S945
Clinical - Non-malignant & functional radiotherapy
ESTRO 2026
7 Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
arrhythmia burden following radiotherapy (Figure 2).Figure 2
Purpose/Objective: Heart failure is associated with chronic sympathetic activation which triggers life-threatening ventricular arrhythmias (VA)[1]. Implantable cardioverter defibrillators (ICDs) save lives by treating VAs but cannot prevent them from occurring. Recurrent ICD shocks lead to worse outcomes and reduced quality of life [2]. Cardiac sympathetic denervation (CSD) by surgical removal of the stellate ganglia is highly successful in preventing VAs but suffers from high rates of peri-operative complications [3].RADIO STAR is a phase 1 safety and dose finding study to establish the feasibility of achieving CSD non-invasively through ultra-hypofractionated MR-guided radiotherapy to the stellate ganglia. We hypothesise that non-invasive CSD will have an improved safety profile compared to surgical CSD, while maintaining efficacy in terms of arrhythmia burden and improved quality of life. Material/Methods: A total of thirteen patients with structural heart disease, requiring recurrent ICD therapy for VAs, will undergo MR-guided radiotherapy to their stellate ganglia. Treatment planning will be performed on 0.35 T MR-Linac scans, with additional CT scan to provide electron density information and 1.5 T MR images to aid identification of the stellate ganglia and adjacent organs at risk (OARs). Heterogeneous dose distributions will be planned, with a maximum dose of 120% and PTV coverage compromised to ensure that OAR dose constraints [4,5] and ICD tolerance [6] are adhered to (minimum acceptable 75%). Cohorts of 3 patients will be treated with 24 Gy/3# (cohort 1), increasing by 1 Gy per fraction, to a maximum of 33Gy/3# (4 patients, cohort 4), on alternate days. Patients will be monitored throughout with physical assessments, biomarkers and clinician and patient reported outcomes (including KCCQ-23 questionnaire) for 6 months. Results: To-date five participants have completed radiotherapy treatment on the study and cohort 1 (3 patients; Figure 1) has completed trial follow up. Figure 1
Conclusion: ConclusionRadiotherapy to the stellate ganglia is feasible and safe and early results suggest this is effective at preventing VAs in patients previously refractory to optimal medical therapy. References: 1. Herring N, et al. Nat Rev Cardiol. 2019;16:707- 726. 2. Poole JE, et al. N Engl J Med. 2008;359:1009-1017. 3. Shah R, et al. Heart Rhythm. 2019;16:1499-15054. Diez P, et al. Clin Oncol (R Coll Radiol). 2022;34:288–300. 5. Gogineni, E et al. Head & Neck. 2020;42:2880–28866. Working Group comprised of the Royal College of Radiologists Radiotherapy Board BC OSaBHRS. Guidance on the management of patients with cardiac implantable electronic devices receiving radiotherapy. In; 2025. Keywords: arrhythmia, stellate ganglion, hypofractionation Safety and efficacy of stereotactic arrhythmia radioablation (STAR) in Europe: Interim analysis from the STOPSTORM.eu consortium registry Luuk van der Pol 1 , Bartlomiej Tomasik 2 , Stefano Mandija 1 , Manuel Algara 3 , Nicolaus Andratschke 4 , Slawomir Blamek 5 , Jasna But Had ž i ć 6 , David Calvo 7 , Jakub Cvek 8 , Gaetano Maria De Ferrari 9 , Melanie Grehn 10 , Tomasz Jadczyk 11 , Stefan Jaschik 12 , David Krug 10 , Mario Levis 13 , Felix Mehrhof 14 , Roland Merten 15 , Marcin Miszczyk 10,16 , Pieter P.G. Postema 17 , Etienne Pruvot 18 , Lukas Seiß 19 , Joost J.C. Verhoeff 20 , Katja Zeppenfeld 21,22 , Oliver Blanck 10 , Martin F. Fast 1 1 Department of Radiotherapy, UMC Utrecht, Utrecht, Netherlands. 2 Department of Radiotherapy, Gda ń ski Uniwersytet Medyczny, Gdansk, Poland. 3 Radiation Oncology Department, Hospital del Mar, Barcelona, Spain. 4 University Hospital of Zurich, University of Zurich, Zurich, Switzerland. 5 Department of Radiotherapy, Maria Sk ł odowska-Curie National Research Institute of Oncology, Gliwice, Poland. 6 Department of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia. 7 Department of Cardiology, Hospital Clínico San Carlos, Madrid, Proffered Paper 2256
In cohort 1, no treatment related serious adverse events occurred. The only patient reported symptom was mild (1/5) fatigue which persisted to 6-month follow-up in one patient. No objective neurological or cardiovascular sequelae were detected. KCCQ-23 showed improved quality of life and clinical scores at 6 months, and there was a marked reduction in
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