TY - JOUR
T1 - A Review of Cardiac Radioablation (CR) for Arrhythmias
T2 - Procedures, Technology, and Future Opportunities
AU - Lydiard, PGDip, Suzanne
AU - Blanck, Oliver
AU - Hugo, Geoffrey
AU - O'Brien, Ricky
AU - Keall, Paul
N1 - Funding Information:
P.K. acknowledges support from an Australian Government NHMRC Senior Principal Research Fellowship.
Funding Information:
Disclosures: O.B. was an employee of CyberHeart, Inc (Sunnyvale, CA) from 2008 to 2010 but reports no financial ties or obligations or conflict of interest with the company or its legal successor, Varian Medical (Palo Alto, CA). G.H. reports personal fees and grants from Varian Medical Systems and grants from Siemens and ViewRay, Inc, outside the submitted work. In addition, G.H. has patents PCT/US2016/000103 and PCT/US2018/065278 licensed to Varian Medical Systems. P.K. and S.L. have a patent on an image guidance method for cardiac targeting in preparation.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Purpose: Cardiac radioablation (CR), a new treatment for cardiac arrhythmias such as ventricular tachycardia and atrial fibrillation, has had promising clinical outcomes to date. There is consequent desire for rapid clinical adoption. However, CR presents unique challenges to radiation therapy, and it is paramount that clinical adoption be performed safely and effectively. Recent reviews comprehensively detail patient selection, clinical history, treatment outcomes, and treatment toxicities but only briefly mention the technical aspects of CR. To address this knowledge gap, this review collates currently available knowledge regarding CR technology choice and procedural details to help inform and guide clinics considering implementing their own CR program, to aid technique standardization, and to highlight areas that require further development or verification. Methods and Materials: Original preclinical and clinical scientific articles that sufficiently detailed CR technical aspects, including pretreatment electrophysiology and imaging, motion analysis and management techniques, treatment planning, and/or treatment delivery, were identified within a comprehensive literature search. Results: Nineteen preclinical and 18 clinical scientific articles sufficiently detailed the technical aspects of CR treatment deliveries on live subjects. The technical aspects of these scientific articles were diverse: Preclinical treatments have been performed with brachytherapy, photons, protons, and carbon ions, and clinical treatments have been performed with photons using conventional, robotic, and magnetic resonance imaging guided systems. Other technical aspects demonstrated similar variability. Conclusions: This review summarizes the technical aspects and procedural details of preclinical and clinical CR treatment deliveries and highlights the complexity and current variability of CR. There is need for standardized procedural reporting to aid multicenter and multiplatform evaluation and potential for significant technological improvements in imaging, planning, delivery, and monitoring to maximize the clinical outcomes for selected patients with arrhythmia.
AB - Purpose: Cardiac radioablation (CR), a new treatment for cardiac arrhythmias such as ventricular tachycardia and atrial fibrillation, has had promising clinical outcomes to date. There is consequent desire for rapid clinical adoption. However, CR presents unique challenges to radiation therapy, and it is paramount that clinical adoption be performed safely and effectively. Recent reviews comprehensively detail patient selection, clinical history, treatment outcomes, and treatment toxicities but only briefly mention the technical aspects of CR. To address this knowledge gap, this review collates currently available knowledge regarding CR technology choice and procedural details to help inform and guide clinics considering implementing their own CR program, to aid technique standardization, and to highlight areas that require further development or verification. Methods and Materials: Original preclinical and clinical scientific articles that sufficiently detailed CR technical aspects, including pretreatment electrophysiology and imaging, motion analysis and management techniques, treatment planning, and/or treatment delivery, were identified within a comprehensive literature search. Results: Nineteen preclinical and 18 clinical scientific articles sufficiently detailed the technical aspects of CR treatment deliveries on live subjects. The technical aspects of these scientific articles were diverse: Preclinical treatments have been performed with brachytherapy, photons, protons, and carbon ions, and clinical treatments have been performed with photons using conventional, robotic, and magnetic resonance imaging guided systems. Other technical aspects demonstrated similar variability. Conclusions: This review summarizes the technical aspects and procedural details of preclinical and clinical CR treatment deliveries and highlights the complexity and current variability of CR. There is need for standardized procedural reporting to aid multicenter and multiplatform evaluation and potential for significant technological improvements in imaging, planning, delivery, and monitoring to maximize the clinical outcomes for selected patients with arrhythmia.
UR - http://www.scopus.com/inward/record.url?scp=85099620612&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2020.10.036
DO - 10.1016/j.ijrobp.2020.10.036
M3 - Review article
C2 - 33160007
AN - SCOPUS:85099620612
SN - 0360-3016
VL - 109
SP - 783
EP - 800
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 3
ER -