Phantom study of stereotactic radioablation for ventricular tachycardia (STRA-MI-VT) using Cyberknife Synchrony Respiratory Tracking System with a single fiducial marker

Stereotactic arrhythmia radioablation for ventricular tachycardia: a review of clinical trials and emerging roles of imaging

Ventricular tachycardia (VT) is a severe arrhythmia commonly treated with implantable cardioverter defibrillators, antiarrhythmic drugs and catheter ablation (CA). Although CA is effective in reducing recurrent VT, its impact on survival remains uncertain, especially in patients with extensive scarring. Stereotactic arrhythmia radioablation (STAR) has emerged as a novel treatment for VT in patients unresponsive to CA, leveraging techniques from stereotactic body radiation therapy used in cancer treatments. Recent clinical trials and case series have demonstrated the short-term efficacy and safety of STAR, although long-term outcomes remain unclear. Imaging techniques, such as electroanatomical mapping, contrast-enhanced magnetic resonance imaging and nuclear imaging, play a crucial role in treatment planning by identifying VT substrates and guiding target delineation. However, challenges persist owing to the complex anatomy and variability in target volume definitions. Advances in imaging and artificial intelligence are expected to improve the precision and efficacy of STAR. The exact mechanisms underlying the antiarrhythmic effects of STAR, including potential fibrosis and improvement in cardiac conduction, are still being explored. Despite its potential, STAR should be cautiously applied in prospective clinical trials, with a focus on optimizing dose delivery and understanding long-term outcomes. Collaborative efforts are necessary to standardize treatment strategies and enhance the quality of life for patients with refractory VT.

Non-Oncological Radiotherapy: A Review of Modern Approaches

Despite being usually delivered in oncological patients, radiotherapy can be used as a successful treatment for several non-malignant disorders. Even though this use of radiotherapy has been scarcely investigated since the 1950s, more recent interest has actually shed the light on this approach. Thus, the aim of this narrative review is to analyze the applications of non-oncological radiotherapy in different disorders. Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. This review contains a narrative report and a critical discussion of non-oncological radiotherapy approaches. In conclusion, non-oncological radiotherapy is a safe and efficacious approach to treat several disorders that needs to be further investigated and used in clinical practice.