A Comparative Dosimetric Study of Proton and Photon Therapy in Stereotactic Arrhythmia Radioablation for Ventricular Tachycardia

TL;DR

This study compares proton and photon stereotactic arrhythmia radioablation (STAR) for ventricular tachycardia, showing proton therapy offers superior sparing of critical organs while maintaining effective target coverage.

Contribution

It provides the first detailed dosimetric comparison between proton and photon STAR for VT, demonstrating the advantages of proton therapy in organ sparing.

Findings

Proton therapy significantly reduces doses to heart, lungs, and esophagus.

Target coverage is comparable between proton and photon plans.

Proton therapy may lower treatment-related toxicity in VT patients.

Abstract

Purpose: VT is a life-threatening arrhythmia commonly treated with catheter ablation; however, some cases remain refractory to conventional treatment. STAR has emerged as a non-invasive option for such patients. While photon-based STAR has shown efficacy, proton therapy offers potential advantages due to its superior dose conformity and sparing of critical OARs, including the heart itself. This study aims to investigate and compare the dosimetry between proton and photon therapy for VT, focusing on target coverage and OAR sparing. Methods: We performed a retrospective study on a cohort of 34 VT patients who received photon STAR. Proton STAR plans were generated using robust optimization in RayStation to deliver the same prescription dose of 25 Gy in a single fraction while minimizing dose to OARs. Dosimetric metrics, including D99, D95, Dmean, and D0.03cc, were extracted for critical OARs and VAS. Shapiro-Wilk tests were used to assess normality, followed by paired t-tests or Wilcoxon signed-rank tests for statistical comparisons between modalities, with Bonferroni correction applied for multiple comparisons. Results: Proton and photon plans achieved comparable target coverage, with VAS D95 of 24.1 +/- 1.2 Gy vs. 24.7 +/- 1.0 Gy (p=0.294). Proton therapy significantly reduced OAR doses, including heart Dmean (3.6 +/- 1.5 Gy vs. 5.5 +/- 2.0 Gy, p<0.001), lungs Dmean (1.6 +/- 1.5 Gy vs. 2.1 +/- 1.4 Gy, p<0.001), and esophagus Dmean (0.3 +/- 0.6 Gy vs. 1.6 +/- 1.3 Gy, p<0.001), while maintaining optimal target coverage. Conclusion: Proton therapy for STAR demonstrates significant dosimetric advantages in sparing the heart and other critical OARs compared to photon therapy for VT, while maintaining equivalent target coverage. These findings highlight the potential of proton therapy to reduce treatment-related toxicity and improve outcomes for VT patients.