S958
Clinical - Non-malignant & functional radiotherapy
ESTRO 2026
treatment-related causes ( ✝ in Figure 1), one of which due to a cardiac cause. One treatment-related SAE was observed, a grade 3 implantable-cardioverter defibrillator error requiring a prolongation of hospital admission (P10; asymptomatic). Two patients have not reached the end of the blanking period yet and were therefore not evaluable for the efficacy endpoint. Of the other seven patients, one underwent a new epicardial VT ablation after STAR (P3). The median change in treated VT episodes was -97% (-100% - +169%); Figure 1). Conclusion: Preliminary results from the ongoing prospective STARNL-2 trial confirm the favourable short-term safety and efficacy of STAR for therapy-refractory VT. These results support the use of STAR as a promising
1 Department of Clinical and Experimental Cardiology, Amsterdam UMC, Amsterdam, Netherlands. 2 Department of Radiotherapy, Amsterdam UMC, Amsterdam, Netherlands. 3 Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands. 4 Clinical and Experimental Cardiology, Amsterdam UMC, Amsterdam, Netherlands Purpose/Objective: Stereotactic Arrhythmia Radiotherapy (STAR) is an emerging treatment modality for malignant cardiac arrhythmias. However, the number of prospective trials published to date remains limited. Therefore, we arim to prospectively evaluate the safety and efficacy of STAR for therapy-refractory ventricular tachycardia (VT). Material/Methods: This was a planned interim analysis of the ongoing prospective, single-centre Stereotactic Arrhythmia Radiotherapy in the Netherlands no. 2 (STARNL-2) trial. The STARNL-2 trial is a single-arm pre-post intervention study aiming to include 12 patients with therapy-refractory VT. Patients were treated with a single fraction of 25 Gy stereotactic radiotherapy delivered at the VT substrate. The primary endpoints for safety and efficacy are treatment related serious adverse event (SAE) rate and a 50% reduction in treated VT episodes 12-months after STAR compared with 12 months before STAR. Per protocol, a 3-month blanking period is used for the efficacy endpoint. Results:
non-invasive treatment option in future trials. Keywords: STAR, Stereotactic Arrhythmia Radiotherapy, VT
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Middle-term Safety and Efficacy Results After Stereotactic Arrhythmia Radiotherapy: Results from the Prospective STARNL Registry Wiert F Hoeksema 1 , Martijn H Van der Ree 1 , Edith MT Dieleman 2 , Nils Planken 3 , Rianne de Bruin-Bon 1 , Rianne MAJ De Jong 2 , Joost JC Verhoeff 2 , Michiel JB Kemme 1 , Jippe C Balt 4 , Brian V Balgobind 2 , Pieter G Postema 1 1 Department of Clinical and Experimental Cardiology, Amsterdam UMC, Amsterdam, Netherlands. 2 Department of Radiotherapy, Amsterdam UMC, Amsterdam, Netherlands. 3 Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands. 4 Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands Purpose/Objective: Stereotactic Arrhythmia Radiotherapy (STAR) is a promising treatment option for patients with therapy- refractory ventricular tachycardia (VT). Despite encouraging safety and efficacy results in short-term follow-up studies, the middle- and long-term safety and efficacy remain unclear. We aimed to evaluate the safety and efficacy of STAR for VT over a two-year follow-up. Material/Methods: The STARNL registry is a prospective registry including patients treated with STAR for therapy-refractory VT within a prospective trial or based on compassionate use. Patients with VT episodes despite optimal conventional antiarrhythmic therapy were considered therapy-refractory and were treated with a single fraction of 25 Gy stereotactic body radiotherapy. Safety and efficacy were evaluated over a middle-term
Ten patients have been included in the STARNL-2 trial so far. One patient died prior to STAR and was therefore not included in this analysis. The median age was 71 (range 60-81), eight were male (89%) and six suffered from nonischaemic cardiomyopathy (two ischaemic and one both ischaemic and nonischaemic) with a median left ventricular ejection fraction of 32% (15%-50%). Before STAR, all patients were on amiodarone and mexiletine with median daily doses of 400mg (200-600) and 800mg (400-1000), respectively. The median number of previous VT ablations was 3 (1-4) and seven patients had previously undergone epicardial VT ablation (78%). During follow-up, two patients died from non-
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