Stereotactic Arrhythmia Radioablation (STAR): Assessment of cardiac and respiratory heart motion in ventricular tachycardia patients - A STOPSTORM.eu consortium review

Raoul R F Stevens; Colien Hazelaar; Martin F Fast; Stefano Mandija; Melanie Grehn; Jakub Cvek; Lukas Knybel; Pavel Dvorak; Etienne Pruvot; Joost J C Verhoeff; Oliver Blanck; Wouter van Elmpt

doi:10.1016/j.radonc.2023.109844

Stereotactic Arrhythmia Radioablation (STAR): Assessment of cardiac and respiratory heart motion in ventricular tachycardia patients - A STOPSTORM.eu consortium review

Radiother Oncol. 2023 Nov:188:109844. doi: 10.1016/j.radonc.2023.109844. Epub 2023 Aug 4.

Authors

Affiliations

¹ Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands. Electronic address: raoul.stevens@maastro.nl.
² Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands.
³ Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands.
⁴ Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany.
⁵ Department of Oncology, University Hospital and Faculty of Medicine, Ostrava, Czech Republic.
⁶ Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

PMID: 37543057
DOI: 10.1016/j.radonc.2023.109844

Abstract

Aim: To identify the optimal STereotactic Arrhythmia Radioablation (STAR) strategy for individual patients, cardiorespiratory motion of the target volume in combination with different treatment methodologies needs to be evaluated. However, an authoritative overview of the amount of cardiorespiratory motion in ventricular tachycardia (VT) patients is missing.

Methods: In this STOPSTORM consortium study, we performed a literature review to gain insight into cardiorespiratory motion of target volumes for STAR. Motion data and target volumes were extracted and summarized.

Results: Out of the 232 studies screened, 56 provided data on cardiorespiratory motion, of which 8 provided motion amplitudes in VT patients (n = 94) and 10 described (cardiac/cardiorespiratory) internal target volumes (ITVs) obtained in VT patients (n = 59). Average cardiac motion of target volumes was < 5 mm in all directions, with maximum values of 8.0, 5.2 and 6.5 mm in Superior-Inferior (SI), Left-Right (LR), Anterior-Posterior (AP) direction, respectively. Cardiorespiratory motion of cardiac (sub)structures showed average motion between 5-8 mm in the SI direction, whereas, LR and AP motions were comparable to the cardiac motion of the target volumes. Cardiorespiratory ITVs were on average 120-284% of the gross target volume. Healthy subjects showed average cardiorespiratory motion of 10-17 mm in SI and 2.4-7 mm in the AP direction.

Conclusion: This review suggests that despite growing numbers of patients being treated, detailed data on cardiorespiratory motion for STAR is still limited. Moreover, data comparison between studies is difficult due to inconsistency in parameters reported. Cardiorespiratory motion is highly patient-specific even under motion-compensation techniques. Therefore, individual motion management strategies during imaging, planning, and treatment for STAR are highly recommended.

Keywords: Cardiac SBRT; Cardiac radioablation; Stereotactic Arrhythmia Radioablation; Ventricular tachycardia.

Publication types

Review