Dosimetric feasibility of stereotactic ablative radiotherapy in pulmonary vein isolation for atrial fibrillation using intensity‐modulated proton therapy

Purpose To evaluate dosimetric properties of intensity‐modulated proton therapy (IMPT) for simulated treatment planning in patients with atrial fibrillation (AF) targeting left atrial‐pulmonary vein junction (LA‐PVJ), in comparison with volumetric‐modulated arc therapy (VMAT) and helical tomotherapy...

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Bibliographic Details
Published in:Journal of applied clinical medical physics 2021-05, Vol.22 (5), p.79-88
Main Authors: Ren, Xue‐Ying, He, Peng‐Kang, Gao, Xian‐Shu, Zhao, Zhi‐Lei, Zhao, Bo, Bai, Yun, Liu, Si‐Wei, Li, Kang, Qin, Shang‐Bin, Ma, Ming‐Wei, Zhou, Jing, Rong, Yi
Format: Article
Language:English
Subjects:
Ablation
atrial fibrillation
Cardiac arrhythmia
Catheters
Coronary vessels
Esophagus
Heart failure
helical tomotherapy
intensity‐modulated proton therapy
Medical imaging
Patients
Pericardium
Planning
Pulmonary arteries
Radiation Oncology Physics
Radiation therapy
Spinal cord
stereotactic ablative radiotherapy
Veins & arteries
volumetric‐modulated arc therapy
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Summary:Purpose To evaluate dosimetric properties of intensity‐modulated proton therapy (IMPT) for simulated treatment planning in patients with atrial fibrillation (AF) targeting left atrial‐pulmonary vein junction (LA‐PVJ), in comparison with volumetric‐modulated arc therapy (VMAT) and helical tomotherapy (TOMO). Methods Ten thoracic 4D‐CT scans with respiratory motion and one with cardiac motion were used for the study. Ten respiratory 4D‐CTs were planned with VMAT, TOMO, and IMPT for simulated AF. Targets at the LA‐PVJ were defined as wide‐area circumferential ablation line. A single fraction of 25 Gy was prescribed to all plans. The interplay effects from cardiac motion were evaluated based on the cardiac 4D‐CT scan. Dose‐volume histograms (DVHs) of the ITV and normal tissues were compared. Statistical analysis was evaluated via one‐way Repeated‐Measures ANOVA and Friedman’s test with Bonferroni’s multiple comparisons test. Results The median volume of ITV was 8.72cc. All plans had adequate target coverage (V23.75Gy ≥ 99%). Compared with VMAT and TOMO, IMPT resulted in significantly lower dose of most normal tissues. For VMAT, TOMO, and IMPT plans, Dmean of the whole heart was 5.52 ± 0.90 Gy, 5.89 ± 0.78 Gy, and 3.01 ± 0.57 Gy (P 
ISSN:1526-9914
1526-9914
DOI:10.1002/acm2.13239