Cardiac angiosarcoma treated with 1.5 Tesla MR-guided adaptive stereotactic body radiotherapy – Case report and review of the literature

Noyan, Asli; Yavaş, Güler; Efe, Esma; Arslan, G.; Yavaş, Çağdaş; Onal, Cem

doi:10.1016/j.ijscr.2022.107521

Cited by 7 publications

(10 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The patient tolerated the treatment well and had stable disease 2 months after treatment. 13 Our case differs from those reported in the literature due to the presence of bioprosthetic mitral valve. Bioprosthetic heart valves were introduced for clinical use in the 1970s in order to overcome thromboembolic complications and the need for anticoagulation associated with mechanical prostheses.…”

Section: Discussioncontrasting

confidence: 88%

“…Several cases of MR-Linac guided treatment for cardiac sarcomas have been reported in the literature. [11][12][13] Corradini et al 11 reported on four patients treated using 0.35 T MR-Linac (MRIdian, ViewRay Inc., Mountain View, CA, USA) with a mean GTV dose of 38.9 Gy (range 30.1-41.1 Gy) in five fractions. All treatments were completed as planned and patients tolerated the treatment well with reports of mild grade 1 or 2 symptoms (fatigue, dyspnea or mild chest pain) at early follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are challenges associated with delivering high‐dose radiotherapy to the heart including respiratory 8 and cardiac motion 9 and limiting dose to the heart. More recently, several studies have reported the safe use of magnetic resonance linear accelerator (MR‐Linac) guided SABR in the treatment of cardiac metastases 10 and cardiac sarcomas 11–13 . Advantages of the MR‐Linac system include better soft tissue contrast compared to CT‐based images, real‐time motion monitoring and the ability to conduct daily plan adaptation to deliver the most accurate plan of the day.…”

Section: Introductionmentioning

confidence: 99%

“…More recently, several studies have reported the safe use of magnetic resonance linear accelerator (MR-Linac) guided SABR in the treatment of cardiac metastases 10 and cardiac sarcomas. [11][12][13] Advantages of the MR-Linac system include better soft tissue contrast compared to CT-based images, realtime motion monitoring and the ability to conduct daily plan adaptation to deliver the most accurate plan of the day. We report a unique case of an undifferentiated cardiac sarcoma recurrence adjacent to a bioprosthetic mitral valve treated with MR-Linac guided adaptive SABR.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

MR‐Linac guided adaptive stereotactic ablative body radiotherapy for recurrent cardiac sarcoma with mitral valve bioprosthesis – a case report

Batumalai

Carr

Jameson

et al. 2023

J of Medical Radiation Sci

View full text Add to dashboard Cite

We present the first case in the literature of a 78‐year‐old woman with recurrent cardiac sarcoma adjacent to a bioprosthetic mitral valve treated with magnetic resonance linear accelerator (MR‐Linac) guided adaptive stereotactic ablative body radiotherapy (SABR). The patient was treated using a 1.5 T Unity MR‐Linac system (Elekta AB, Stockholm, Sweden). The mean gross tumour volume (GTV) size was 17.9 cm3 (range 16.6–18.9 cm3) based on daily contours and the mean dose received by the GTV was 41.4 Gy (range 40.9–41.6 Gy) in five fractions. All fractions were completed as planned and the patient tolerated the treatment well with no acute toxicity reported. Follow‐up appointments at 2 and 5 months after the last treatment showed stable disease and good symptomatic relief. Results of transthoracic echocardiogram after radiotherapy showed that the mitral valve prosthesis was normally seated with regular functionality. This study provides evidence that MR‐Linac guided adaptive SABR is a safe and viable option for the treatment of recurrent cardiac sarcoma with mitral valve bioprosthesis.

show abstract

Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

MR‐Linac guided adaptive stereotactic ablative body radiotherapy for recurrent cardiac sarcoma with mitral valve bioprosthesis – a case report

Batumalai

Carr

Jameson

et al. 2023

J of Medical Radiation Sci

View full text Add to dashboard Cite

show abstract

“…Although not so common, radiation therapy has also been used in angiosarcomas, mainly in the setting of metastases (22,30,31,40). A young boy with angiosarcoma was managed using MR-guided radiotherapy and demonstrated acceptable tolerance and a stable disease for two months (41).…”

Section: Case Presentationmentioning

confidence: 99%

Primary Cardiac Angiosarcoma With Pulmonary Metastasis in a Young Female: A Case Report and Review of Literature

Kordjazy

Taheri

Parkhideh

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: Sarcomas are the most prevalent type of malignant primary cardiac tumor. Clinical presentation differs according to the size and location of the tumor and involvement of other structures. Case presentation: In this article, we present a 38 years old lady as a case of primary cardiac angiosarcoma with a huge challenge in diagnosis and management of the disease. On the 4th of June 2020, she emergently presented to the hospital with the chief complaint of cough and tachypnea, diarrhea, and malaise, and a history of blunt chest trauma three weeks ago. Based on the presentation and transthoracic echocardiography which was compatible with cardiac tamponade, emergent pericardiocentesis was performed. The first imaging showed bilateral pleural effusion, pericardial effusion, and no significant parenchymal lung involvement, which was not compatible with rheumatologic diseases or COVID-19. Based on cardiac CT angiography and evidence of dye entrance to the peri-right atrial area, right atrial free wall rupture was suspected as the cause of the massive pericardial effusion. Following multidisciplinary consensus, she underwent cardiac surgery; in addition to the 3*3 cm right atrium free wall rupture repair, concomitant sampling from the lung nodules, lymph nodes, pericardium, and also the surrounding tissue of the right atrium ruptured defect was performed. Based on immunohistochemistry, the diagnosis was compatible with cardiac angiosarcoma with metastasis to the lung. Due to the advanced stage of the tumor, oncologists advised against chemotherapy or radiotherapy and she went through palliative care. Finally, after a 53-day ICU stay and due to right-sided heart failure, the patient unfortunately died. Conclusion: COVID-19 pandemic has brought diagnostic challenges regarding differentiating SARS-CoV-2 infection from other diagnostic entities. On the other hand, due to the rarity and fatality of primary cardiac angiosarcomas, early diagnosis and possible management seem crucial for prolonged survival. Involving cardiac angiosarcoma in the initial differential diagnosis could warrant timely diagnosis and assessment of various therapies for cure or palliative care.

show abstract

Experimental demonstration of real‐time cardiac physiology‐based radiotherapy gating for improved cardiac radioablation on an MR‐linac

Akdag,

Borman,

Mandija

et al. 2024

Medical Physics

View full text Add to dashboard Cite

BackgroundCardiac radioablation is a noninvasive stereotactic body radiation therapy (SBRT) technique to treat patients with refractory ventricular tachycardia (VT) by delivering a single high‐dose fraction to the VT isthmus. Cardiorespiratory motion induces position uncertainties resulting in decreased dose conformality. Electocardiograms (ECG) are typically used during cardiac MRI (CMR) to acquire images in a predefined cardiac phase, thus mitigating cardiac motion during image acquisition.PurposeWe demonstrate real‐time cardiac physiology‐based radiotherapy beam gating within a preset cardiac phase on an MR‐linac.MethodsMR images were acquired in healthy volunteers (n = 5, mean age = 29.6 years, mean heart‐rate (HR) = 56.2 bpm) on the 1.5 T Unity MR‐linac (Elekta AB, Stockholm, Sweden) after obtaining written informed consent. The images were acquired using a single‐slice balance steady‐state free precession (bSSFP) sequence in the coronal or sagittal plane (TR/TE = 3/1.48 ms, flip angle = 48, SENSE = 1.5, , voxel size = , partial Fourier factor = 0.65, frame rate = 13.3 Hz). In parallel, a 4‐lead ECG‐signal was acquired using MR‐compatible equipment. The feasibility of ECG‐based beam gating was demonstrated with a prototype gating workflow using a Quasar MRI4D motion phantom (IBA Quasar, London, ON, Canada), which was deployed in the bore of the MR‐linac. Two volunteer‐derived combined ECG‐motion traces (n = 2, mean age = 26 years, mean HR = 57.4 bpm, peak‐to‐peak amplitude = 14.7 mm) were programmed into the phantom to mimic dose delivery on a cardiac target in breath‐hold. Clinical ECG‐equipment was connected to the phantom for ECG‐voltage‐streaming in real‐time using research software. Treatment beam gating was performed in the quiescent phase (end‐diastole). System latencies were compensated by delay time correction. A previously developed MRI‐based gating workflow was used as a benchmark in this study. A 15‐beam intensity‐modulated radiotherapy (IMRT) plan ( Gy) was delivered for different motion scenarios onto radiochromic films. Next, cardiac motion was then estimated at the basal anterolateral myocardial wall via normalized cross‐correlation‐based template matching. The estimated motion signal was temporally aligned with the ECG‐signal, which were then used for position‐ and ECG‐based gating simulations in the cranial–caudal (CC), anterior–posterior (AP), and right–left (RL) directions. The effect of gating was investigated by analyzing the differences in residual motion at 30, 50, and 70% treatment beam duty cycles.ResultsECG‐based (MRI‐based) beam gating was performed with effective duty cycles of 60.5% (68.8%) and 47.7% (50.4%) with residual motion reductions of 62.5% (44.7%) and 43.9% (59.3%). Local gamma analyses (1%/1 mm) returned pass rates of 97.6% (94.1%) and 90.5% (98.3%) for gated scenarios, which exceed the pass rates of 70.3% and 82.0% for nongated scenarios, respectively. In average, the gating simulations returned maximum residual motion reductions of 88%, 74%, and 81% at 30%, 50%, and 70% duty cycles, respectively, in favor of MRI‐based gating.ConclusionsReal‐time ECG‐based beam gating is a feasible alternative to MRI‐based gating, resulting in improved dose delivery in terms of high rates, decreased dose deposition outside the PTV and residual motion reduction, while by‐passing cardiac MRI challenges.

show abstract

Cardiac angiosarcoma treated with 1.5 Tesla MR-guided adaptive stereotactic body radiotherapy – Case report and review of the literature

Cited by 7 publications

References 15 publications

MR‐Linac guided adaptive stereotactic ablative body radiotherapy for recurrent cardiac sarcoma with mitral valve bioprosthesis – a case report

MR‐Linac guided adaptive stereotactic ablative body radiotherapy for recurrent cardiac sarcoma with mitral valve bioprosthesis – a case report

Primary Cardiac Angiosarcoma With Pulmonary Metastasis in a Young Female: A Case Report and Review of Literature

Experimental demonstration of real‐time cardiac physiology‐based radiotherapy gating for improved cardiac radioablation on an MR‐linac

Contact Info

Product

Resources

About