用于室性心动过速的立体定向心律失常射频消融中质子治疗与光子治疗的剂量学比较研究。

A Comparative Dosimetric Study of Proton and Photon Therapy in Stereotactic Arrhythmia Radioablation for Ventricular Tachycardia.

作者信息

Shah Keyur D, Chang Chih-Wei, Patel Pretesh, Tian Sibo, Shao Yuan, Higgins Kristin A, Wang Yinan, Roper Justin, Zhou Jun, Tian Zhen, Yang Xiaofeng

机构信息

Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA.

School of Public Health, University of Illinois, Chicago, IL.

出版信息

ArXiv. 2025 Feb 4:arXiv:2501.18433v2.

PMID:39975428

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11838769/

Abstract

PURPOSE

Ventricular tachycardia (VT) is a life-threatening arrhythmia commonly treated with catheter ablation; however, some cases remain refractory to conventional treatment. Stereotactic arrhythmia radioablation (STAR) has emerged as a non-invasive option for such patients. While photon-based STAR has shown efficacy, proton therapy offers potential advantages due to its superior dose conformity and sparing of critical organs at risk (OARs), including the heart itself. This study aims to investigate and compare the dosimetry between proton and photon therapy for VT, focusing on target coverage and OAR sparing.

METHODS

We performed a retrospective study on a cohort of 34 VT patients who received photon STAR. Proton STAR plans were generated using robust optimization in RayStation to deliver the same prescription dose of 25 Gy in a single fraction while minimizing dose to OARs. Dosimetric metrics, including D, D, D, and D, were extracted for critical OARs (heart, lungs, esophagus) and ventricular arrhythmogenic substrates (VAS). Shapiro-Wilk tests were used to assess normality, followed by 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 VAS D of 24.1 ± 1.2 Gy vs. 24.7 ± 1.0 Gy (p=0.294). Proton therapy significantly reduced OAR doses, including heart D (3.6 ± 1.5 Gy vs. 5.5 ± 2.0 Gy, p<0.001), lungs D (1.6 ± 1.5 Gy vs. 2.1 ± 1.4 Gy, p<0.001), and esophagus D (0.3 ± 0.6 Gy vs. 1.6 ± 1.3 Gy, p<0.001), while maintaining optimal target coverage.

CONCLUSION

Proton therapy for STAR demonstrates significant dosimetric advantages in sparing the heart and other critical OARs compared to photon therapy for VT, while maintaining equivalent target coverage. These findings highlight the potential of proton therapy to reduce treatment-related toxicity and improve outcomes for VT patients.

摘要

目的

室性心动过速（VT）是一种危及生命的心律失常，通常采用导管消融治疗；然而，有些病例对传统治疗仍无反应。立体定向心律失常放射消融（STAR）已成为此类患者的一种非侵入性选择。虽然基于光子的STAR已显示出疗效，但质子治疗因其卓越的剂量适形性和对包括心脏本身在内的关键危及器官（OARs）的保护而具有潜在优势。本研究旨在调查和比较质子治疗与光子治疗对VT的剂量学，重点关注靶区覆盖和OARs保护。

方法

我们对一组接受光子STAR治疗的34例VT患者进行了回顾性研究。使用RayStation中的稳健优化生成质子STAR计划，以单次分割给予相同的处方剂量25 Gy，同时将对OARs的剂量降至最低。提取关键OARs（心脏、肺、食管）和室性心律失常基质（VAS）的剂量学指标，包括D、D、D和D。使用Shapiro-Wilk检验评估正态性，然后使用配对t检验或Wilcoxon符号秩检验进行两种治疗方式之间的统计学比较，并应用Bonferroni校正进行多重比较。

结果

质子和光子计划实现了相当的靶区覆盖，VAS的D为24.1±1.2 Gy，而光子治疗为24.7±1.0 Gy（p=0.294）。质子治疗显著降低了OARs的剂量，包括心脏的D（3.6±1.5 Gy对5.5±2.0 Gy，p<0.001）、肺的D（1.6±1.5 Gy对2.1±1.4 Gy，p<0.001）和食管的D（0.3±0.6 Gy对1.6±1.3 Gy，p<0.001），同时保持了最佳的靶区覆盖。