Background The presentation, management and outcome of patients with primary cardiac sarcomas are not well defined. Furthermore, the role of adjuvant therapy has not been delineated in the management of primary cardiac sarcomas. Methods Patients with primary cardiac sarcoma and non-cardiac sarcoma, diagnosed between 1988 and 2005, were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Clinical characteristics and outcomes of primary cardiac sarcoma were defined and compared to the characteristics of non-cardiac sarcomas. Univariate and multivariate methods were used to identify factors associated with primary cardiac sarcoma survival. Results Compared to non-cardiac sarcomas, primary cardiac sarcomas were found to occur in a younger age group and were more likely to present with advanced disease. Primary cardiac sarcomas were ten times more likely to be vessel-derived (e.g. angiosarcoma), comprising almost half of all cases. Median overall survival for cardiac sarcoma patients was 6 months while that of non-cardiac sarcoma patients was significantly longer at 93 months (p < .001). Furthermore, cardiac sarcoma patients who underwent surgery had a median survival of 12 months while those who did not undergo surgery had a median survival of one month (p < .001). Conclusions Cardiac sarcomas are a distinct, rare subset of soft tissue sarcomas with a very poor prognosis. Surgery continues to be the central component of successful management. Future clinical efforts should be directed at developing approaches to permit safe radical excision and, potentially, developing effective adjuvant therapy.

Objectives Despite evidence that radiation therapy (RT) improves outcome in multiple malignancies, some patients with strong clinical indications still refuse RT. Data on factors associated with RT refusal are limited. Furthermore, the effect of RT refusal on outcome has not been clearly defined. Methods Patients with nonmetastatic cancer, diagnosed between 1988 and 2005, were identified in the Surveillance, Epidemiology, and End Results database. Univariate and multivariate methods were used to identify factors associated with RT refusal and the impact of refusal on outcomes. Results On univariate analysis, age, sex, marital status, tumor site, and tumor stage were associated with RT refusal (P < 0.001). On multivariate analysis, sex and tumor stage were not found to be associated with RT refusal. In contrast, age, race, marital status, and tumor location were significantly associated with RT refusal. The median survival of compliant patients was 171 months compared with just 96 months among patients who refused RT. Conclusions A significant percentage of patients continue to refuse RT despite medical advice and evidence. Subgroups at particular risk of RT refusal include elderly, black and widowed patients. RT refusal is associated with markedly worse clinical outcomes.

Purpose This study examines the management and outcomes of muscle-invasive bladder cancer in the U.S. Methods and Materials Patients with muscle-invasive bladder cancer diagnosed between 1988 and 2006 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Patients were classified according to three mutually exclusive treatment categories based on the primary initial treatment: no local management, radiotherapy, or surgery. Overall survival was assessed with Kaplan-Meier analysis and Cox models based on multiple factors including treatment utilization patterns. Results The study population consisted of 26,851 patients. Age, sex, race, tumor grade, histology and geographic location were associated with differences in treatment (all P < 0.01). Patients receiving definitive radiotherapy tended to be older and have less differentiated tumors than patients undergoing surgery (RT: median age 78 years and 90.6% grade 3/4 tumors; surgery: median age 71 years and 77.1% grade 3/4 tumors). No large shifts in treatment were seen over time, with the vast majority of patients managed with surgical resection (86.3% for overall study population). Significant survival differences were observed according to initial treatment: median survival 14 months with no definitive local treatment, 17 months with radiotherapy, and 43 months for surgery. On multivariate analysis, differences in local utilization rates of definitive radiotherapy did not demonstrate a significant effect on overall survival (H.R. = 1.002 (95% C.I. 0.999–1.005)). Conclusions Multiple factors influence the initial treatment strategy for muscle-invasive bladder cancer but definitive radiotherapy continues to be uncommonly employed. Although patients who undergo surgery fare better, a multivariable model that accounted for patient and tumor characteristics found no survival detriment to the utilization of definitive radiotherapy. These results support continued research into bladder-preservation strategies and suggest that definitive radiotherapy represents a viable initial treatment strategy for those who wish to attempt to preserve their native bladder.

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