Non-Neoplastic Disease

Stereo Hearts: Radiation Ablation as Salvation from Fibrillation?

For our June #radonc journal club, we will discuss a non-oncology topic. It doesn’t hurt to remember that radiation medicine has a role in benign disease as well.

Refractory ventricular tachycardia (VT) can be as serious as some cancers. For patients with ventricular tachycardia, 5-year mortality is over 20% in non-ischemic cardiomyopathy and over 50% with ischemic cardiomyopathy after catheter ablation. One-year mortality is about 15-25%, due in great measure to sudden cardiac death from progression to ventricular fibrillation.

Our article this month is:

Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia N Engl J Med 2017;377:2325-36

The article should be free for download now that 6 months have passed from publication. If you have a problem, let me know.

Early but promising data explore the use of stereotactic body radiotherapy as a new way to treat VT. Both Dr. Phillip Cuculich and Dr. Cliff Robinson at Washington University will join us to educate us on this innovative, investigational use of radiation for cardiac ablation.

Since we’re trying to learn how to avoid cardiac issues, we’ll try to sneak in a little best practices on radiation safety for cancer patients with defibrillators and pacemakers.

Our #radonc journal club starts Saturday June 23rd at 7 AM Central Standard Time for open chat. The structured one hour live conversation will be Sunday June 24th at 12-1 PM Central Standard Time. We will focus on the following topics:

T1.   What proportion of patients with ventricular tachycardia need ablation, and how effective are standard treatment options? Are these patients outliers, or do they have a fairly common problem facing electrophysiologists?

T2.  How did the hypothesis of using stereotactic radiation for VT evolve? Please explain how you designed the treatment protocol.

T3. The study has only five patients, the results look quite impressive. Are they? What would we expect for response to catheter ablation or medical therapy for the same endpoints?

T4. AAPM report TG-101 offers guidance on cardiac injury with SBRT but didn’t anticipate the CTV being the heart itself. Any concerns regarding cardiac blowout, or other types of toxicities?

T5. Even if clinical trials support cardiac SBRT for VT, it seems specialized enough to require referral. What do you see as the barriers to effective adoption?

T6. All patients had defibrillators. Please share your experience on best practices for electrophysiology-radiation oncology coordination to monitor adverse effects of radiation on EP devices in cancer patients.

 

  • Here are guidelines on how to sign up and participate
  • Read our disclaimer for ways to keep it rewarding and professional. If you’re not ready, just lurk and tune into the conversation.
  • We would love to have participation from cardiology as well as radiation oncology. Tell your friends!

Any suggestions? Leave a comment or tweet us at @Rad_Nation. And please join us next weekend!

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