Comparison of proton and photon therapy in stereotactic arrhythmia radioablation for ventricular tachycardia
Background and Purpose: Ventricular tachycardia (VT) is a life-threatening arrhythmia commonly treated with catheter ablation; however, some cases remain refractory. Stereotactic arrhythmia radioablation (STAR) offers a non-invasive alternative. While photon-based STAR is effective, proton therapy m...
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Elsevier
2025-07-01
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| Series: | Physics and Imaging in Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405631625001125 |
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| author | Keyur D. Shah Chih-Wei Chang Pretesh Patel Sibo Tian Yuan Shao Kristin A Higgins Yinan Wang Justin Roper Jun Zhou Zhen Tian Xiaofeng Yang |
| author_facet | Keyur D. Shah Chih-Wei Chang Pretesh Patel Sibo Tian Yuan Shao Kristin A Higgins Yinan Wang Justin Roper Jun Zhou Zhen Tian Xiaofeng Yang |
| author_sort | Keyur D. Shah |
| collection | DOAJ |
| description | Background and Purpose: Ventricular tachycardia (VT) is a life-threatening arrhythmia commonly treated with catheter ablation; however, some cases remain refractory. Stereotactic arrhythmia radioablation (STAR) offers a non-invasive alternative. While photon-based STAR is effective, proton therapy may improve dose conformity and spare critical organs at risk (OARs), including the heart itself. The aim of this study was to compare the dose-volume metrics between proton and photon therapy for VT. Materials and Methods: We retrospectively analyzed 34 VT patients who received photon STAR. Proton STAR plans were generated using robust optimization in a commercial treatment planning system to deliver the same prescription dose of 25 Gy in a single fraction. Dose-volume metrics, including D99, D95, Dmean, and D0.03cm3, were extracted for critical OARs (heart, lungs, cardiac-chambers) and target. Shapiro-Wilk tests were used to assess normality, with paired t-tests or Wilcoxon signed-rank tests for statistical comparisons between modalities, with Bonferroni correction applied for multiple comparisons. Results: Proton and photon plans achieved comparable target coverage, with CTV D95 of 25.8 [21.6–28.7] Gy(RBE) vs. 27.2 [21.6–29.3] Gy (p < 0.001). Proton therapy significantly reduced OAR doses, including heart Dmean (3.6 ± 1.5 Gy(RBE) vs. 5.5 ± 2.0 Gy, p < 0.001) and lungs Dmean (0.6 [0.0–1.9] Gy(RBE) vs. 1.2 [0.2–2.6] Gy, p < 0.001), while maintaining optimal target coverage. Conclusion: Proton therapy for STAR demonstrated significant potential for OARs sparing compared to photon therapy for VT, while maintaining equivalent target coverage. These findings highlight the potential of proton therapy to improve outcomes for VT patients. |
| format | Article |
| id | doaj-art-1c2562e5d38f4735bd6f36adbc18faa9 |
| institution | Matheson Library |
| issn | 2405-6316 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Physics and Imaging in Radiation Oncology |
| spelling | doaj-art-1c2562e5d38f4735bd6f36adbc18faa92025-07-11T04:31:29ZengElsevierPhysics and Imaging in Radiation Oncology2405-63162025-07-0135100807Comparison of proton and photon therapy in stereotactic arrhythmia radioablation for ventricular tachycardiaKeyur D. Shah0Chih-Wei Chang1Pretesh Patel2Sibo Tian3Yuan Shao4Kristin A Higgins5Yinan Wang6Justin Roper7Jun Zhou8Zhen Tian9Xiaofeng Yang10Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USADepartment of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USADepartment of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USADepartment of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USASchool of Public Health, University of Illinois, Chicago, IL, USADepartment of Radiation Oncology, City of Hope Cancer Center Atlanta, Atlanta, GA, USADepartment of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USADepartment of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USADepartment of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USADepartment of Radiation & Cellular Oncology, University of Chicago, Chicago, IL, USADepartment of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA; Corresponding author.Background and Purpose: Ventricular tachycardia (VT) is a life-threatening arrhythmia commonly treated with catheter ablation; however, some cases remain refractory. Stereotactic arrhythmia radioablation (STAR) offers a non-invasive alternative. While photon-based STAR is effective, proton therapy may improve dose conformity and spare critical organs at risk (OARs), including the heart itself. The aim of this study was to compare the dose-volume metrics between proton and photon therapy for VT. Materials and Methods: We retrospectively analyzed 34 VT patients who received photon STAR. Proton STAR plans were generated using robust optimization in a commercial treatment planning system to deliver the same prescription dose of 25 Gy in a single fraction. Dose-volume metrics, including D99, D95, Dmean, and D0.03cm3, were extracted for critical OARs (heart, lungs, cardiac-chambers) and target. Shapiro-Wilk tests were used to assess normality, with paired t-tests or Wilcoxon signed-rank tests for statistical comparisons between modalities, with Bonferroni correction applied for multiple comparisons. Results: Proton and photon plans achieved comparable target coverage, with CTV D95 of 25.8 [21.6–28.7] Gy(RBE) vs. 27.2 [21.6–29.3] Gy (p < 0.001). Proton therapy significantly reduced OAR doses, including heart Dmean (3.6 ± 1.5 Gy(RBE) vs. 5.5 ± 2.0 Gy, p < 0.001) and lungs Dmean (0.6 [0.0–1.9] Gy(RBE) vs. 1.2 [0.2–2.6] Gy, p < 0.001), while maintaining optimal target coverage. Conclusion: Proton therapy for STAR demonstrated significant potential for OARs sparing compared to photon therapy for VT, while maintaining equivalent target coverage. These findings highlight the potential of proton therapy to improve outcomes for VT patients.http://www.sciencedirect.com/science/article/pii/S2405631625001125Ventricular TachycardiaProton TherapySTARDose-Volume Analysis |
| spellingShingle | Keyur D. Shah Chih-Wei Chang Pretesh Patel Sibo Tian Yuan Shao Kristin A Higgins Yinan Wang Justin Roper Jun Zhou Zhen Tian Xiaofeng Yang Comparison of proton and photon therapy in stereotactic arrhythmia radioablation for ventricular tachycardia Physics and Imaging in Radiation Oncology Ventricular Tachycardia Proton Therapy STAR Dose-Volume Analysis |
| title | Comparison of proton and photon therapy in stereotactic arrhythmia radioablation for ventricular tachycardia |
| title_full | Comparison of proton and photon therapy in stereotactic arrhythmia radioablation for ventricular tachycardia |
| title_fullStr | Comparison of proton and photon therapy in stereotactic arrhythmia radioablation for ventricular tachycardia |
| title_full_unstemmed | Comparison of proton and photon therapy in stereotactic arrhythmia radioablation for ventricular tachycardia |
| title_short | Comparison of proton and photon therapy in stereotactic arrhythmia radioablation for ventricular tachycardia |
| title_sort | comparison of proton and photon therapy in stereotactic arrhythmia radioablation for ventricular tachycardia |
| topic | Ventricular Tachycardia Proton Therapy STAR Dose-Volume Analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2405631625001125 |
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