the heart ( 37 ), or of in-house or open-source 3D data matching software ( 38 ) only, yield great potential for improvement.…”

Section: Discussionmentioning

confidence: 99%

A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis

Levis

Dusi

Magnano

et al. 2022

Front. Cardiovasc. Med.

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IntroductionCatheter ablation (CA) is the current standard of care for patients suffering drug-refractory monomorphic ventricular tachycardias (MMVTs). Yet, despite significant technological improvements, recurrences remain common, leading to increased morbidity and mortality. Stereotactic arrhythmia radioablation (STAR) is increasingly being adopted to overcome the limitations of conventional CA, but its safety and efficacy are still under evaluation.Case presentationWe hereby present the case of a 73-year-old patient implanted with a mitral valve prosthesis, a cardiac resynchronization therapy-defibrillator, and a cardiac contractility modulation device, who was successfully treated with STAR for recurrent drug and CA-resistant MMVT in the setting of advanced heart failure and a giant left atrium. We report a 2-year follow-up and a detailed dosimetric analysis.ConclusionOur case report supports the early as well as the long-term efficacy of 25 Gy single-session STAR. Despite the concomitant severe heart failure, with an overall heart minus planned target volume mean dosage below 5 Gy, no major detrimental cardiac side effects were detected. To the best of our knowledge, our dosimetric analysis is the most accurate reported so far in the setting of STAR, particularly for what concerns cardiac substructures and coronary arteries. A shared dosimetric planning among centers performing STAR will be crucial in the next future to fully disclose its safety profile.

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Section: Discussionmentioning

confidence: 99%

A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis

Levis

Dusi

Magnano

et al. 2022

Front. Cardiovasc. Med.

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“…To aid anatomic orientation on the radiotherapy planning system, semi-automatic angulation and segmentation was performed as previously described. 14 The clinical target volume (CTV) was delineated by a cardiologist-electrophysiologist in close collaboration with other members of the STAR team. Subsequently, an internal target volume (ITV) was created to correct for cardiorespiratory motion based on the 4D-CT.…”

Section: Methodsmentioning

confidence: 99%

“… 13 The delivered radiation dose appears to induce electrophysiological changes altering the pro-arrhythmic substrate. 11 , 14 , 15 Clinical experience of STAR is very limited but is steadily growing since the first reports in 2014–2015. 11 , 16 , 17 Evidence regarding efficacy and safety is mainly based on case reports and case series, 12 , 16 , 18–21 and evidence based on completed prospective trials is scarce ( n = 22 patients).…”

Section: Introductionmentioning

confidence: 99%

Non-invasive stereotactic arrhythmia radiotherapy for ventricular tachycardia: results of the prospective STARNL-1 trial

et al. 2023

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Aims Stereotactic arrhythmia radiotherapy (STAR) is suggested as potentially effective and safe treatment for patients with therapy-refractory ventricular tachycardia (VT). However, the current prospective knowledge base and experience with STAR is limited. In this study we aimed to prospectively evaluate the efficacy and safety of STAR. Methods and results The StereoTactic Arrhythmia Radiotherapy in the Netherlands no.1 was a pre-post intervention study to prospectively evaluate efficacy and safety of STAR. In patients with therapy-refractory VT, the pro-arrhythmic region was treated with a 25 Gy single radiotherapy fraction. The main efficacy measure was a reduction in the number of treated VT-episodes by ≥50%, comparing the 12 months before and after treatment (or end of follow-up, excluding a 6-week blanking period). The study was deemed positive when ≥50% of patients would meet this criterion. Safety evaluation included left ventricular ejection fraction, pulmonary function, and adverse events. Six male patients with an ischaemic cardiomyopathy were enrolled, and median age was 73 years (range 54–83). Median left ventricular ejection fraction was 38% (range 24–52). The median planning target volume was 187 mL (range 93–372). Four (67%) patients completed the 12-month follow-up, and two patients died (not STAR related) during follow-up. The main efficacy measure of ≥50% reduction in treated VT-episodes at the end of follow-up was achieved in four patients (67%). The median number of treated VT-episodes was reduced by 87%. No reduction in left ventricular ejection fraction or pulmonary function was observed. No treatment related serious adverse events occurred. Conclusions STAR resulted in a ≥ 50% reduction in treated VT-episodes in 4/6 (67%) patients. No reduction in cardiac and pulmonary function nor treatment-related serious adverse events were observed during follow-up. Clinical trial registration Netherlands Trial Register—NL7510.

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“… 9 Segments with electro-anatomic alterations such as VT exit sites, delayed enhancement on cardiac MRI, and wall-thinning on cardiac CT are translated to a semiautomatically segmented treatment-planning 4D-CT-scan. 10 An earlier cardiac MRI and CT scan revealed myocardial scar in the anteroseptal segments ( Figure 1 ). Echocardiographic deformation imaging revealed abnormal strain percentages in all but the basal inferior segment, which was the only segment with normal shortening of >18%.…”

Section: Case Reportmentioning

confidence: 96%

Direct Clinical Effects of Cardiac Radioablation in the Treatment of a Patient With Therapy-Refractory Ventricular Tachycardia Storm

Ree

Dieleman

Visser

et al. 2022

Advances in Radiation Oncology

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Standardizing the Cardiac Radioablation Targeting Workflow: Enabling Semi-Automated Angulation and Segmentation of the Heart According to the American Heart Association Segmented Model

Cited by 20 publications

References 12 publications

A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis

A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis

Non-invasive stereotactic arrhythmia radiotherapy for ventricular tachycardia: results of the prospective STARNL-1 trial

Direct Clinical Effects of Cardiac Radioablation in the Treatment of a Patient With Therapy-Refractory Ventricular Tachycardia Storm

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