立体定向心脏放射消融术用于室性心律失常初探  

Preliminary study of stereotactic cardiac radioablation in radiotherapy of ventricular arrhythmia

作　　者：李京 陈清勇 李光俊[1] 李燕[3] 张英杰[1] 李长虎 白龙 钟仁明[1] 何垠波[1] 柏森[1] 杨庆[2] 许峰[3] Li Jing;Chen Qingyong;Li Guangjun;Li Yan;Zhang Yingjie;Li Changhu;Bai Long;Zhong Renming;He Yinbo;Bai Sen;Yang Qing;Xu Feng(Department of Radiotherapy,Oncology Center,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Cardiology,West China Hospital,Sichuan University,Chengdu 610041,China;Lung Cancer Center,WestChina Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院肿瘤中心放疗科,成都610041 [2]四川大学华西医院心内科,成都610041 [3]四川大学华西医院肺癌中心,成都610041

出　　处：《中华放射肿瘤学杂志》2022年第3期260-265,共6页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金(81972848);中华国际医学交流基金会肿瘤精准放疗星火计划(2019-N-11-04);四川省科技厅项目(2021YFS0143);四川省科技厅项目(2016JY0072)。

摘　　要：目的介绍基于立体定向放疗(SBRT)技术的立体定向心脏放射消融术(SCRA),并通过短期有效性和安全性对该新型治疗方法进行综合评估。方法室性心律失常(VA)患者被评估并纳入临床试验,受试者均接受了真空垫体位固定和四维CT模拟定位,本研究以计划靶区体积(PTV)为目标,采用容积旋转调强(VMAT)技术设计立体定向放疗计划,使用R50%、均匀性指数、适形性指数等参数评估治疗计划,并对比受试者治疗前后动态心电图和超声心动图检查结果。结果3例室性心动过速(VT)和1例室性期前收缩(PVC)受试者接受了处方剂量25 Gy的单次SCRA,PTV平均值为71.3 cm^(3)(60.3~89.4 cm^(3)),平均治疗时长12.0 min(4.5~21.0 min)。短期随访平均持续了18周(14~25周),结果显示受试者未出现并发症,VT负荷和PVC负荷显著下降。结论SCRA术短期内有效和安全,但关键放疗技术的效果和使用规范仍需要继续探索。Objective To introduce the stereotactic cardiac radioablation(SCRA)based on the stereotactic body radiotherapy(SBRT),and comprehensively evaluate the new approach by short-term effectiveness and safety.Methods Patients with ventricular arrhythmia(VA)were evaluated and included in this clinical trial,who were immobilized by vacuum bag and performed simulation with 4-dimensional computed tomography(4DCT).In this study,the planning target volume(PTV)was set as the target to design a SBRT plan using volumetric modulated arc therapy(VMAT),which was evaluated by dose parameters such as R50%,homogeneity index and conformity index,etc.The results of Holter and echocardiography were monitored during the follow-up and compared with the data before treatment.Results Three subjects with ventricular tachycardia(VT)and one with premature ventricular contraction(PVC)received the same prescription of 25Gy in a single fraction.The average volume of PTV was 71.4cm^(3)(60.3-89.4cm^(3)).The average time of beam delivery was 12.0min(4.5-21.0min).And the short-term follow-up lasted for an average of 18 weeks(14-25 weeks),which showed significant decrease in both VT and PVC load without complications.Conclusion This study reports the implementation method of SCRA and proves its short-term effectiveness and safety,but the effects and standards of the key radiotherapy techniques still need to be explored.

关 键 词：室性心律失常/立体定向心脏放射消融术 立体定向放射疗法 初步研究 

分 类 号：R541.7[医药卫生—心血管疾病]