Presented by Ebison Chinherende, CMD
GenesisCare UK

Conventionally, SBRT doses are delivered in the treatment of malignant tumours. This session (as part of the RADIO STAR clinical trial ISRCTN 49861434 funded by the British Heart Foundation) will justify the use of SBRT doses to achieve a non-inversive permanent cardiac sympathetic denervation (CSD). CSD has been shown to effectively reduce Ventricular Arrhythmias (VA) burden in patients with long QT Syndrome (1) catecholaminergic polymorphic ventricular tachycardia(2) and patients with structural heart disease (3). Ventricular arrhythmias (VA) are a life threatening event and are the most common cause of cardiac arrest and sudden cardiac death (SCD) (4).

Capitalizing on the unique advantages of a Magnetic Resonance Guided SBRT technique that include, precise soft tissue visualization; automatic beam gating; real time intrafraction cine target tracking; reduced PTV margins minimizing damage to nearby OARs, safe dose escalation is possible. (5, 6). In this session the presenter will cover:

• Stellate Ganglia dose prescriptions and biological effective dose considerations,
• Dose constraints for organs at risk, immobilization techniques, and tracking capabilities,
• The advantages of reduced PTV and PRV margins leveraging on MR-guided platform advantages,
• Plan evaluation criteria based on intensive test planning that was carried out and treatment delivery resource requirements

To date, five patients have successfully completed treatment in this Phase 1 trial, with ongoing enrolment to validate the safety and efficacy of this promising non-invasive technique.

Learner Outcomes:

1. Discuss the rationale for SBRT doses to the Stellate Ganglia (SG) for Ventricular Arrhythmias (VA)
2. Explain the versatility of MR-Guided Radiotherapy platform in delivering SBRT doses to the Stellate Ganglia.
3. Discern the dosimetry approach – dose prescription(s) and plan evaluation.

Educational Level: Advanced

Presenter: Ebison Chinherende, CMD, is a Certified Medical Dosimetrist with over 15 years of experience. He achieved his CMD status, on his first attempt, in February of 2017. Based in London, UK, Ebison is a specialist in Adaptive MR-Guided Radiotherapy at GenesisCare UK, currently stationed at the Cromwell Hospital in Kensington.

Ebison has made significant contributions to the RADIO STAR (ISRCTN 49861434) first in man, British Heart Foundation (BHF) funded phase 1 clinical trial (REC:24/SC/0005), that hypothesise - a non-invasive cardiac symphathetic denervation (CSD) technique, MR – Guided Stereotactic Body Radiation Therapy (SBRT) dose, targeting the lower half of the SG bilaterally, aiming for modification rather than complete destruction would provide a more favourable complication profile whilst maintaining anti-arrhythmic efficacy for patients with Ventricular arrhythmias.

ARRT CQR Credit Distribution
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