Proton or photon radiosurgery for cardiac ablation of ventricular tachycardia? Breath and ECG gated robust optimization. (October 2020)

• Record Type: Journal Article
• Authors: Widesott, Lamberto; Dionisi, Francesco; Fracchiolla, Francesco; Tommasino, Francesco; Centonze, Maurizio; Amichetti, Maurizio; Del Greco, Maurizio
• Is Part Of: Physica medica. Volume 78(2020)
• Page Start: 15
• Page End: 31
• Publication Date: 2020-10
• Subjects: IMRT proton therapy -- Ventricular tachycardia -- Radiosurgery; Medical physics -- Periodicals; Biophysics -- Periodicals; Biophysics -- Periodicals; Imagerie médicale -- Périodiques; Radiothérapie -- Périodiques; Rayons X -- Sécurité -- Mesures -- Périodiques; Physique -- Périodiques; Médecine -- Périodiques; 610.153
• DOI: 10.1016/j.ejmp.2020.08.021
• Languages: English
• ISSNs: 1120-1797

Abstract

Highlights: First comparison of intensity modulated photon plan vs proton plan for the treatment of a ventricular tachycardia. First time robust optimization is proposed for this type of target. Significant dose sparing achievable with robust optimization (both with photons and with protons). Cardiac motion, breath hold management and radiobiological issue are taken into account. Abstract: Purpose: Ventricular tachycardia (VT) is a life-threatening heart disorder. The aim of this preliminary study is to assess the feasibility of stereotactic body radiation therapy (SBRT) photon and proton therapy (PT) plans for the treatment of VT, adopting robust optimization technique for both irradiation techniques. Methods: ECG gated CT images (in breath hold) were acquired for one patient. Conventional planning target volume (PTV) and robust optimized plans (25GyE in single fraction) were simulated for both photon (IMRT, 5 and 9 beams) and proton (SFO, 2 beams) plans. Robust optimized plans were obtained both for protons and photons considering in the optimization setup errors (5 mm in the three orthogonal directions), range (±3.5%) and the clinical target volume (CTV) motion due to heartbeat and breath-hold variability. Results: The photon robust optimization method, compared to PTV-based plans, showed a reduction in the average dose to the heart by about 25%; robust optimization allowed also reducing the mean dose to the left lung from 3.4. to 2.8 Gy for 9-beams configuration and from 4.1 to 2.9 Gy for 5-beams configuration. Robust optimization with protons, allowed further reducing the OAR doses: average dose to the heart and to the left lung decreased from 7.3 Gy to 5.2 GyE and from 2.9 Gy to 2.2 GyE, respectively. Conclusions: Our study demonstrates the importance of the optimization technique adopted in the treatment planning system for VT treatment. It has been shown that robust optimization can significantly reduce the dose to healthy cardiac tissues and that PT further increases this gain.