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.

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Feasibility and compliance were high. Some objective and subjective effects of progressive load on muscle strength and swallowing function could be demonstrated.

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