Stereotactic radiosurgery as neuromodulation of refractory angina: an initial case series
Abstract Background This intervention pilot case series assessed 40-Gy stereotactic radiosurgery (SRS) neuromodulation applied to the bilateral stellate ganglion (SG) as a bailout procedure for patients with refractory angina pectoris (RAP). Materials and methods The local institutional review board...
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| Format: | Article |
| Language: | English |
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BMC
2025-03-01
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| Series: | Radiation Oncology |
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| Online Access: | https://doi.org/10.1186/s13014-025-02608-9 |
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| author | Jakub Cvek Otakar Jiravsky Lukas Knybel Miroslav Hudec Radim Spacek Adrian Reichenbach Jan Hecko Radek Neuwirth Josef Kautzner |
| author_facet | Jakub Cvek Otakar Jiravsky Lukas Knybel Miroslav Hudec Radim Spacek Adrian Reichenbach Jan Hecko Radek Neuwirth Josef Kautzner |
| author_sort | Jakub Cvek |
| collection | DOAJ |
| description | Abstract Background This intervention pilot case series assessed 40-Gy stereotactic radiosurgery (SRS) neuromodulation applied to the bilateral stellate ganglion (SG) as a bailout procedure for patients with refractory angina pectoris (RAP). Materials and methods The local institutional review board approved this feasibility study. In three patients with RAP, after repeated good response, symptoms were temporarily relieved after anaesthetic blockade of the left SG under ultrasound guidance. Radiosurgical neuromodulation with a dose of 40 Gy in one fraction was used for more permanent pain control. When RAP recurred after the initial SRS, right-sided procedures were considered after a confirmed positive response to right SG anesthetic block. Results No acute or late radiation-related toxicities were observed. Two patients (67%) responded to bilateral SRS (follow-up: 60 and 48 months, respectively). From baseline to 24 months, their average prescribed nitrate package count decreased from 5.5 to 0 and remained low. Daily emergency nitrates declined from 20 to 30 to 1–2 applications, and walking distance improved from 10 to 20 m to 200–400 m and remained stable. Quality of life as measured with the EQ-5D and all domains of the Seattle Angina Questionnaire improved. The third patient received only unilateral SRS, had a temporary improvement for 6 months before a return to baseline, and died after 42 months of follow-up. Conclusions Bilateral radiosurgical neuromodulation at 40 Gy appears to be feasible, safe, and effective as a bailout procedure for RAP. |
| format | Article |
| id | doaj-art-79cc0d2b616d4aaca35ef2e4ffc4c3a1 |
| institution | DOAJ |
| issn | 1748-717X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj-art-79cc0d2b616d4aaca35ef2e4ffc4c3a12025-08-20T02:56:15ZengBMCRadiation Oncology1748-717X2025-03-0120111010.1186/s13014-025-02608-9Stereotactic radiosurgery as neuromodulation of refractory angina: an initial case seriesJakub Cvek0Otakar Jiravsky1Lukas Knybel2Miroslav Hudec3Radim Spacek4Adrian Reichenbach5Jan Hecko6Radek Neuwirth7Josef Kautzner8Department of Oncology, , University Hospital and Faculty of MedicineDepartment of Cardiology, Agel Hospital Trinec-PodlesiDepartment of Oncology, , University Hospital and Faculty of MedicineDepartment of Cardiology, Agel Hospital Trinec-PodlesiDepartment of Cardiology, Agel Hospital Trinec-PodlesiDepartment of Cardiology, Institute for Clinical and Experimental MedicineDepartment of Cardiology, Agel Hospital Trinec-PodlesiDepartment of Cardiology, Agel Hospital Trinec-PodlesiDepartment of Cardiology, Institute for Clinical and Experimental MedicineAbstract Background This intervention pilot case series assessed 40-Gy stereotactic radiosurgery (SRS) neuromodulation applied to the bilateral stellate ganglion (SG) as a bailout procedure for patients with refractory angina pectoris (RAP). Materials and methods The local institutional review board approved this feasibility study. In three patients with RAP, after repeated good response, symptoms were temporarily relieved after anaesthetic blockade of the left SG under ultrasound guidance. Radiosurgical neuromodulation with a dose of 40 Gy in one fraction was used for more permanent pain control. When RAP recurred after the initial SRS, right-sided procedures were considered after a confirmed positive response to right SG anesthetic block. Results No acute or late radiation-related toxicities were observed. Two patients (67%) responded to bilateral SRS (follow-up: 60 and 48 months, respectively). From baseline to 24 months, their average prescribed nitrate package count decreased from 5.5 to 0 and remained low. Daily emergency nitrates declined from 20 to 30 to 1–2 applications, and walking distance improved from 10 to 20 m to 200–400 m and remained stable. Quality of life as measured with the EQ-5D and all domains of the Seattle Angina Questionnaire improved. The third patient received only unilateral SRS, had a temporary improvement for 6 months before a return to baseline, and died after 42 months of follow-up. Conclusions Bilateral radiosurgical neuromodulation at 40 Gy appears to be feasible, safe, and effective as a bailout procedure for RAP.https://doi.org/10.1186/s13014-025-02608-9RadiosurgeryRefractory angina |
| spellingShingle | Jakub Cvek Otakar Jiravsky Lukas Knybel Miroslav Hudec Radim Spacek Adrian Reichenbach Jan Hecko Radek Neuwirth Josef Kautzner Stereotactic radiosurgery as neuromodulation of refractory angina: an initial case series Radiation Oncology Radiosurgery Refractory angina |
| title | Stereotactic radiosurgery as neuromodulation of refractory angina: an initial case series |
| title_full | Stereotactic radiosurgery as neuromodulation of refractory angina: an initial case series |
| title_fullStr | Stereotactic radiosurgery as neuromodulation of refractory angina: an initial case series |
| title_full_unstemmed | Stereotactic radiosurgery as neuromodulation of refractory angina: an initial case series |
| title_short | Stereotactic radiosurgery as neuromodulation of refractory angina: an initial case series |
| title_sort | stereotactic radiosurgery as neuromodulation of refractory angina an initial case series |
| topic | Radiosurgery Refractory angina |
| url | https://doi.org/10.1186/s13014-025-02608-9 |
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