Reducing Physical Uncertainties in Stereotactic Arrhythmia Radiotherapy (STAR)
Chairs:
- Martin Fast
- Oliver Blanck
Description and Motivation
Ventricular tachycardia (VT) is a major contributor to sudden cardiac death. Despite standard treatments—including implantable cardioverter-defibrillators, anti-arrhythmic drugs, and catheter ablation—recurrence rates after ablation remain high. Over the past decade, stereotactic arrhythmia radiotherapy (STAR) has emerged as a promising non-invasive salvage option for patients with therapy-refractory VT. STAR is a complex, interdisciplinary procedure requiring close collaboration between cardiology and radiotherapy. It combines anatomical imaging with electrophysiological mapping to define the arrhythmogenic substrate, transfers this information into treatment planning systems, and delivers a high-dose single fraction (typically 25 Gy) while accounting for cardiac and respiratory motion.
Recent work by the STOPSTORM.eu consortium has advanced harmonization and understanding of STAR. Interim registry results show up to 80% reduction in VT burden with minimal side effects, alongside benchmark studies on contouring, planning, and quality assurance. However, these efforts also highlighted persistent uncertainties, particularly in physics-related aspects, that remain unresolved. This ESTRO Physics workshop aims to address these challenges by bringing together experts to exchange knowledge, evaluate current practices, and build consensus on key technical aspects of STAR.
Planned Outcomes
Overall, the workshop aims to provide practical guidance, improve harmonization across centres, and support safe, effective implementation of STAR within the ESTRO community and beyond. A primary goal is the development of consensus guidelines and benchmarks on key workflow components such as target volume transfer, data integration, motion management, margin definition, plan visualization, end-to-end and patient-specific quality assurance, and image guidance during treatment. In addition, the workshop aims to create an ESTRO-based educational platform for STAR to enable support for STAR programme start-up and refinement.