This is a research study that aims to understand if giving a lower dose of treatment all at once is as effective and safe as dividing it into three smaller doses for patients with a heart condition called refractory ventricular tachycardia (VT). These patients have not exhibited positive responses to conventional medications or procedures. This study aims to explore whether an alternative approach could yield more beneficial outcomes.
Ventricular tachycardia (VT) is a life-threatening heart rhythm disorder that arises from areas of diseased tissue in the heart. Treatment of VT can involve anti-arrhythmic drugs and catheter-based ablations. Unfortunately, despite multiple antiarrhythmic drugs, as well as the catheter-based ablation procedures, VT continues to persist in your case. At this point in time, The investigators believe that stereotactic body radiotherapy (SBRT) remains the only possible option to potentially treat VT. The investigators hypothesize that by administering SBRT at different dose levels and fractionation may achieve a better therapeutic ratio, defined as comparable efficacy with less risk of toxicity due to lower dose exposure to the normal tissue, including the heart vasculature, in patients when compared to VT patients who receive a dose of 25Gy in a single fraction which is the current treatment option. This is a randomized dose de-escalation trial where the patients will be randomized in in one of the two experimental arms, receiving 1 single fraction OR 3 daily consecutive fractions of RT, and will be treated into a prespecified dose level group, based on the study development. The study includes three de-escalated consecutive dose level groups for each of two randomized treatment arms and there will be 3 patients per group and each group will receive a particular radiation treatment either as single treatments or three treatments. The purpose of this treatment is to safely reduce episodes of VT.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Group 1 (3 participants) - will receive a dose of 20 Gy ("Gray", a measurement of radiation) in a single study intervention (one study intervention day)
Group 2 (3 participants) - will receive a dose of 15 Gy in a single study intervention (one study intervention day)
Group 3 (3 participants) - will receive a dose of 10 Gy in a single study intervention (one study intervention day)
Weill Cornell Medicine
New York, New York, United States
RECRUITINGEfficacy as measured by number of subjects with a reduction ≥ 60% (tracked by ICD recordings) ventricular tachycardia (VT) episodes
Time frame: 6 months before treatment
Efficacy as measured by number of subjects with a reduction ≥ 60% (tracked by ICD recordings) ventricular tachycardia (VT) episodes
Time frame: 6 weeks post treatment
Number of treatment-related serious adverse events (SAEs)
Safety: SAEs rate ≤ 30% defined using Common Terminology Criteria for Adverse Events (CTCAE) criteria (version 5.0) that could be treatment-related (possibly, probably, or definitely related to treatment) at 6 weeks after treatment is considered clinically acceptable. The SAEs are defined as any grade 3 toxicity requiring hospitalization or any grade 4 to 5 toxicity.
Time frame: 6 weeks post treatment
Number of ventricular tachycardia (VT) episodes
Time frame: 3 months post
Number of ventricular tachycardia (VT) episodes
Time frame: 6 months post
Number of ventricular tachycardia (VT) episodes
Time frame: 12 months
Number of subacute treatment side-effects
Subacute treatment side effects, defined as any grade according to CTCAE criteria (version 5.0)
Time frame: 3 months post
Number of subacute treatment side-effects
Subacute treatment side effects, defined as any grade according to CTCAE criteria (version 5.0)
Time frame: 6 months post
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Enrollment
40
Group 1 (3 participants) - will receive a dose of 12 Gy given over 3 days (Days 1, 2 and 3). (Total radiation dose = 36Gy)
Group 2 (3 participants) - will receive a dose of 10 Gy given over 3 days (Days 1, 2 and 3). (Total radiation dose = 30Gy)
Group 3 (3 participants) - will receive a dose of 8 Gy given over 3 days (Days 1, 2 and 3). (Total radiation dose = 24Gy)
Number of late Adverse events
Long term treatment side effects, defined as any grade according to CTCAE criteria (version 5.0)
Time frame: 1 year post
Number of late Adverse events
Long term treatment side effects, defined as any grade according to CTCAE criteria (version 5.0)
Time frame: 2 year post
Overall survival
Overall survival, defined as time calculated from treatment to death for any cause;
Time frame: 1 year post
Overall survival
Overall survival, defined as time calculated from treatment to death for any cause;
Time frame: 2 year post
Recurrence free survival
Recurrence free survival, defined as "time to VT storm" with VT storm defined as ≥ 3 VT/VF episodes leading to ICD therapy within 24 hours
Time frame: 3 months post
Recurrence free survival
Recurrence free survival, defined as "time to VT storm" with VT storm defined as ≥ 3 VT/VF episodes leading to ICD therapy within 24 hours
Time frame: 6 months post
Recurrence free survival
Recurrence free survival, defined as "time to VT storm" with VT storm defined as ≥ 3 VT/VF episodes leading to ICD therapy within 24 hours
Time frame: 12 months post
Recurrence free survival
Recurrence free survival, defined as "time to VT storm" with VT storm defined as ≥ 3 VT/VF episodes leading to ICD therapy within 24 hours
Time frame: 24 months post
Number of incidents of implantable cardiac device (ICD) shock
Time frame: 3 months before treatment
Number of incidents of implantable cardiac device (ICD) shock
Time frame: 3 months post treatment
Number of Anti-Arrhythmic Drugs (AADs) administration
Any reduction in Anti-Arrhythmic Drugs (AADs) administration
Time frame: 3 months before treatment
Number of Anti-Arrhythmic Drugs (AADs) administration
Any reduction in Anti-Arrhythmic Drugs (AADs) administration
Time frame: 3 months post treatment