Shannon J Jiang, Pamela Samson, Phillip Cuculich, Carlos Contreras, Kaitlin Moore, Mitchell N Faddis, Timothy W Smith, Marye J Gleva, Daniel H Cooper, Clifford G Robinson
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引用次数: 0
Abstract
Purpose: Stereotactic Arrhythmia Radiotherapy (STAR) is a noninvasive treatment alternative to repeat catheter ablation (CA) for refractory ventricular tachycardia (VT). However, no studies have directly compared the two modalities. This study reports on 3-year safety and efficacy outcomes for STAR vs CA in refractory VT patients at a high-volume center.
Methods: We conducted a retrospective cohort analysis of all patients with recurrent VT who failed medical management with antiarrhythmic medications and failed at least one prior CA (or were deemed medically unfit for CA) who were then treated with either STAR or repeat CA between 2015-2018 at a single institution. Patients treated with STAR who did not receive prior CA were evaluated on a case-by-case basis and deemed by the treating electrophysiologist to be too high risk to undergo repeat CA ("medically unfit for CA"). Patients were evaluated for serious adverse events (SAE); freedom from death, shock, or storm (FFDSS); and overall survival (OS). Survival analyses were performed via Kaplan-Meier method and compared by log-rank test.
Results: Forty-three patients were included: 22 received STAR and 21 repeat CA. Baseline characteristics were similar, however generally patients treated with STAR were older (median 64.5 vs 59 years), had "High Risk" I-VT scores (64% vs 52%), and had higher PAINESD scores (median 18.5 vs 17). Median follow-up was 3 years. More patients treated with CA (N=8, 38%) developed 1-year treatment-related SAEs compared to STAR (N=2, 9%). Median time to any SAE was shorter for patients treated with CA compared to STAR (6 days vs 10.0 months), and most early CA deaths occurred immediately after SAE. Twelve patients died within 3 years of STAR, 75% (N=9) were unrelated to VT and none from treatment-related SAE. There was no statistically significant difference in FFDSS between patients treated by STAR vs CA (6.9 vs 2.9 months, p=0.88). FFDSS for STAR vs CA was 32% vs 27% at 1-year, 27% for both at 2-years, and 18% vs 21% at 3-years. There was no statistically significant difference in OS between patients treated with STAR vs CA (28.2 vs 12.2 months, p=0.91).
Conclusion: At 3-year follow-up, STAR offers comparable VT control with fewer SAEs and longer time to toxicity; supporting its possible role as a noninvasive alternative to repeat CA. These findings warrant further prospective study.
目的：立体定向心律失常放疗（STAR）是治疗难治性室性心动过速（VT）的一种非侵入性治疗方法，可替代重复导管消融（CA）。然而，没有研究直接比较这两种模式。本研究报告了在一个大容量中心，STAR与CA治疗难治性室速患者3年的安全性和有效性结果。方法：我们对所有复发性VT患者进行了回顾性队列分析，这些患者使用抗心律失常药物治疗失败，并且至少有一次CA失败（或被认为医学上不适合CA），然后在2015-2018年期间在一家机构接受STAR或重复CA治疗。先前未接受CA的STAR治疗的患者将逐案评估，并由治疗的电生理学家认为风险太高而不能进行重复CA（“医学上不适合CA”）。对患者进行严重不良事件（SAE）评估；免于死亡、冲击或风暴（FFDSS）；总生存期（OS）。生存率分析采用Kaplan-Meier法，log-rank检验。结果：纳入43例患者：22例接受STAR治疗，21例接受重复CA治疗。基线特征相似，但通常接受STAR治疗的患者年龄较大（中位64.5 vs 59岁），具有“高风险”I-VT评分（64% vs 52%），并且具有较高的PAINESD评分（中位18.5 vs 17）。中位随访时间为3年。与STAR相比，更多接受CA治疗的患者（N= 8,38%）发生了1年治疗相关的SAEs （N= 2,9%）。与STAR相比，接受CA治疗的患者到任何SAE的中位时间更短（6天vs 10.0个月），并且大多数早期CA死亡发生在SAE之后。12例患者在STAR 3年内死亡，其中75% （N=9）与VT无关，没有一例与治疗相关的SAE有关。STAR治疗组与CA治疗组FFDSS无统计学差异（6.9个月vs 2.9个月，p=0.88）。1年STAR和CA的FFDSS分别为32%和27%，2年和3年分别为27%和18%。STAR与CA治疗患者的OS无统计学差异（28.2个月vs 12.2个月，p=0.91）。结论：在3年的随访中，STAR提供了相当的VT控制，更少的SAEs和更长的毒性时间；支持其作为重复CA的无创替代方案的可能作用。这些发现值得进一步的前瞻性研究。
期刊介绍：
International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field.
This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.
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