目的:对难治性室性心动过速(VT)患者进行定向性心律失常放射消融术(STAR)显示出良好的效果。然而,临床数据稀缺且异质。停止。欧盟财团的成立是为了调查和协调欧洲的STAR。这项基准研究的主要目标是调查STOPSTORM项目中当前的治疗计划实践,作为未来协调的基准。
方法:针对3例STAR病例,生成与心脏外危险器官和/或心脏亚结构重叠的规划目标体积(PTV)。要求参与中心根据内部临床实践创建具有25Gy剂量处方的单部分治疗计划。由专家小组审查所有治疗计划,并使用独立软件对ICRU报告91相关参数和人群剂量-体积-直方图的描述性统计进行基于人群知识的定量分析。此后,使用双阶段投票程序建立治疗计划共识声明.
结果:20个研究中心提交了67份治疗计划。在大多数计划(75%)中,使用具有6MV无平坦滤波器束的强度调制电弧疗法(IMAT)。剂量处方主要基于PTVD95%(49%)或D96-100%(19%)。许多参与者更愿意通过减少PTV覆盖率来保留接近的心脏外器官(75%)和心脏亚结构(50%)。PTVD0.035cm3范围25.5-34.6Gy,表现出大量的剂量不均匀性。没有运动补偿或设置的估计治疗时间为2-80分钟。对于共识声明,波束技术规划达成了强有力的协议,剂量计算,处方方法和目标和心脏外关键结构之间的权衡。在心脏亚结构剂量限制和目标中期望的剂量不均匀性上未达成一致。
结论:这项STOPSTORM多中心治疗计划基准研究在STAR治疗计划的几个方面显示出强烈的一致性,但也暴露了对其他人的分歧。为了规范和协调未来的STAR,达成共识,然而,迫切需要临床数据来制定可行的治疗计划指南.
OBJECTIVE: STereotactic Arrhythmia Radioablation (STAR) showed promising results in patients with refractory ventricular tachycardia (VT). However, clinical data is scarce and heterogeneous. The STOPSTORM.eu consortium was established to investigate and harmonize STAR in Europe. The primary goal of this benchmark study was to investigate current treatment planning practice within the STOPSTORM project as a baseline for future harmonization.
METHODS: Planning target volumes (PTV) overlapping extra-cardiac organs-at-risk and/or cardiac substructures were generated for three STAR cases. Participating centers were asked to create single fraction treatment plans with 25 Gy dose prescription based on in-house clinical practice. All treatment plans were reviewed by an expert panel and quantitative crowd knowledge-based analysis was performed with independent software using descriptive statistics for ICRU report 91 relevant parameters and crowd dose-volume-histograms. Thereafter, treatment planning consensus statements were established using a dual-stage voting process.
RESULTS: Twenty centers submitted 67 treatment plans for this study. In most plans (75%) Intensity Modulated Arc Therapy (IMAT) with 6 MV flattening-filter-free beams was used. Dose prescription was mainly based on PTV D95% (49%) or D96-100% (19%). Many participants preferred to spare close extra-cardiac organs-at-risk (75%) and cardiac substructures (50%) by PTV coverage reduction. PTV D0.035cm3 ranged 25.5-34.6 Gy, demonstrating a large variety of dose inhomogeneity. Estimated treatment times without motion compensation or setup ranged 2-80 minutes. For the consensus statements, strong agreement was reached for beam technique planning, dose calculation, prescription methods and trade-offs between target and extra-cardiac critical structures. No agreement was reached on cardiac substructure dose limitations and on desired dose inhomogeneity in the target.
CONCLUSIONS: This STOPSTORM multi-center treatment planning benchmark study showed strong agreement on several aspects of STAR treatment planning, but also revealed disagreement on others. To standardize and harmonize STAR in the future, consensus statements were established, however clinical data is urgently needed for actionable guidelines for treatment planning.