S955
Clinical - Non-malignant & functional radiotherapy
ESTRO 2026
(VT/VF case), nitrate use, emergency nitrates, walking distance, and EQ-5D/Seattle Angina Questionnaire (RAP series). Radiation-related side effects were recorded per CTCAE v5.0. Results: In the VT/VF case, total arrhythmic events decreased by 85.2% (27 → 4) over 18 months, with complete elimination of ICD shocks/ATP; no radiation-related toxicities occurred. Clinical benefit appeared within the first month and remained stable. No contralateral neuromodulation was needed. In the RAP series (5 procedures in 3 patients), no acute or late radiation- related side effects were observed. Two bilaterally treated responders showed durable improvements through 48–60 months: prescribed nitrate packages fell from 5–6 at baseline to 0 by 24 months and remained 0; daily emergency nitrates fell from 20–30 to 0–1; walking distance rose from 10–20 m to 200– 400 m; EQ-5D and all SAQ domains improved and were sustained at the end of October 2026. The unilaterally treated patient had only transient benefit and died at 42 months from causes unrelated to SRS. Conclusion: Across two complementary use-cases, 40 Gy SG SRS was feasible and well-tolerated, with (i) robust suppression of refractory VT/VF and abolition of ICD therapies over 21 months, and (ii) multi-year, patient- reported improvements in RAP when bilateral treatment was completed. No radiation-related side effect was observed. These convergent findings support prospective trials to refine patient selection (including diagnostic block criteria), laterality, and dose optimization for SG radiosurgical neuromodulation. References: 1. Cvek J, Jiravsky O, Knybel L, et al. Stereotactic radiosurgery targeting the stellate ganglion for refractory ventricular arrhythmias: first-in-human 18- month outcome (preprint). 2. Cvek J, Jiravsky O, Knybel L, et al. Stereotactic radiosurgery as neuromodulation of refractory angina: an initial case series. Radiat Oncol. 2025;20:33. 3. Vaseghi M, et al. Cardiac sympathetic denervation for refractory ventricular arrhythmias. J Am Coll Cardiol. 2017;69:3070-80.This work was supported by the STOPSTORM consortium under the European Union’s Horizon 2020 research and innovation programme (grant agreement No. 945119). Keywords: neuromodulation, radiosurgery, stellate ganglion
dizziness and slight hearing loss. No deficits of 7 and 5 nerves were recorded. Symtomps resolved with the use of steroids. Conclusion: Our preliminary data indicate that both single-fraction and 3-fraction SRS were well tolerated with no grade 3 toxicity ( CTC criteria v.5 ). A slight enlargement of the lesion was seen in 17 patients, being associated with grade 1 or 2 symptoms which resolved with a short course of steroids. References: Jonathan D. Breshears et al Temporal Dynamics of Pseudoprogression After Gamma Knife Radiosurgery for Vestibular Schwannomas—A Retrospective Volumetric Study Neurosurgery 0:1–9, 2018 Yamazaki M, et al Notch appearance as a novel radiological predictor of transient expansion and good outcome of expanding schwannoma after radiotherapy. Discov Oncol. 2024 Mar 19;15(1):79. Régis, J., Balossier, A. From the perspective of pseudo-progression rather than treatment failure, how long should we wait before considering treatment failure if large cystic enlargement occurs after Gamma Knife radiosurgery for vestibular schwannoma? Insight into pseudo- progression based on two case reports. Acta Neurochir 165, 2101–2103 (2023). Keywords: Acoustic neurinoma, pseudoprogression, cyberknife Mini-Oral 4653 Stereotactic radiosurgery for neuromodulation of the stellate ganglion for refractory cardiac syndromes: feasibility, safety, and long-term outcomes Jakub Cvek 1 , Otakar Jiravsky 2 , Lukas Knybel 1 1 Oncology, LF OU and FNO, Ostrava, Czech Republic. 2 Cardiology, Podlesi Hospital, Trinec, Czech Republic Purpose/Objective: To evaluate stereotactic radiosurgery (SRS) of the stellate ganglion (SG) as neuromodulation across two high-risk indications: refractory ventricular tachycardia/fibrillation (VT/VF) and refractory angina pectoris (RAP). Material/Methods: We combined (i) a first-in-human radiosurgical neuromodulation (single 40 Gy fraction; CyberKnife, Xsight Spine; planning target volume 0.386 mL; outpatient) with 18-month prospective follow-up, and (ii) a single-center pilot case series of RAP (n=3) treated with the same dose of 40 Gy. For RAP, bilateral treatment was performed in responders after a positive contralateral diagnostic anaesthetic block. Outcomes included arrhythmia burden and implantable cardioverter-defibrillator (ICD) therapies
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