Dosimetric comparison between volumetric-modulated arc radiotherapy and intensity-modulated proton therapy in patients with ventricular tachycardia using stereotactic ablative radiotherapy
Ren Xueying1, Gao Xianshu1, He Pengkang2, Zhao Zhilei3, Zhao Bo1, Bai Yun1, Ma Mingwei1, Qin Shangbin1, Zhang Min1, Zhou Jing2
1Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China; 2Department of Cardiology, Peking University First Hospital, Beijing 100034, China; 3Hebei Yizhou International Proton Medical Center, Zhuozhou 072750, China
Abstract：Objective To evaluate the dosimetric properties of intensity-modulated proton therapy (IMPT) plans for simulated treatment planning in patients with ventricular tachycardia (VT) using stereotactic ablative body radiotherapy (SABR), in comparison with the volumetric-modulated arc therapy (VMAT).Methods A total of 25 gross target volume (GTV) of the apical, anterior, septal, inferior and lateral wall of the left ventricle (LV) were delineated on the CT simulation images of 5 patients with complete data. An additional 5 mm GTV margin was added to the internal target volume (ITV), and an additional 3 mm ITV margin was added to the planning target volume (PTV). VMAT and IMPT plans were designed in each target area. Dose prescription was 25 Gy (RBE) in a single fraction. The dosimetric differences of ITV and organ at risk (OAR) were compared between VMAT and IMPT.Results The median volume of ITV was 45.40 cm3(26.72-67.59 cm3). All plans had adequate target coverage(V95%Rx≥99%). Compared with the VMAT plans, IMPT reduced the Dmean of whole heart, pericardium and non-target cardiac tissues (relative difference) by 44.52%, 44.91% and 60.16%, respectively, which also reduced D0.03 cm3 of the left anterior descending artery by 17.58%(P<0.05). After stratified analysis according to the lesion sites, IMPT could still reduce the dose of most OAR. However, the D0.03 cm3 of LAD and LCX for the lesions in the anterior wall of LV, the D0.03 cm3 of LCX in the inferior wall and D0.03 cm3 of LAD in the apical wall did not significantly differ (both P>0.05).Conclusions Both VMAT and IMPT plans can meet the clinical dosimetric requirements when SABR is simulated in patients with VT. However, IMPT can lower the dose of normal heart tissues, which has the potential benefit of reducing the risk of complications, such as ischemic heart disease, pericarditis/pericardial effusion, etc.
Ren Xueying,Gao Xianshu,He Pengkang et al. Dosimetric comparison between volumetric-modulated arc radiotherapy and intensity-modulated proton therapy in patients with ventricular tachycardia using stereotactic ablative radiotherapy[J]. Chinese Journal of Radiation Oncology, 2020, 29(6): 466-471.
[1] Cronin EM, Bogun FM, Maury P, et al. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias[J]. Europace, 2019, 21(8):1143-1144. DOI:10.1093/europace/euz132. [2] Sapp JL, Wells GA, Parkash R, et al. Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs[J]. N Engl J Med, 2016, 375(2):111-121. DOI:10.1056/NEJMoa1513614. [3] Benedict SH, Yenice KM, Followill D, et al. Stereotactic body radiation therapy:the report of AAPM Task Group 101[J]. Med Phys, 2010, 37(8):4078-4101. DOI:10.1118/1.3438081. [4] Cuculich PS, Schill MR, Kashani R, et al. Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia[J]. N Engl J Med, 2017, 377(24):2325-2336. DOI:10.1056/NEJMoa1613773. [5] Neuwirth R, Cvek J, Knybel L, et al. Stereotactic radiosurgery for ablation of ventricular tachycardia[J]. Europace, 2019, 21(7):1088-1095. DOI:10.1093/europace/euz133. [6] Lloyd MS, Wight J, Schneider F, et al. Clinical experience of stereotactic body radiation for refractory ventricular tachycardia in advanced heart failure patients[J]. Heart Rhythm, 2020, 17(3):415-422. DOI:10.1016/j.hrthm.2019.09.028. [7] Robinson CG, Samson PP, Moore KMS, et al. Phase Ⅰ/Ⅱtrial of electrophysiology-guided noninvasive cardiac radioablation for ventricular tachycardia[J]. Circulation, 2019, 139(3):313-321. DOI:10.1161/CIRCULATIONAHA.118.038261. [8] Dess RT, Sun Y, Matuszak MM, et al. Cardiac events after radiation therapy:combined analysis of prospective multicenter trials for locally advanced non-small-cell lung cancer[J]. J Clin Oncol, 2017, 35(13):1395-1402. DOI:10.1200/JCO.2016.71.6142. [9] Darby SC, Ewertz M, McGale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer[J]. N Engl J Med, 2013, 368(11):987-998. DOI:10.1056/NEJMoa1209825. [10] van den Bogaard VA, Ta BD, van der Schaaf A, et al. Validation and modification of a prediction model for acute cardiac events in patients with breast cancer treated with radiotherapy based on three-dimensional dose distributions to cardiac substructures[J]. J Clin Oncol, 2017, 35(11):1171-1178. DOI:10.1200/JCO.2016.69.8480. [11] Duane F, Aznar MC, Bartlett F, et al. A cardiac contouring atlas for radiotherapy[J]. Radiother Oncol, 2017, 122(3):416-422. DOI:10.1016/j.radonc.2017.01.008. [12] Knutson NC, Samson PP, Hugo GD, et al. Radiation therapy workflow and dosimetric analysis from a phase 1/2 trial of noninvasive cardiac radio ablation for ventricular tachycardia[J]. Int J Radiat Oncol Biol Phys, 2019, 104(5):1114-1123. DOI:10.1016/j.ijrobp.2019.04.005. [13] Mohan R, Das IJ, Ling CC. Empowering intensity modulated proton therapy through physics and technology:an overview[J]. Int J Radiat Oncol Biol Phys, 2017, 99(2):304-316. DOI:10.1016/j.ijrobp.2017.05.005. [14] Tokuda M, Kojodjojo P, Tung S, et al. Acute failure of catheter ablation for ventricular tachycardia due to structural heart disease:causes and significance[J]. J Am Heart Assoc, 2013, 2(3):e000072. DOI:10.1161/jaha.113.000072. [15] Radiotherapy for arrythmia[DB/OL].[2020-03-10]. https://www.clinicaltrials.gov/. [16] Xue J, Han C, Jackson A, et al. Doses of radiation to the pericardium, instead of heart, are significant for survival in patients with non-small cell lung cancer[J]. Radiother Oncol, 2019, 133:213-219. DOI:10.1016/j.radonc.2018.10.029. [17] Yegya-Raman N, Wang K, Kim S, et al. Dosimetric predictors of symptomatic cardiac events after conventional-dose chemoradiation therapy for inoperable NSCLC[J]. J Thorac Oncol, 2018, 13(10):1508-1518. DOI:10.1016/j.jtho.2018.05.028. [18] Hahn E, Jiang H, Ng A, et al. Late cardiac toxicity after mediastinal radiation therapy for hodgkin lymphoma:contributions of coronary artery and whole heart dose-volume variables to risk prediction[J]. Int J Radiat Oncol Biol Phys, 2017, 98(5):1116-1123. DOI:10.1016/j.ijrobp.2017.03.026. [19] Robinson CG, Samson P, Moore KMS, et al. Longer term results from a phase Ⅰ/Ⅱ study of ep-guided noninvasive cardiac radioablation for treatment of ventricular tachycardia (ENCORE-VT)[J]. Int J Radiat Oncol Biol Phys, 2019, 105(3):682. DOI:10.1016/j.ijrobp.2019.08.032.
2020, Vol. 29 
