Stereotactic Radiotherapy Ablation and Atrial Fibrillation: Technical Issues and Clinical Expectations Derived From a Systematic Review

Frontiers in Cardiovascular Medicine

article

Jessica Franzetti¹  Stefania Volpe¹  Valentina Catto³  Edoardo Conte⁵  Consiglia Piccolo⁶  Matteo Pepa¹  Gaia Piperno¹  Anna Maria Camarda¹  Federica Cattani⁶  Daniele Andreini⁵  Claudio Tondo³  Barbara Alicja Jereczek-Fossa¹  Corrado Carbucicchio³ 

[1] Department of Radiation Oncology, European Institute of Oncology;Department of Oncology and Hemato-Oncology, University of Milan;Department of Clinical Electrophysiology and Cardiac Pacing;Department of Electronics, Information and Biomedical Engineering;Cardiovascular Computed Tomography and Radiology Unit;Unit of Medical Physics, European Institute of Oncology;Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan;Department of Biomedical, Surgical and Dental Sciences, University of Milan

关键词: systematic review;    stereotactic arrhythmia radio ablation (STAR);    atrial fibrillation;    arrhythmias;    stereotactic body radiotherapy (SBRT);    particle beam radiotherapy;    target motion;   

DOI  :  10.3389/fcvm.2022.849201

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Aim The purpose of this study is to collect available evidence on the feasibility and efficacy of stereotactic arrhythmia radio ablation (STAR), including both photon radiotherapy (XRT) and particle beam therapy (PBT), in the treatment of atrial fibrillation (AF), and to provide cardiologists and radiation oncologists with a practical overview on this topic. Methods Three hundred and thirty-five articles were identified up to November 2021 according to preferred reporting items for systematic reviews and meta-analyses criteria; preclinical and clinical studies were included without data restrictions or language limitations. Selected works were analyzed for comparing target selection, treatment plan details, and the accelerator employed, addressing workup modalities, acute and long-term side-effects, and efficacy, defined either by the presence of scar or by the absence of AF recurrence. Results Twenty-one works published between 2010 and 2021 were included. Seventeen studies concerned XRT, three PBT, and one involved both. Nine studies (1 in silico and 8 in vivo ; doses ranging from 15 to 40 Gy) comprised a total of 59 animals, 12 (8 in silico , 4 in vivo ; doses ranging from 16 to 50 Gy) focused on humans, with 9 patients undergoing STAR: average follow-up duration was 5 and 6 months, respectively. Data analysis supported efficacy of the treatment in the preclinical setting, whereas in the context of clinical studies the main favorable finding consisted in the detection of electrical scar in 4/4 patients undergoing specific evaluation; the minimum dose for efficacy was 25 Gy in both humans and animals. No acute complication was recorded; severe side-effects related to the long-term were observed only for very high STAR doses in 2 animals. Significant variability was evidenced among studies in the definition of target volume and doses, and in the management of respiratory and cardiac target motion. Conclusion STAR is an innovative non-invasive procedure already applied for experimental treatment of ventricular arrhythmias. Particular attention must be paid to safety, rather than efficacy of STAR, given the benign nature of AF. Uncertainties persist, mainly regarding the definition of the treatment plan and the role of the target motion. In this setting, more information about the toxicity profile of this new approach is compulsory before applying STAR to AF in clinical practice.

【 授权许可】

CC BY