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Volume 13
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10.3390/jpm13040596
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Brief Report

Phase II Trial of LINAC-Based STereotactic Arrhythmia Radioablation (STAR) for Paroxysmal Atrial Fibrillation in Elderly: Planning and Dosimetric Point of View

by
Ilaria Bonaparte
1,
Fabiana Gregucci
1,
Antonio Di Monaco
2,3,
Federica Troisi
2,
Alessia Surgo
1,*,
Elena Ludovico
4,
Roberta Carbonara
1,
Eleonora Paulicelli
1,
Giuseppe Sanfrancesco
1,
Christian De Pascali
1,
Nicola Vitulano
2,
Federico Quadrini
2,
Maria Paola Ciliberti
1,
Imma Romanazzi
5,
Fiorella Cristina Di Guglielmo
1,
Davide Cusumano
6,
Roberto Calbi
4,
Massimo Grimaldi
2 and
Alba Fiorentino
1,7
1
Department of Radiation Oncology, General Regional Hospital “F. Miulli”, 70021 Acquaviva delle Fonti, Italy
2
Department of Cardiology, General Regional Hospital “F. Miulli”, 70021 Acquaviva delle Fonti, Italy
3
Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
4
Department of Radiology, General Regional Hospital “F. Miulli”, 70021 Acquaviva delle Fonti, Italy
5
Department of Cardiology, Policlinico “G. Rodolico”-Azienda O.U. Policlinico “G. Rodolico”, 95123 San Marco Catania, Italy
6
Department of Radiation Oncology, Mater Olbia Hospital, 07026 Olbia, Italy
7
Department of Medicine, LUM Giuseppe Degennaro University, 70010 Casamassima, Italy
*
Author to whom correspondence should be addressed.
J. Pers. Med. 2023, 13(4), 596; https://doi.org/10.3390/jpm13040596
Submission received: 12 December 2022 / Revised: 13 March 2023 / Accepted: 26 March 2023 / Published: 29 March 2023
(This article belongs to the Section Methodology, Drug and Device Discovery)
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Abstract

Purpose: Approaching treatment for elderly patients with atrial fibrillation is difficult. A prospective phase II trial evaluating LINAC-based stereotactic arrhythmia radioablation (STAR) safety in this population started in 2021. Dosimetric and planning data were reported. Materials and Methods: A vac-lock bag was used for immobilization in the supine position and a computed tomography (CT, 1 mm) was performed. The clinical target volume (CTV) was defined as the area around the pulmonary veins. An internal target volume (ITV) was added to the CTV to compensate heart and respiratory movement. The planning target volume (PTV) was defined by adding 0–3 mm to the ITV. STAR was performed during free-breathing with a PTV prescription total dose (Dp) of 25 Gy/1 fraction. Flattening filter-free volumetric-modulated arc therapy plans were generated, optimized, and delivered by TrueBeamTM. Image-guided radiotherapy with cone-beam CT and surface-guided radiotherapy with Align-RT (Vision RT) were employed. Results: From May 2021 to March 2022, 10 elderly patients were treated. Mean CTVs, ITVs, and PTVs were 23.6 cc, 44.32 cc, and 62.9 cc, respectively; the mean prescription isodose level and D2% were 76.5% and 31.2 Gy, respectively. The average heart and left anterior descending artery (LAD) Dmean were 3.9 and 6.3 Gy, respectively; the mean Dmax for LAD, spinal cord, left and right bronchus, and esophagus were 11.2, 7.5, 14.3, 12.4, and 13.6 Gy, respectively. The overall treatment time (OTT) was 3 min. Conclusions: The data showed an optimal target coverage, sparing surrounding tissue, in 3 min of OTT. LINAC-based STAR for AF could represent a valid non-invasive alternative for elderly patients who were excluded from catheter ablation.
Keywords: radiosurgery; atrial fibrillation; stereotactic radiotherapy; arrhythmia radiosurgery; atrial fibrillation; stereotactic radiotherapy; arrhythmia

Share and Cite

MDPI and ACS Style

Bonaparte, I.; Gregucci, F.; Di Monaco, A.; Troisi, F.; Surgo, A.; Ludovico, E.; Carbonara, R.; Paulicelli, E.; Sanfrancesco, G.; De Pascali, C.; et al. Phase II Trial of LINAC-Based STereotactic Arrhythmia Radioablation (STAR) for Paroxysmal Atrial Fibrillation in Elderly: Planning and Dosimetric Point of View. J. Pers. Med. 2023, 13, 596. https://doi.org/10.3390/jpm13040596

AMA Style

Bonaparte I, Gregucci F, Di Monaco A, Troisi F, Surgo A, Ludovico E, Carbonara R, Paulicelli E, Sanfrancesco G, De Pascali C, et al. Phase II Trial of LINAC-Based STereotactic Arrhythmia Radioablation (STAR) for Paroxysmal Atrial Fibrillation in Elderly: Planning and Dosimetric Point of View. Journal of Personalized Medicine. 2023; 13(4):596. https://doi.org/10.3390/jpm13040596

Chicago/Turabian Style

Bonaparte, Ilaria, Fabiana Gregucci, Antonio Di Monaco, Federica Troisi, Alessia Surgo, Elena Ludovico, Roberta Carbonara, Eleonora Paulicelli, Giuseppe Sanfrancesco, Christian De Pascali, and et al. 2023. "Phase II Trial of LINAC-Based STereotactic Arrhythmia Radioablation (STAR) for Paroxysmal Atrial Fibrillation in Elderly: Planning and Dosimetric Point of View" Journal of Personalized Medicine 13, no. 4: 596. https://doi.org/10.3390/jpm13040596

APA Style

Bonaparte, I., Gregucci, F., Di Monaco, A., Troisi, F., Surgo, A., Ludovico, E., Carbonara, R., Paulicelli, E., Sanfrancesco, G., De Pascali, C., Vitulano, N., Quadrini, F., Ciliberti, M. P., Romanazzi, I., Di Guglielmo, F. C., Cusumano, D., Calbi, R., Grimaldi, M., & Fiorentino, A. (2023). Phase II Trial of LINAC-Based STereotactic Arrhythmia Radioablation (STAR) for Paroxysmal Atrial Fibrillation in Elderly: Planning and Dosimetric Point of View. Journal of Personalized Medicine, 13(4), 596. https://doi.org/10.3390/jpm13040596

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