Physics and imaging in radiation oncology · 2025
Comparison of proton and photon therapy in stereotactic arrhythmia radioablation for ventricular tachycardia.
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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
Аннотация
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 D 0.03 c m 3 , 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.
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 D 0.03 c m 3 , 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.