Why the study?
To provide insight into a novel cardiac radioablation technique using deep inspiration breath-hold to reduce gastrointestinal radiation dose.
Using deep inspiration breath-hold during cardiac radioablation for inferior left ventricular targets can physically separate the target from the stomach, minimizing the risk of gastrointestinal radiation toxicity.
May enable safer radioablation near GI structures; leaves open prospective validation before clinical use.
PURPOSE: To provide a new insight on a novel safe cardiac radioablation using deep inspiration breath-hold (DIBH) to reduce gastrointestinal dose. MATERIALS AND METHODS: For treating incessant ventricular tachycardia (VT) originated from left ventricle inferior scar abutting the stomach, a target delineation and treatment planning for cardiac radioablation was performed. With four different computed tomography (CT) scan protocols-DIBH, full expiration breath-hold, four-dimensional (4D) CT without and with abdominal compression, the distances between the target and the stomach were compared. RESULTS: Among the protocols, the CT scan with DIBH showed largest distance between the target and the stomach and selected for the treatment planning. The prescribed dose was 25 Gy in a single fraction, and satisfactory dosimetric parameters were achieved with the DIBH. The patient was successfully treated with the DIBH, and experienced no acute toxicity. CONCLUSION: To gain the best benefit from cardiac radioablation, understanding the possible toxicity in the adjacent organs is crucial. By moving the heart with thoraco-diaphragmatic movement by DIBH, the target could be physically separated from the stomach.
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Cha et al. (2021) studied this question.
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