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Knowledge-Based Planning for Cardiac Stereotactic Body Radiation Therapy Decreases Mean Dose Values to Normal Heart Tissue Without Compromising Target Coverage in the Treatment of Ventricular Tachycardia

P Samson*, S Goddu , J Hilliard , N Knutson , G Hugo , P Cuculich , C Robinson , Washington University, St. Louis, MO


(Sunday, 7/29/2018) 3:00 PM - 6:00 PM

Room: Exhibit Hall

Purpose: To create a knowledge-based planning (KBP) model and determine if implementation would decrease dose to normal heart tissue for cardiac stereotactic body radiation therapy (SBRT) for the treatment of refractory ventricular tachycardia.

Methods: KBP software was used to create a cardiac model from the original clinical treatment plans (CP) of 23 patients that had received cardiac SBRT (25Gy/1 fraction to the arrythmogenic focus) for the ablation of ventricular tachycardia on a prospective Phase I trial. We then compared the internal target volume (ITV) and planning target volume (PTV) coverage by treatment plan type. Heart – PTV mean dose, Heart-PTV V25 Gy, V20 Gy, V15Gy, V10Gy, V5Gy, and the ratio of the 50% isodose volume to the PTV (R50%) were also compared for each group. Paired t-tests were used to compare continuous values, and values are reported as means ± standard error of the mean (SEM) for each group.

Results: In comparing the delivered CP to the KBP, no difference was seen in target coverage to the ITV (CP 99.5 ± 0.21 versus 99.7 ± 0.15, p=0.2) or PTV (CP 99.4 ± 0.3 versus KBP 99.6 ± 0.2, p=0.07). The difference in global maximum heart dose by treatment plan type approached, but did not reach significance (CP 43.3 ± 0.5 versus KPB 42.3 ± 0.4, p=0.07). KBP did deliver significantly lower mean heart dose, Heart-PTV mean dose, Heart-PTV V25 Gy, V20 Gy, V15Gy, V10Gy, and V5Gy (Table 1). Additionally, the R50% was significantly lower for the KBP compared to the CP (2.8 ± 0.08 versus 4.8 ± 0.26, p<0.001).

Conclusion: For the treatment of ventricular tachycardia using single fraction cardiac SBRT, a KBP model significantly improved several Heart-PTV parameters. KBP also improved the conformality of the treatment plan without decreasing coverage to the ITV/PTV to the arrythmogenic focus.


Not Applicable / None Entered.


TH- External beam- photons: extracranial stereotactic/SBRT

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