Immobilization for carbon ion beam ablation of cardiac structures in a porcine model

Prall, M.; Eichhorn, Anna; Richter, Daniel; Lehmann, H. Immo; Constantinescu, A.; Kaderka, Robert; Lugenbiel, Patrick; Thomas, Dierk; Bert, Christoph; Packer, Douglas L.; Durante, Marco; Graeff, Christian

doi:10.1016/j.ejmp.2017.10.016

Cited by 5 publications

(6 citation statements)

References 16 publications

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“…It should be noted though that the delivery of scanned particle therapy to moving targets is highly complex 14 . In spite of careful 4D-planning and efforts to suppress target motion 56,57 , the uncertainty in the dose distribution remains high and likely explains the heterogeneous outcome in this study. Nevertheless, this problem also is present with other radiation techniques.…”

Section: Discussionmentioning

confidence: 92%

Biological Cardiac Tissue Effects of High-Energy Heavy Ions – Investigation for Myocardial Ablation

Rapp

Simoniello

Wiedemann

et al. 2019

Sci Rep

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Noninvasive X-ray stereotactic treatment is considered a promising alternative to catheter ablation in patients affected by severe heart arrhythmia. High-energy heavy ions can deliver high radiation doses in small targets with reduced damage to the normal tissue compared to conventional X-rays. For this reason, charged particle therapy, widely used in oncology, can be a powerful tool for radiosurgery in cardiac diseases. We have recently performed a feasibility study in a swine model using high doses of high-energy C-ions to target specific cardiac structures. Interruption of cardiac conduction was observed in some animals. Here we report the biological effects measured in the pig heart tissue of the same animals six months after the treatment. Immunohistological analysis of the target tissue showed (1.) long-lasting vascular damage, i.e. persistent hemorrhage, loss of microvessels, and occurrence of siderophages, (2.) fibrosis and (3.) loss of polarity of targeted cardiomyocytes and wavy fibers with vacuolization. We conclude that the observed physiological changes in heart function are produced by radiation-induced fibrosis and cardiomyocyte functional inactivation. No effects were observed in the normal tissue traversed by the particle beam, suggesting that charged particles have the potential to produce ablation of specific heart targets with minimal side effects.

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Section: Discussionmentioning

confidence: 92%

Biological Cardiac Tissue Effects of High-Energy Heavy Ions – Investigation for Myocardial Ablation

Rapp

Simoniello

Wiedemann

et al. 2019

Sci Rep

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“…Preclinical studies were mainly exploratory, investigating the electrophysiologic effects of irradiating various regions of rabbit, 19,20 pig, [21][22][23][24][25][26][27][28][29][30][31][32] or dog 30,33,34 hearts with different doses. Early studies used Sr 90 and P 32 b-emitting sources.…”

Section: Preclinical Studiesmentioning

confidence: 99%

“…ventilation. 19,[22][23][24]26,27,29,31,32,34,36,37 Computed tomography (CT) imaging was always used for treatment planning. [22][23][24]26,27,29,31,32,35,36 Respiratory motion management techniques included direct tracking of gold fiducials or a temporary implanted catheter tip, 24,29,30 internal target volume (ITV), 22,31,32 or breath-hold during paused ventilation.…”

Section: Aid Target Volume Generationmentioning

confidence: 99%

“…19,[22][23][24]26,27,29,31,32,34,36,37 Computed tomography (CT) imaging was always used for treatment planning. [22][23][24]26,27,29,31,32,35,36 Respiratory motion management techniques included direct tracking of gold fiducials or a temporary implanted catheter tip, 24,29,30 internal target volume (ITV), 22,31,32 or breath-hold during paused ventilation. 25,26,28,35 An ITV derived from a cardiac-gated CT was commonly used to mitigate cardiac motion, 22,23,26,28,29,31,32,35 but a predefined isotropic margin expansion was also used.…”

Section: Aid Target Volume Generationmentioning

confidence: 99%

“…25 Isotropic treatment planning margin expansions of 3 to 5 mm were used in CyberKnife and c-arm LINAC treatments to compensate for treatment delivery uncertainties. 23,25,27,31,32,36 For AF, the right superior pulmonary vein was mainly targeted 24,26,31,32 because other pulmonary veins exhibited larger mobility or extensive branching in animal models and/or had limited catheter accessibility for electrophysiology investigation. 24,31,32 Preclinical studies have irradiated the left ventricle, cavotricuspid isthmus, atrioventricular node, left atrial appendage, and pulmonary veins.…”

Section: Aid Target Volume Generationmentioning

confidence: 99%

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A Review of Cardiac Radioablation (CR) for Arrhythmias: Procedures, Technology, and Future Opportunities

Lydiard

Blanck

Hugo³

et al. 2021

International Journal of Radiation Oncology*Biology*Physics

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Purpose: Cardiac radioablation (CR), a new treatment for cardiac arrhythmias such as ventricular tachycardia and atrial fibrillation, has had promising clinical outcomes to date. There is consequent desire for rapid clinical adoption. However, CR presents unique challenges to radiation therapy, and it is paramount that clinical adoption be performed safely and effectively. Recent reviews comprehensively detail patient selection, clinical history, treatment outcomes, and treatment toxicities but only briefly mention the technical aspects of CR. To address this knowledge gap, this review collates currently available knowledge regarding CR technology choice and procedural details to help inform and guide clinics considering implementing their own CR program, to aid technique standardization, and to highlight areas that require further development or verification. Methods and Materials: Original preclinical and clinical scientific articles that sufficiently detailed CR technical aspects, including pretreatment electrophysiology and imaging, motion analysis and management techniques, treatment planning, and/or treatment delivery, were identified within a comprehensive literature search. Results: Nineteen preclinical and 18 clinical scientific articles sufficiently detailed the technical aspects of CR treatment deliveries on live subjects. The technical aspects of these scientific articles were diverse: Preclinical treatments have been performed with brachytherapy, photons, protons, and carbon ions, and clinical treatments have been performed with photons using conventional, robotic, and magnetic resonance imaging guided systems. Other technical aspects demonstrated similar variability. Conclusions: This review summarizes the technical aspects and procedural details of preclinical and clinical CR treatment deliveries and highlights the complexity and current variability of CR. There is need for standardized procedural reporting NotedAn online CME test for this article can be taken at https:// academy.astro.org.

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Proton or photon radiosurgery for cardiac ablation of ventricular tachycardia? Breath and ECG gated robust optimization

et al. 2020

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Immobilization for carbon ion beam ablation of cardiac structures in a porcine model

Cited by 5 publications

References 16 publications

Biological Cardiac Tissue Effects of High-Energy Heavy Ions – Investigation for Myocardial Ablation

Biological Cardiac Tissue Effects of High-Energy Heavy Ions – Investigation for Myocardial Ablation

A Review of Cardiac Radioablation (CR) for Arrhythmias: Procedures, Technology, and Future Opportunities

Proton or photon radiosurgery for cardiac ablation of ventricular tachycardia? Breath and ECG gated robust optimization

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