Reducing Physical Uncertainties in Stereotactic Arrhythmia Radiotherapy (STAR)

 

Chairs: 

• Martin Fast, Medical Physicist, UMC Utrecht (NL)
• Oliver Blanck, Computer Scientist, University Medical Center of Schleswig-Holstein, Kiel (DE)

 

Speakers: 

• Judit Boda-Heggemann, Radiation Oncologist, University Medicine Mannheim (DE)
• Yesim Kaya, PhD, Department of Cardiology, Maastricht University (NL)
• Gustavo Pozo Rodríguez,  Medical Physicist, Radiation Oncology Department, Hospital Universitario 12 de Octubre (ES)

 

Programme

Time	Topic
Day 1
09:00 – 09:15	Welcome & workshop introduction
09:15 - 10:00	Opening lecture
10:00 - 10:30	Coffee break
10:30 – 12:30	Goals for the days, aims of workshop (30’) Introductory talk - State of the art in STAR (Oliver Blanck) (20’+10’) Paired participant introductions (12 pairs) (60’)
12:30 - 13:30	Lunch break
13:30 – 15:30	Invited talk – Target definition & transfer (Yesim Kaya) (20’+10’) Participant survey – current practice/challenges (20’) Selected participant pitch Industry pitch -  Álvaro Leva Ligero / Adas3d (5’+5’) Breakout group (60’) - Defining the aim
15:30 - 16:00	Coffee break
16:00 – 18:00	Invited talk – Treatment planning (Judit Boda-Heggemann) (20’+10’) Selected participant pitches Participant pitch – Julien Bellec / Rennes (5’+5’) Industry pitch -  Rudi Labarbe / IBA (5’+5’) Breakout group discussion (60’)
Day 2
08:30 – 10:30	Introductory talk – Image guidance & motion management (Martin Fast) (20’+10’) Selected participant pitches Participant pitch – Lukas Knybel / Ostrava (5’+5’) Industry pitch – Philipp Freislederer / Brainlab (5’+5’) Industry pitch - Bojan Strbac / EBAmed (5’+5’) Breakout group (60’) - wrap up and next steps
10:30 - 11:00	Coffee break
11:00 – 13:00	Introductory talk – QA (Gustavo Pozo Rodríguez) (20’+10’) Selected participant pitches Participant pitch – George Ntentas / London (5’+5’) Participant pitch – Ariadna Cherit-Hernandez / Vienna (5’+5’) Plenary discussion on the two breakout topics (2x30’)
13:00 - 14:00	Lunch break
14:00 – 15:00	Wrap up preparation and final discussion
15:00 - 16:00	Wrap-up: highlights and planned next steps of the different workshops. (12 min per topic) (All participants together)
16:00 - 16:15	Closing remarks

 

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.