Endovascular brachytherapy for extensive right-heart and pulmonary artery sarcoma – a case report

Abstract

Primary sarcoma of the heart is a rare but devastating tumor. Median survival with conventional treatment is 8-12 months. When resection is not feasible, patients often succumb to heart failure secondary to obstruction of blood flow, valve dysfunction, chamber compression or conduction abnormalities. Palliative treatment options include systemic chemotherapy and external beam irradiation. We herein describe a novel technique using endovascular brachytherapy, aiming at reducing tumor mass, alleviating right ventricular pressure overload and at the same time keeping the option of R0 resection viable. Material and methods: A 35-year-old man was diagnosed with a non-resectable high-grade intimal sarcoma of the right ventricle (RV), main pulmonary artery (PA) and right PA. After three cycles of doxorubicin and ifosfamide, the patient's symptoms of right heart failure worsened. Imaging documented tumor progression and supra-systemic pulmonary artery pressure. Through a trans-femoral venous access, a brachytherapy sleeve was placed in the RV and main and right PA. A dose of 20 Gy was delivered over a period of ten minutes. Results: The patient had an uneventful course and was discharged home 24 hours after the procedure. Ten months after brachytherapy, repeat imaging demonstrated a significant reduction in tumor volume and an increase in pulmonary artery cross-sectional area with a marked reduction of pulmonary artery pressure, leading to a complete resolution of heart failure symptoms. Conclusions: Endovascular brachytherapy is a novel, safe and effective therapeutic modality for non-resectable primary cardiac sarcomas either for palliation of obstruction, or tumor mass reduction to allow complete resection.

Cardiac intima sarcoma: a rapid review of case reports

“…Through a backward citation search, 24 additional articles were retrieved, bringing the total to 74 articles included in this study. Figure 1 shows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) flowchart and screening methods, while Table 1 displays the general characteristics of the patient population [18–85] .…”

“…In our review, we found that local spread was common, involving the atrial wall, myocardium, and pulmonary veins. The lungs were identified as the most common site of metastasis; however, some authors demonstrated a widespread pattern of metastasis involving multiple organs [26,46,71] . Metastasis was confirmed by biopsy for most authors or inferred from staging images.…”

“…Metastasis was confirmed by biopsy for most authors or inferred from staging images. Notably, metastasis was found to be present at the time of diagnosis, occurring either after complete resection with negative margins or representing the progression of unresectable disease [26,46,71] .…”

“…Aviel et al [26] 35 M Dyspnea and palpitations Widespread metastasis Died Nael et al [27] 63 M Fatigue, back pain, and weight loss Vertebra, small and large intestine Died Alam et al [28] 55 F Left-sided weakness after sustaining a fall Small bowel and right femur Died Rahmouni et al [29] 16 M Palpitations, shortness of breath on exertion, sudden respiratory failure, ventricular tachycardia, and occasional dizziness Skull, brain, thoracolumbar spine, pelvic bones, and all the long bones in both lower limbs Died Holzhauser et al [30] 70 F Atrial fibrillation and right humerus fracture Right humerus, liver, and thoracic vertebra Died Abreu et al [31] 70 F Weight loss and night sweat Pulmonary vein Died Cho et al [32] 29 F Dyspnea was aggravated at the inspiratory phase and right decubital position Ovaries Died Guerriero et al [33] 56 M Malaise, sweating, restlessness, dysarthria, dysgraphia, and lateral right homonymous hemianopsia None Died Morisaki et al [34] 50 M Cough and dyspnea None Died Ibrahim et al [35] 69 M Abdominal discomfort and weight loss None Died Andersen et al [36] 60 M Night sweats, dyspnea, and malaise None Died Ohnaka et al [37] 65 M Progressive shortness of breath and cough None Died Smail et al [38] 23 F Abdominal pain and hepatic congestion None Died Salazar et al [39] 65 M Asthenia, anorexia, weight loss, and dyspnea on exertion NA Died Yafasova et al [40] 60 M Night sweats, malaise, and exertional dyspnea NA Died Son et al [41] 28 F NA NA Died Scheidl et al [42] 40 M Shortness of breath and syncope on exertion NA Died Edquist et al [43] 36 M Dyspnea on exertion, syncope, night sweats, and occasional palpitations NA Died Marques Mendes et al [44] 43 F Fever, night sweats, anorexia, weight loss and productive cough NA Died (Continued )…”

Primary Intimal Sarcoma of the Pulmonary Artery in a 25-Year-Old Woman with Dyspnea and Palpitation: A Case Report

“…IS shows various histological subtypes of differentiation, such as fibrosarcoma, leiomyosarcoma, anaplastic sarcoma, osteosarcoma, and chondrosarcoma [5]. The standard therapy currently available for IS is only surgical resection, as no systemic treatment has been established for this rare disease [2, 6, 7].…”