Left ventricular function after noninvasive cardiac ablation using proton beam therapy in a porcine model

Hohmann, Stephan; Deisher, A.; Suzuki, Atsushi; Konishi, Hirokazu; Rettmann, Maryam E.; Merrell, Kenneth W.; Kruse, Jon J.; Newman, Laura K.; Parker, Kay; Monahan, Kristi H.; Foote, Robert L.; Herman, Michael; Packer, Douglas L.

doi:10.1016/j.hrthm.2019.04.030

Cited by 35 publications

(39 citation statements)

References 30 publications

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“…Still, the cell biological mechanisms and the temporal process of the effects of RA/CRS are poorly understood. For a single fraction dose of 25 Gy, the phenomenon of marked clinical effects in terms of reduction of VT burden or ICD interventions without the clear formation of a scar has been reported from preclinical data [34,36,38,39] and even from patients treatments [24,31].…”

Section: Discussionmentioning

confidence: 99%

“…Finally, we added initial technical, pre-clinical, and clinical manuscripts not covered by the search based on our own experience in cardiac radiosurgery in the past 12 years. Evidence was finally extracted from the remaining 42 manuscripts, which include reports on two clinical trials [22,23], two clinical case series [24,25], eight case reports [19,20,[26][27][28][29][30][31], eight preclinical studies [18,[32][33][34][35][36][37][38][39], fourteen technical studies [40][41][42][43][44][45][46][47][48][49][50][51][52][53], and eight reviews or opinions [7,[54][55][56][57][58][59][60].…”

Section: Clinical Trial and Literature Reviewmentioning

confidence: 99%

“…On the other hand, a lethal bronchial fistula occurred at a dose of 40 Gy in one minipig. The other group pursued the use of heavy ions instead of photons for RA/CRS [35,38,39]. In principle, particles have the major advantage over photons that the maximum dose intensity delivered per beam can be varied in depth at the so-called Bragg Peak, while for photons, the maximum dose is always close to the body surface (approximately 1.5 cm for 6 MeV photons).…”

Section: Preclinical/animal Studies For Cardiac Radiosurgerymentioning

confidence: 99%

“…In principle, particles have the major advantage over photons that the maximum dose intensity delivered per beam can be varied in depth at the so-called Bragg Peak, while for photons, the maximum dose is always close to the body surface (approximately 1.5 cm for 6 MeV photons). The authors conducted various animal experiments and reported histopathological findings in great detail, yet they also found that much higher doses are needed (> 25 Gy) to generate therapeutic effects [38,39].…”

Section: Preclinical/animal Studies For Cardiac Radiosurgerymentioning

confidence: 99%

“…Both patients received a single fraction radiation dose of 25 Gy to the VT substrate, as defined by electroanatomical voltage mapping and showed only limited-to-no toxicity with a significant reduction in VT burden and ICD shock frequency after treatment. The clinical treatment effects with 25 Gy were remarkable, given the results from the animal models, in which 25 Gy showed only limited-to-no effects on electrical block and transmural fibrosis [32][33][34][35][36][37][38][39]. It might be hypothesized that modulation of cardiac conduction rather than induction of transmural fibrosis explains the treatment effect seen after RA/CRS with 25 Gy.…”

Section: Clinical Data For Cardiac Radiosurgerymentioning

confidence: 99%

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Radiosurgery for ventricular tachycardia: preclinical and clinical evidence and study design for a German multi-center multi-platform feasibility trial (RAVENTA)

et al. 2020

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Background Single-session high-dose stereotactic radiotherapy (radiosurgery) is a new treatment option for otherwise untreatable patients suffering from refractory ventricular tachycardia (VT). In the initial single-center case studies and feasibility trials, cardiac radiosurgery has led to significant reductions of VT burden with limited toxicities. However, the full safety profile remains largely unknown. Methods/design In this multi-center, multi-platform clinical feasibility trial which we plan is to assess the initial safety profile of radiosurgery for ventricular tachycardia (RAVENTA). High-precision image-guided single-session radiosurgery with 25 Gy will be delivered to the VT substrate determined by high-definition endocardial electrophysiological mapping. The primary endpoint is safety in terms of successful dose delivery without severe treatment-related side effects in the first Jürgen Dunst and Hendrik Bonnemeier have equally contributed to this work. This is the first publication for the RAVENTA study.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Trial and Literature Reviewmentioning

confidence: 99%

Section: Preclinical/animal Studies For Cardiac Radiosurgerymentioning

confidence: 99%

Section: Preclinical/animal Studies For Cardiac Radiosurgerymentioning

confidence: 99%

Section: Clinical Data For Cardiac Radiosurgerymentioning

confidence: 99%

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Radiosurgery for ventricular tachycardia: preclinical and clinical evidence and study design for a German multi-center multi-platform feasibility trial (RAVENTA)

et al. 2020

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Dosimetric feasibility of stereotactic ablative radiotherapy in pulmonary vein isolation for atrial fibrillation using intensity‐modulated proton therapy

Ren

Gao

et al. 2021

J Applied Clin Med Phys

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Purpose: To evaluate dosimetric properties of intensity-modulated proton therapy (IMPT) for simulated treatment planning in patients with atrial fibrillation (AF) targeting left atrial-pulmonary vein junction (LA-PVJ), in comparison with volumetric-modulated arc therapy (VMAT) and helical tomotherapy (TOMO).Methods: Ten thoracic 4D-CT scans with respiratory motion and one with cardiac motion were used for the study. Ten respiratory 4D-CTs were planned with VMAT, TOMO, and IMPT for simulated AF. Targets at the LA-PVJ were defined as wide-area circumferential ablation line. A single fraction of 25 Gy was prescribed to all plans. The interplay effects from cardiac motion were evaluated based on the cardiac 4D-CT scan. Dose-volume histograms (DVHs) of the ITV and normal tissues were compared. Statistical analysis was evaluated via one-way Repeated-Measures ANOVA and Friedman's test with Bonferroni's multiple comparisons test. Results:The median volume of ITV was 8.72cc. All plans had adequate target coverage (V 23.75Gy ≥ 99%). Compared with VMAT and TOMO, IMPT resulted in significantly lower dose of most normal tissues. For VMAT, TOMO, and IMPT plans, D mean of the whole heart was 5.52 ± 0.90 Gy, 5.89 ± 0.78 Gy, and 3.01 ± 0.57 Gy (P < 0.001), mean dose of pericardium was 4.74 ± 0.76 Gy, 4.98 ± 0.62 Gy, and 2.59 ± 0.44 Gy (P < 0.001), and D 0.03cc of left circumflex artery (LCX) was 13.96 ± 5.45 Gy, 14.34 ± 5.91 Gy, and 8.43 ± 7.24 Gy (P < 0.001), respectively. However, no significant advantage for one technique over the others was observed when examining the D 0.03cc of esophagus and main bronchi.Conclusions: IMPT targeting LA-PVJ for patients with AF has high potential to reduce dose to surrounding tissues compared to VMAT or TOMO. Motion mitigation techniques are critical for a particle-therapy approach.

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AAPM Task Group Report 290: Respiratory motion management for particle therapy

Dong

Bert

et al. 2022

Medical Physics

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Dose uncertainty induced by respiratory motion remains a major concern for treating thoracic and abdominal lesions using particle beams. This Task Group report reviews the impact of tumor motion and dosimetric considerations in particle radiotherapy, current motion‐management techniques, and limitations for different particle‐beam delivery modes (i.e., passive scattering, uniform scanning, and pencil‐beam scanning). Furthermore, the report provides guidance and risk analysis for quality assurance of the motion‐management procedures to ensure consistency and accuracy, and discusses future development and emerging motion‐management strategies. This report supplements previously published AAPM report TG76, and considers aspects of motion management that are crucial to the accurate and safe delivery of particle‐beam therapy. To that end, this report produces general recommendations for commissioning and facility‐specific dosimetric characterization, motion assessment, treatment planning, active and passive motion‐management techniques, image guidance and related decision‐making, monitoring throughout therapy, and recommendations for vendors. Key among these recommendations are that: (1) facilities should perform thorough planning studies (using retrospective data) and develop standard operating procedures that address all aspects of therapy for any treatment site involving respiratory motion; (2) a risk‐based methodology should be adopted for quality management and ongoing process improvement.

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Left ventricular function after noninvasive cardiac ablation using proton beam therapy in a porcine model

Cited by 35 publications

References 30 publications

Radiosurgery for ventricular tachycardia: preclinical and clinical evidence and study design for a German multi-center multi-platform feasibility trial (RAVENTA)

Radiosurgery for ventricular tachycardia: preclinical and clinical evidence and study design for a German multi-center multi-platform feasibility trial (RAVENTA)

Dosimetric feasibility of stereotactic ablative radiotherapy in pulmonary vein isolation for atrial fibrillation using intensity‐modulated proton therapy

AAPM Task Group Report 290: Respiratory motion management for particle therapy

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