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2. Recurrences of ventricular tachycardia after stereotactic arrhythmia radioablation arise outside the treated volume: analysis of the swiss cohort

Author

Siklody, C Herrera; https://orcid.org/0000-0001-6881-3073, Schiappacasse, L; https://orcid.org/0000-0001-7621-1662, Jumeau, R; https://orcid.org/0000-0002-0098-8835, Reichlin, T; https://orcid.org/0000-0002-7197-8415, Saguner, A M; https://orcid.org/0000-0003-1896-0803, Andratschke, N; https://orcid.org/0000-0003-3647-5916, Elicin, O; https://orcid.org/0000-0002-6996-0646, Schreiner, F, Kovacs, B; https://orcid.org/0000-0002-7972-5199, Mayinger, M, Huber, A; https://orcid.org/0000-0001-6146-8238, Verhoeff, J J C; https://orcid.org/0000-0001-9673-0793, Pascale, P; https://orcid.org/0000-0001-7328-2481, Solana Muñoz, J; https://orcid.org/0000-0002-2633-7248, Luca, A; https://orcid.org/0000-0002-0040-8191, Domenichini, G, Moeckli, R; https://orcid.org/0000-0002-5885-934X, Bourhis, J, Ozsahin, E M; https://orcid.org/0000-0003-2947-5360, Pruvot, E; https://orcid.org/0000-0003-1386-9285, Siklody, C Herrera; https://orcid.org/0000-0001-6881-3073, Schiappacasse, L; https://orcid.org/0000-0001-7621-1662, Jumeau, R; https://orcid.org/0000-0002-0098-8835, Reichlin, T; https://orcid.org/0000-0002-7197-8415, Saguner, A M; https://orcid.org/0000-0003-1896-0803, Andratschke, N; https://orcid.org/0000-0003-3647-5916, Elicin, O; https://orcid.org/0000-0002-6996-0646, Schreiner, F, Kovacs, B; https://orcid.org/0000-0002-7972-5199, Mayinger, M, Huber, A; https://orcid.org/0000-0001-6146-8238, Verhoeff, J J C; https://orcid.org/0000-0001-9673-0793, Pascale, P; https://orcid.org/0000-0001-7328-2481, Solana Muñoz, J; https://orcid.org/0000-0002-2633-7248, Luca, A; https://orcid.org/0000-0002-0040-8191, Domenichini, G, Moeckli, R; https://orcid.org/0000-0002-5885-934X, Bourhis, J, Ozsahin, E M; https://orcid.org/0000-0003-2947-5360, and Pruvot, E; https://orcid.org/0000-0003-1386-9285

Abstract

BACKGROUND AND AIMS Stereotactic arrhythmia radioablation (STAR) has been recently introduced for the management of therapy-refractory ventricular tachycardia (VT). VT recurrences have been reported after STAR but the mechanisms remain largely unknown. We analyzed recurrences in our patients after STAR. METHODS From 09.2017 to 01.2020, 20 patients (68±8y, LVEF 37±15%) suffering from refractory VT were enrolled, 16/20 with a history of at least 1 electrical storm. Before STAR, an invasive electro-anatomical mapping (Carto3) of the VT substrate was performed. A mean dose of 23±2Gy was delivered to the planning target volume (PTV). RESULTS The median ablation volume was 26 ml (range 14-115) and involved the interventricular septum in 75% of patients. During the first 6 months after STAR, VT burden decreased by 92% (median value, from 108 to 10 VT/semester). After a median follow-up of 25 months, 12/20 (60%) developed a recurrence and underwent a redo ablation. VT recurrence was located in proximity of the treated substrate in 9 cases, remote from the PTV in 3 cases and involved a larger substrate over ≥3 LV segments in 2 cases. No recurrences occurred inside the PTV. Voltage measurements showed a significant decrease in both bipolar and unipolar signal amplitude after STAR. CONCLUSION STAR is a new tool available for the treatment of VT, allowing for a significant reduction of VT burden. VT recurrences are common during follow-up, but no recurrences were observed inside the PTV. Local efficacy was supported by a significant decrease in both bipolar and unipolar signal amplitude.

Published
2023

4. FLASH radiotherapy treatment planning and models for electron beams

Author

Rahman, M., Trigilio, A., Franciosini, G., Moeckli, R., Zhang, R., and Böhlen, T.T.

Subjects
Humans, Electrons, Radiometry/methods, Radiotherapy Planning, Computer-Assisted/methods, Photons, Neoplasms/radiotherapy, Radiotherapy Dosage, Electron beams, FLASH, IORT, TPS, UHDR, VHEE
Abstract

The FLASH effect designates normal tissue sparing at ultra-high dose rate (UHDR, >40 Gy/s) compared to conventional dose rate (∼0.1 Gy/s) irradiation while maintaining tumour control and has the potential to improve the therapeutic ratio of radiotherapy (RT). UHDR high-energy electron (HEE, 4-20 MeV) beams are currently a mainstay for investigating the clinical potential of FLASH RT for superficial tumours. In the future very-high energy electron (VHEE, 50-250 MeV) UHDR beams may be used to treat deep-seated tumours. UHDR HEE treatment planning focused at its initial stage on accurate dosimetric modelling of converted and dedicated UHDR electron RT devices for the clinical transfer of FLASH RT. VHEE treatment planning demonstrated promising dosimetric performance compared to clinical photon RT techniques in silico and was used to evaluate and optimise the design of novel VHEE RT devices. Multiple metrics and models have been proposed for a quantitative description of the FLASH effect in treatment planning, but an improved experimental characterization and understanding of the FLASH effect is needed to allow for an accurate and validated modelling of the effect in treatment planning. The importance of treatment planning for electron FLASH RT will augment as the field moves forward to treat more complex clinical indications and target sites. In this review, TPS developments in HEE and VHEE are presented considering beam models, characteristics, and future FLASH applications.

Published
2022

15. SP-0719 FLASH radiotherapy

Author

R. Moeckli

Subjects
Radiation therapy, Flash (photography), Materials science, Oncology, business.industry, medicine.medical_treatment, medicine, Radiology, Nuclear Medicine and imaging, Hematology, Nuclear medicine, business
Published
2021
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25. Abstracts from the 8th Annual Meeting of the Scientific Association of Swiss Radiation Oncology (SASRO)

Author

Ph Morel, H. P. Do, W. Van den Bogaert, M. F. Fey, P. Hueber, H. Schefer, G. Goitein, S. Bressan, C. Verdan, W. Jeanneret Sozzi, L. Escudé, J. Heuberger, J. C. Horiot, O. Stadelmann, S. Balmer Majno, D. Schneiter, G. Lutters, A. Schott, Damien C. Weber, R. Mini, Peter Thum, Gábor J. Székely, G. Höpfl, B. Lippold, A. Coray, A. Azria, J. B. Davis, M. Betz, A. Hügli, Y. Zimmer, S. Berthou, Ch. Landmann, T. Boehringer, M. I. Saunders, S. Gourgou, L. Bortoluzzi, G. Ries, M. Allaoua, E. J. Born, A. Gallino, Christos Kolotas, G. Ueltschi, S. Bouville, Alessandra Bolsi, A. Richetti, K. T. Beer, S. Presilla, A. D. Roth, B. Streit, Richard H. Greiner, A. J. Lomax, F. Corminboeuf, J. Verwey, R. D. Gelber, J. Lindtner, O. Özsoy, R. Stupp, B. Thürlimann, R. H. Greiner, B. Hofstetter, I. F. Ciernik, M.-A. Bründler, C. von Briel, M. Honer, A. Merçay, E. Tschanz, M. Pruschy, L. Kemmerling, K. Rufibach, A. Franzetti, F. Luthi, A. Goldhirsch, J. Krayenbühl, St. Bodis, P. Martineau, Karl T. Beer, A. Pèlegrin, Peter D. Juelke, S. Cunat, J. Curschmann, M. Huser, A. Carbone, H. Rutz, Anthony Lomax, S. M. Bentzen, David Azria, W. Weder, N. Mach, H. Kranzbuehler, F. Mahler, L. Cozzi, P. Jichlinski, K. N. Price, M. Jörger, A. S. Coates, Christine Bouchardy, Frank Behrensmeier, Oscar Matzinger, Urs M. Lütolf, C. Taverna, H. Vees, D. Szczerba, R. Miralbell, D. Stalder, P. Pasche, C. Oehler, Eros Pedroni, M. Notter, P. Pujol, S. Bulling, W. Krek, D. Zingg, C. Larbouret, B. Pajic, G. Gruber, Oliver Riesterer, Beate Timmermann, L. Guillou, D. Weber, P. Dulguerov, P. Tebeu, F. Ludicke, P. Gervaz, Dagmar Laluhová, F. Munier, Abderrahim Zouhair, S. Lin, R. Gol-ouh, Ch. Taverna, M. Motta, R. Bigler, J. C. Luthi, S. Bieri, Malgorzata Roos, Paul Erne, S. Ganapathipillai, S. Ametamey, A. Tenzer, C. Burger, C. Bonny, B. J. Cummings, Stefanie Ohlerth, J. Bernier, M. Castiglione-Gertsch, M. Mollà, G. Pasche, J. F. Valley, G. Romieu, A. S. Allal, N. Stanek, U. Ulmer, Hans-Peter Hafner, S. Bodis, D. B. Evans, E. Pedroni, C.-M. Rudenstam, A. A. Khalil, G. Curti, D. M. Aebersold, C. Girardet, M. Jerman, A. Pica, G. Pache, E. Simoncini, R. Moeckli, T. Collen, A. Balmer, P. Mhawech, Peiman Jamshidi, Hans Peter Rutz, George N. Thalmann, Bernhard Isaak, E. E. Friedrich, M. Suleiman, M. Becker, D. Taussky, S. B. Holmberg, V. Vuong, Philippe Coucke, M. Abdou, Max Gassmann, G. Pesce, D. Crivellari, M. Weitzel, C. Rohrer Bley, H. Verkooijen, E. Schoenmaker, R. Stahel, R.O. Mirimanoff, C. Ares, M. Rouzaud, M. Bonetti, J. Collins, Barbara Kaser-Hotz, M. Bargetzi, P. Gertsch, H. P. Hafner, Y. Popowski, G. Nicolini, Natalie Inteeworn, Melanie Wergin, K. Allemann, P. Nouet, P. Kestenholz, H. Zenklusen, Brigitta G. Baumert, M. Usel, D. Lardinois, Therese Josephine Resink, S. Dische, H. Wang, H. Kranzbühler, T. Kebdani, D. Vetterli, H. J. Vees, W. Jochum, I. A. Norton, J. B. Dubois, C. Jargy, D. O. Slosman, A. Kramar, A. Fogliata, G. Studer, M. L. Nasi, Mahmut Ozsahin, G. Dipasquale, and P. Huguenin

Subjects
Radiation therapy, medicine.medical_specialty, Oncology, business.industry, medicine.medical_treatment, Radiation oncology, MEDLINE, medicine, Radiology, Nuclear Medicine and imaging, Medical physics, business
Published
2016

33. The concept and challenges of TomoTherapy accelerators

Author

Bailat, C.J., Baechler, S., Moeckli, R., Pachoud, M., Pisaturo, O., and Bochud, F.O.

Subjects
IMAGE-GUIDED RADIOTHERAPY, MODULATED ARC THERAPY, STOPPING-POWER RATIOS, HELICAL TOMOTHERAPY, QUALITY-ASSURANCE, MONTE-CARLO, CONFORMAL RADIOTHERAPY, LINEAR-ACCELERATOR, RADIATION-THERAPY, SHIELDING CONSIDERATIONS
Published
2011

41. Seroepidemiological survey of hepatitis E in Hong Kong by recombinant-based enzyme immunoassays

Author

P.O. Yarbough, Ching-Lung Lai, T.S.T. Lai, R. Moeckli, H. T. Chung, Anna S.F. Lok, G.R. Reyes, R.T. Chan, and W.-K. Kwan

Subjects
Adult, Male, Adolescent, viruses, medicine.disease_cause, Serology, Immunoenzyme Techniques, Hepatitis E virus, Seroepidemiologic Studies, Prevalence, medicine, Humans, Serologic Tests, Hepatitis Antibodies, Longitudinal Studies, Aged, Retrospective Studies, Hepatitis, biology, business.industry, virus diseases, Hepatitis A, General Medicine, Middle Aged, medicine.disease, Hepatitis E, Recombinant Proteins, digestive system diseases, Acute Disease, Immunology, biology.protein, Coinfection, Hong Kong, Female, Antibody, business, Viral hepatitis
Abstract

The agent that causes the enterally transmitted form of non-A, non-B hepatitis has been cloned and called hepatitis E virus (HEV). We have carried out a seroepidemiological survey on the prevalence of hepatitis E in Hong Kong. In a retrospective study, serum from 394 patients with acute viral hepatitis and 355 healthy subjects was tested for antibodies to HEV (anti-HEV) with a recombinant-based enzyme immunoassay. 65 (16.5%) patients with hepatitis were positive for IgM anti-HEV and 23 (5.8%) were also positive for IgM anti-HEV. Of 18 patients diagnosed as having acute non-A, non-B, non-C hepatitis, 6 were IgM anti-HEV positive. 17 (6%) patients in whom acute hepatitis A was diagnosed were also infected with HEV. None of 70 patients with acute hepatitis B or C or exacerbation of chronic hepatitis B was IgM anti-HEV positive. 57 (16.1%) of the healthy subjects were positive for IgG anti-HEV. The prevalence of IgG anti-HEV was higher in subjects over 20 years old than in younger subjects (24% vs 4%, p < 0.0001). IgG anti-HEV was detected in 26% of subjects who were positive for IgG antibody to HAV and in 7% of those negative for that antibody (p < 0.0001). We demonstrated the validity of the recombinant-based enzyme immunoassays for the diagnosis of hepatitis E. Our results suggest that hepatitis E accounts for a third of non-A, non-B, non-C hepatitis in Hong Kong and that coinfection of hepatitis A and E can occur.

Published
1992
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43. [Prospective study of accelerated postoperative radiation therapy in patients with squamous-cell carcinoma of the head and neck]

Author

A, Zouhair, P A, Coucke, D, Azria, P, Pache, R, Stupp, R, Moeckli, R O, Mirimanoff, and M, Ozsahin

Subjects
Adult, Aged, 80 and over, Male, Radiotherapy, Middle Aged, Combined Modality Therapy, Survival Analysis, Treatment Outcome, Head and Neck Neoplasms, Weight Loss, Carcinoma, Squamous Cell, Humans, Female, Dose Fractionation, Radiation, Neoplasm Recurrence, Local, Aged
Abstract

To assess the feasibility and efficacy of accelerated postoperative radiation therapy (RT) in patients with squamous-cell carcinoma of the head and neck (SCCHN).Between December 1997 and July 2001, 68 patients (male to female ratio: 52/16; median age: 60-years (range: 43-81) with pT1-pT4 and/or pN0-pN3 SCCHN (24 oropharynx, 19 oral cavity, 13 hypopharynx, 5 larynx, 3 unknown primary, 2 maxillary sinus, and 2 salivary gland) were included in this prospective study. Postoperative RT was indicated because extracapsular infiltration (ECI) was observed in 20 (29%), positive surgical margins (PSM) in 20 (29%) or both in 23 patients (34%). Treatment consisted of external beam RT 66 Gy in 5 weeks and 3 days. Median follow-up was 15 months.According to CTC 2.0, acute morbidity was acceptable: grade 3 mucositis was observed in 15 (22%) patients, grade 3 dysphagia in 19 (28%) patients, grade 3 skin erythema in 21 (31%) patients with a median weight loss of 3.1 kg (range: 0-16). No grade 4 toxicity was observed. Median time to relapse was 13 months; we observed only three (4%) local and four (6%) regional relapses, whereas eight (12%) patients developed distant metastases without any evidence of locoregional recurrence. The 2 years overall-, disease-free survival, and actuarial locoregional control rates were 85, 73 and 83% respectively.The reduction of the overall treatment time using postoperative accelerated RT with weekly concomitant boost (six fractions per week) is feasible with local control rates comparable to that of published data. Acute RT-related morbidity is acceptable.

Published
2003

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