立体定向心律失常射频消融术（STAR）：室性心动过速患者心脏和呼吸性心脏运动评估——STOPSTORM.eu联盟综述
Stereotactic Arrhythmia Radioablation (STAR): Assessment of cardiac and respiratory heart motion in ventricular tachycardia patients - A STOPSTORM.eu consortium review.
作者信息
Stevens Raoul R F, Hazelaar Colien, Fast Martin F, Mandija Stefano, Grehn Melanie, Cvek Jakub, Knybel Lukas, Dvorak Pavel, Pruvot Etienne, Verhoeff Joost J C, Blanck Oliver, van Elmpt Wouter
机构信息
Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands.
Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands.
出版信息
Radiother Oncol. 2023 Nov;188:109844. doi: 10.1016/j.radonc.2023.109844. Epub 2023 Aug 4.
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.
目的
为确定针对个体患者的最佳立体定向心律失常射频消融（STAR）策略，需要评估靶区的心肺运动与不同治疗方法的结合情况。然而，目前尚缺乏关于室性心动过速（VT）患者心肺运动量的权威概述。
方法
在这项STOPSTORM联盟研究中，我们进行了文献综述，以深入了解STAR靶区的心肺运动。提取并总结了运动数据和靶区。
结果
在筛选的232项研究中，56项提供了心肺运动数据，其中8项提供了VT患者的运动幅度（n = 94），10项描述了VT患者获得的（心脏/心肺）内部靶区（ITV）（n = 59）。靶区的平均心脏运动在各个方向均<5 mm，在上下（SI）、左右（LR）、前后（AP）方向的最大值分别为8.0、5.2和6.5 mm。心脏（亚）结构的心肺运动在SI方向的平均运动为5-8 mm，而LR和AP方向的运动与靶区的心脏运动相当。心肺ITV平均为总靶区的120-284%。健康受试者在SI方向的平均心肺运动为10-17 mm，在AP方向为2.4-7 mm。
结论
本综述表明，尽管接受治疗的患者数量不断增加，但关于STAR心肺运动的详细数据仍然有限。此外，由于报告参数的不一致，研究之间的数据比较困难。即使在运动补偿技术下，心肺运动也具有高度的患者特异性。因此，强烈建议在STAR的成像、规划和治疗过程中采用个体化的运动管理策略。
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