Stereotactic radioablation of ventricular arrhythmias in patients with structural heart disease – A systematic review

Kovacs, Boldizsar; Mayinger, Michael; Schindler, Matthias; Steffel, Jan; Andratschke, Nicolaus; Saguner, Ardan M.

doi:10.1016/j.radonc.2021.06.036

Cited by 28 publications

(25 citation statements)

References 33 publications

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“…VT burden was reduced in all patients, but recurrence affected most of the patients (75%), with several adverse events (81%) and no treatment-related deaths. The authors concluded that STAR preliminary experience appears safe and efficacious despite the recurrence rate and deserve to be further investigated [ 18 ]. Despite this, there are still few conflicting data on the follow-up of patients and on the influence of respiratory movement on the cardiac dose.…”

Section: Resultsmentioning

confidence: 99%

Non-Oncological Radiotherapy: A Review of Modern Approaches

Nardone

D’Ippolito

Grassi

et al. 2022

JPM

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Despite being usually delivered in oncological patients, radiotherapy can be used as a successful treatment for several non-malignant disorders. Even though this use of radiotherapy has been scarcely investigated since the 1950s, more recent interest has actually shed the light on this approach. Thus, the aim of this narrative review is to analyze the applications of non-oncological radiotherapy in different disorders. Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. This review contains a narrative report and a critical discussion of non-oncological radiotherapy approaches. In conclusion, non-oncological radiotherapy is a safe and efficacious approach to treat several disorders that needs to be further investigated and used in clinical practice.

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Section: Resultsmentioning

confidence: 99%

Non-Oncological Radiotherapy: A Review of Modern Approaches

Nardone

D’Ippolito

Grassi

et al. 2022

JPM

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“…This technique is therefore used as a last line of treatment for patients with malignant ventricular arrhythmias who do not respond to all other treatments as per current guidelines and recommendations ( 1 , 29 ). Patients treated with STAR generally have advanced heart disease with a short life expectancy, in which STAR is usually considered on an individual case-by-case compassionate use basis ( 30 , 31 ). Overall all studies have shown that STAR is a safe technique with low risk of serious complications in the short-to-midterm as shown in Table 2 .…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Stereotactic Arrhythmia Radioablation for the Treatment of Ventricular Tachycardia: A Systematic Review

Volpato

Compagnucci

Cipolletta

et al. 2022

Front. Cardiovasc. Med.

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Catheter ablation (CA) is a fundamental therapeutic option for the treatment of recurrent ventricular arrhythmias. Notwithstanding the tremendous improvements in the available technology and the increasing amount of evidence in support of CA, in some patients the procedure fails, or is absolutely contraindicated due to technical or clinical issues. In these cases, the clinical management of patients is highly challenging, and mainly involves antiarrhythmic drugs escalation. Over the last 5 years, stereotactic arrhythmia radioablation (STAR) has been introduced into clinical practice, with several small studies reporting favorable arrhythmia-free outcomes, without severe side effects at a short to mid-term follow-up. In the present systematic review, we provide an overview of the available studies on stereotactic arrhythmia radioablation, by describing the potential indications and technical aspects of this promising therapy.

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“…To the best of our knowledge, in literature few severe adverse events, definitely correlated to STAR, are reported. In particular, one patient died of esophagopericardial fistula after 9 months from STAR: of note, the patient had previous bypass surgery with a gastroepiploic artery that might have contributed to this severe adverse event ( 79 ); few clinically relevant or symptomatic radiation-induced pericarditis and pericardial effusion and a gastropericardial fistula 2 years after STAR were recorded ( 80 ).…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Radiotherapy Ablation and Atrial Fibrillation: Technical Issues and Clinical Expectations Derived From a Systematic Review

Franzetti

Volpe²,

Catto³

et al. 2022

Front. Cardiovasc. Med.

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AimThe purpose of this study is to collect available evidence on the feasibility and efficacy of stereotactic arrhythmia radio ablation (STAR), including both photon radiotherapy (XRT) and particle beam therapy (PBT), in the treatment of atrial fibrillation (AF), and to provide cardiologists and radiation oncologists with a practical overview on this topic.MethodsThree hundred and thirty-five articles were identified up to November 2021 according to preferred reporting items for systematic reviews and meta-analyses criteria; preclinical and clinical studies were included without data restrictions or language limitations. Selected works were analyzed for comparing target selection, treatment plan details, and the accelerator employed, addressing workup modalities, acute and long-term side-effects, and efficacy, defined either by the presence of scar or by the absence of AF recurrence.ResultsTwenty-one works published between 2010 and 2021 were included. Seventeen studies concerned XRT, three PBT, and one involved both. Nine studies (1 in silico and 8 in vivo; doses ranging from 15 to 40 Gy) comprised a total of 59 animals, 12 (8 in silico, 4 in vivo; doses ranging from 16 to 50 Gy) focused on humans, with 9 patients undergoing STAR: average follow-up duration was 5 and 6 months, respectively. Data analysis supported efficacy of the treatment in the preclinical setting, whereas in the context of clinical studies the main favorable finding consisted in the detection of electrical scar in 4/4 patients undergoing specific evaluation; the minimum dose for efficacy was 25 Gy in both humans and animals. No acute complication was recorded; severe side-effects related to the long-term were observed only for very high STAR doses in 2 animals. Significant variability was evidenced among studies in the definition of target volume and doses, and in the management of respiratory and cardiac target motion.ConclusionSTAR is an innovative non-invasive procedure already applied for experimental treatment of ventricular arrhythmias. Particular attention must be paid to safety, rather than efficacy of STAR, given the benign nature of AF. Uncertainties persist, mainly regarding the definition of the treatment plan and the role of the target motion. In this setting, more information about the toxicity profile of this new approach is compulsory before applying STAR to AF in clinical practice.

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Stereotactic radioablation of ventricular arrhythmias in patients with structural heart disease – A systematic review

Cited by 28 publications

References 33 publications

Non-Oncological Radiotherapy: A Review of Modern Approaches

Non-Oncological Radiotherapy: A Review of Modern Approaches

Safety and Efficacy of Stereotactic Arrhythmia Radioablation for the Treatment of Ventricular Tachycardia: A Systematic Review

Stereotactic Radiotherapy Ablation and Atrial Fibrillation: Technical Issues and Clinical Expectations Derived From a Systematic Review

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