Therapy Insight: malignant primary cardiac tumors

Abstract

Benign cardiac tumors are resected with a high degree of success with modern cardiac surgical techniques. Malignant cardiac tumors, however, continue to pose a therapeutic challenge to cardiac surgeons and oncologists because of the technical difficulty involved in extensive cardiac resections and the aggressive biological nature of the tumors. The majority of malignant cardiac tumors are sarcomas and can be categorized as right heart sarcoma, left heart sarcoma or pulmonary artery sarcoma. Right heart sarcomas are generally angiosarcomas, which infiltrate widely and metastasize early. A combination of chemotherapy and surgical resection is the preferred therapy. Left heart sarcomas, although large, are often less infiltrative and metastasize later than right heart sarcomas, but a similar approach to treatment is usually employed. Surgical resection is more-frequently necessary for left heart sarcomas because of intracardiac blood flow obstruction and congestive heart failure, although the anatomic position and relation of these tumors to cardiac structures can complicate surgery. We have developed and employed the technique of cardiac autotransplantation, which involves cardiac excision, ex vivo tumor resection with cardiac reconstruction, and cardiac reimplantation, to lessen these technical difficulties. Pulmonary artery sarcomas can be treated by radiotherapy, as well as by the other therapies, because the myocardium can be avoided by the radiation fields. Surgical resection of this sarcoma type often requires pneumonectomy and can require pulmonary root replacement.

Survival After Resection of Primary Cardiac Tumors

“…25 Indeed, our multivariate model indicates malignant tumor histology is the most significant clinical predictor of mortality; however, we have also identified that younger patients tend to have particularly aggressive tumors. While some have advocated for highly aggressive surgical resection including cardiomyoplasty 26 and autotransplantation, 27 it is unclear whether either of these approaches result in superior survival outcomes. It is currently our clinical practice to pursue surgical resection when there is a likelihood of complete resection or if patients are severely symptomatic.…”

An Uncommon Presentation for Cardiac Melanoma

“…cardiac explantation, ex vivo tumor resection, reconstruction and reimplantation) also has been described. 39,40 Our patient had stage IV metastatic melanoma that was deemed unresectable. Systemic treatment is the mainstay for disseminated malignant melanoma, while radiation and surgery play an adjunctive role.…”

Primary cardiac malignant fibrous histiocytoma with vulvar metastases: A case report

“…However, the tumor metastasized to the vulva 1 month later and the patient succumbed due to local recurrence 13 months after diagnosis. It is hypothesized that adjuvant therapy may be indispensable to prevent local recurrence and distant metastasis, as well as provide improved survival, even in patients that have undergone complete resection (25).…”