Sarcoma of the Heart Treated with Stereotactic MR-Guided Online Adaptive Radiation Therapy

Abstract

We present the first case in the literature of a patient with a histology-proven intimal sarcoma of the heart, recurrent after surgery, treated with stereotactic MR-guided online adaptive radiation therapy on an MR-Linac machine. The treatment was feasible and well tolerated. The CT scan 6 months after the last treatment showed stable disease.

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

“…SBRT, a well-established method for the ablative treatment, can deliver large doses of radiation in a small number of fractions for RT treatments within sensitive surrounding organs such as the heart. Numerous case reports and small case series detailing their treatment of primary heart sarcomas have been published [3] , [5] , [6] , [13] , [16] ( Table 1 ). However, only a small number of cases utilized ultrahypofractionated SBRT [6] , [7] , and none utilized the simultaneous integrated boost technique to administer higher doses to gross lesions.…”

“…The introduction of magnetic resonance guided RT (MRgRT), in particular, allows for direct visualization of the target even during treatment delivery, allowing for higher-dose administration with less damage to healthy tissue near the tumor [5] . Although promising results demonstrated the feasibility of cardiac MRgRT also for non-oncological diseases in cases of refractory ventricular tachycardia and support the use of such advanced delivery techniques for cardiac irradiation, only a small number of patients with primary cardiac tumors were treated with MRgRT [6] , [7] . We present the case with recurrent cardiac angiosarcoma one year after surgery and was treated with high field 1.5-Tesla (T) MR-linac using stereotactic MR-guided online adaptive radiation therapy (SMART) technique.…”

Primary cardiac atrial sarcomas. Report of two histologically different cases and review of the literature

“…35-50% ex-Table II. Immunohistochemical and molecular characteristics of intimal sarcoma (InS) [4,9,10,12,13,15,16,17,18,19,20,22,23,25,26,27,28,30,31,32,33,36,39,40,44] Atrial intimal sarcomas only (data from references no [9,10,12,13,15,16,17,18,19,20,22,23,25,26,27,28,30,31,32,33,36,39,40])…”

“…only* (data from references no[10,15,17,19,23,25,26,27,28,30,36, immunofenotype of the tumours with MDM2 gene amplification…”

Feasibility of cardiac-synchronized quantitative T1 and T2 mapping on a hybrid 1.5 Tesla magnetic resonance imaging and linear accelerator system

“…Cardiac radioablation was also performed to treat a patient with atrial fibrillation [9] . In an oncological setting, recent case reports describe the treatment of patients with cardiac sarcomas using MR-guided radiotherapy [10] , [11] .…”