Cardiac metastases

Abstract

Cardiac metastaseswith induction chemotherapy, with a poor response. Radiotherapy was initiated in order to reduce dysphagia. After 10.8-Gy radiotherapy was stopped because of increasing dyspnea arising from the narrowed left major bronchus (produced by local progression of the tumor), the placement of a bronchial stent was necessitated. At the same time, a second stent was placed in the esophagus to relieve the dysphagia. Palliative radiotherapy was given in fi ve daily fractions of 4 Gy, with marked alleviation of the dysphagia.In December 2006 he developed atypical chest pain. CT of the chest at that time showed regression of the esophageal tumor; but, surprisingly, cardiac metastasis was seen (Fig. 2). On echocardiography left ventricular function appeared normal. A dense hyperechogenic mass was seen in the myocardium, with a small amount of pericardial effusion. Palliative radiotherapy was delivered with anteriorposterior opposing fi elds. Radiation portals encompassed the CM with a margin of 1.5 cm to make sure that, with cardiac motion, the target volume remained in the portal. In order to shorten the treatment period, we prescribed a total dose of 20 Gy, in daily fractions of 4 Gy. Three weeks after the initiation of the palliative radiotherapy his symptoms were alleviated. Unfortunately we could not confi rm this subjective relief with chest CT, because the patient died of aspiration pneumonia 10 weeks after the initiation of the palliative radiotherapy. No autopsy was performed. Discussion and review of the literature EpidemiologyAlthough cardiac metastases (CM) are much more common than primary cardiac tumors, the diagnosis of CM antemortem is seldom made, because more than 90% are clinically silent. About 75% of primary cardiac tumors are benign and 25% are malignant (4% primary malignancy and 96% CM). According to the literature, CM have been found in 1.5%-20% of autopsies of cancer patients and in 0.2%-6.5% of subjects in unselected autopsy series. Abstract We report a case of esophageal cancer with symptomatic metastases to the heart; the patient was treated with short-course radiotherapy with good symptomatic relief. We reviewed the current literature regarding the epidemiology, clinical presentation, diagnostic tools, treatment modalities, and the prognosis of cardiac metastases. In this report we summarize the most recent autopsy studies (published between 1975 and 2007), in which we found an autopsy incidence of cardiac metastases of 2.3% among the general population, while the incidence among autopsies of cancer patients was 7.1%. Therefore, we share the opinion with others that there has been an increase in the incidence of cardiac metastases among cancer patients diagnosed after 1970, in comparison with the reported incidences in older series before 1970 (7.1% vs 3.8%; Kruskal-Wallis rank test; P = 0.039). Special attention was given to the role of radiotherapy in the management of cardiac metastases.

An Uncommon Presentation for Cardiac Melanoma

“…4,46 Hiniker et al 47 hypothesized that radiationinduced apoptosis may stimulate an antitumor immune response 48 in the setting of anti-CTLA-4 treatment. They employed radiotherapy combined with immunotherapy as a noninvasive in vivo tumor vaccine strategy in a patient with metastatic melanoma involving the liver.…”

“…As a result, more patients may present with late complications of advanced disease, including cardiac metastasis. 4 Cardiac metastasis can manifest as either monomorphic or polymorphic ventricular tachycardia. Lysis of a transmural cardiac metastasis also could result in pericardial bleeding and hemodynamic collapse.…”

“…2,3 Perhaps due to a propensity for hematogenous spread, malignant melanoma has one of the highest cardiac metastatic rates (27%), followed by lung cancer (21%), breast cancer (15.5%) and lymphomas (9.4%). [3][4][5] The majority of cardiac tumors are silent and found incidentally, either on imaging or during autopsy. 6 Only 10% of patients with cardiac metastases develop symptoms.…”

Intracardiac Metastasis from Epitheloid Sarcoma: Rare Localization and Difficult Management

“…Pericardial effusion can also be managed with local radiotherapy or systemic chemotherapy. Another option is the local infusion of chemotherapeutic agents (Ex: bleomycin, cis-platin, mitomycin C, 5-FU) or radioisotopes [15].…”

A Patient with Lung Squamous Cell Carcinoma Presenting with Severe Cardiac Dysfunction Similar to Dilated Cardiomyopathy with Left Bundle Branch Block Induced by Myocardial Metastasis

“…Lung cancer is reported to be the most common malignancy that causes cardiac metastasis followed by breast cancer and hematologic malignancies (1)(2)(3)(4)(5)(6). In some cases, cardiac metastases, specifically epicardial and myocardial metastases, may result in a variety of life-threatening complications including cardiac conduction system disruption such as complete atrioventricular (AV) block or ventricular fibrillation.…”