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Case report: Beyond arrhythmia: STAR-inspired single-fraction cardiac radioablation for Ewing sarcoma metastasis
Erika Galietta1,2, Silvia Strolin3, Lidia Strigari3
1Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy.
Introduction:
Stereotactic arrhythmia radioablation (STAR) has emerged as an effective non-invasive treatment for refractory ventricular arrhythmias, but its ablative single-fraction regimen may also be relevant beyond electrophysiologic indications. We report the application of a STAR-inspired 25 Gy single-fraction cardiac radioablation approach for right-ventricular metastasis from Ewing sarcoma, presented as a CARE-compliant case report.
Case Presentation:
A 26-year-old man with a history of limb Ewing sarcoma developed an incidentally detected right-ventricular mass during routine staging. After partial surgical debulking, multimodal imaging confirmed a 17 × 15 mm residual intracavitary lesion. Because complete surgical resection was not technically feasible, frameless stereotactic body radiotherapy (SBRT) was delivered in a single 25 Gy fraction using STAR workflow principles. Treatment was completed without complication. At 12-month MRI the lesion was reduced (8 × 10 mm), and subsequent imaging confirmed persistent local cardiac control. At 31 months after STAR, the patient remained free of cardiac symptoms and signs of cardiac disease progression.
Conclusion:
Adapting the STAR single-fraction regimen for oncologic cardiac targets is feasible and provided durable control with no observed cardiac toxicity. This experience supports further evaluation of STAR-inspired SBRT for unresectable cardiac tumors.
