SBRT for med refractory v-tach

[Wellness_Seminar]

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Pretty interesting/novel study published in NEJM this week...thoughts?

I know, small sample size and only 1yr f/u thus far. Also seems technically complex but I wonder if this will be something that MRlinac will be well suited for. Thoughts?

 

[medgator]

For reference

nejm link

 

[medgator]

Pretty neat, but I need 15 year follow up before I SRS someone's heart!!!

No you need whatever your hospital or HMO tells you you need

 

[napoleondynamite]

Pretty neat, but I need 15 year follow up before I SRS someone's heart!!!

Not me. Call me crazy, but in the right circumstance, I'd do this now. Keep in mind these are sick patients who face death or cardiac transplant. SBRT is a common sense solution in a population that has been getting ablations via other means for decades.

 

[seper]

To me, this sounds like a very challenging SBRT to do: to accurately delineate such a small ITV and to accurately deliver a 10-min fraction to a fibrillating heart...

 

[napoleondynamite]

To me, this sounds like a very challenging SBRT to do: to accurately delineate such a small ITV and to accurately deliver a 10-min fraction to a fibrillating heart...

I'll be interested to learn about the EP mapping that they used to pinpoint the target area. My reading is that this is very accurate and was fused with the planning CT. If you're talking about a 1-2mm area of scar that needs to be ablated, even with motion and setup margin, your target area is going to end up being pretty dang small with generous margins.

Keeping in mind the alternatives in cases like this, I would have no problem giving it a try if my EP folks were doing the targeting with me.

 

[medgator]

Not me. Call me crazy, but in the right circumstance, I'd do this now. Keep in mind these are sick patients who face death or cardiac transplant. SBRT is a common sense solution in a population that has been getting ablations via other means for decades.

He was being sarcastic

 

[napoleondynamite]

He was being sarcastic

oh, haha, sometimes on this forum it's hard to know, lol

 

[Chartreuse Wombat]

For reference

nejm link

Add it to the growing list of articles with more authors than patients. Sarcasm?

 

[scarbrtj]

If you look at their techniques, the tx volumes are surprisingly large. I see plans where I guesstimate PTVs in the 5-10 cc range. Not teeny tiny. Looked like they were throwing on 5-7mm PTV margins. All in all, seemed like just good 'ol regular, easy SBRT.

 

[OTN]

If you look at their techniques, the tx volumes are surprisingly large. I see plans where I guesstimate PTVs in the 5-10 cc range. Not teeny tiny. Looked like they were throwing on 5-7mm PTV margins. All in all, seemed like just good 'ol regular, easy SBRT.

I was surprised as well to see how non-conformal the final PTVs were. I'm trying to get a trial together between the local medical school (no radonc department, but a cardiology dept) and our private practice to investigate this further. We shall see...

 

[evilbooyaa]

PTVs are likely large because controlling for all that motion reliably is likely difficult. Seems feasible to consider it going forward. The question is whether potential cardiac toxicity in the long-term will end up being a consideration years down the line. That being said, I'd consider this more palliative in nature than anything else.