Role of palliative radiotherapy in the management of mural cardiac metastases: who, when and how to treat? A case series of 10 patients

Abstract

Cardiac metastases (CM), although a rare manifestation of metastatic cancer, are increasing in incidence with the improved prognosis and increased longevity of many patients with cancer. This condition may be life‐threatening, especially for bulky rapidly growing tumors. Such cancer presentations may be amenable to palliative radiotherapy to improve symptoms and to prevent further cardiac function decline. Here, we report on our experience with 10 patients with mural CM who received radiotherapy (RT) to the heart with palliative intent. The radiation treatment was given in different clinical situations using different dose and fractionation, and with a variety of outcomes. Palliative RT was a reasonably effective treatment, leading to good radiographic response in five patients who were evaluable for radiologic response. The mean duration of response in responding patients was 6.3 months (range: 3–11 months). This report describing clinical dilemmas around CM radiation therapy summarizes the previous experiences with radiation in treatment of CM and may assist in the considerations of palliative treatment for these patients.

Case Report: Complete heart block as a manifestation of cardiac metastasis of oral cancer

“…In our case, we assume that the CHB was persistent after trying to correct possible external causes, such as hypercalcemia and hypokalemia, and after a sufficient waiting period. Moreover, it is still also unknown whether CHB would resolve after cancer treatment 2,20 . Our literature review showed that there are only two cases of metastatic CHB that are reversible after undergoing chemotherapy for cardiac metastasis 8,12 , while several other cases showed that CHB is irreversible [2][3][4][5][6][7][9][10][11][13][14][15] .…”

Case Report: Complete heart block as a manifestation of cardiac metastasis of oral cancer

“…In our case, we assume that the CHB was persistent after trying to correct possible external causes, such as hypercalcemia and hypokalemia, and after a sufficient waiting period. Moreover, it is still also unknown whether CHB would resolve after cancer treatment 2,20 . Our literature review showed that there are only two cases of metastatic CHB that are reversible after undergoing chemotherapy for cardiac metastasis 8,12 , while several other cases showed that CHB is irreversible [2][3][4][5][6][7][9][10][11][13][14][15] .…”

Long-term Survival After Treating Cardiac Metastasis With Radiation and Immune Therapy: A Case Report

“…Recent trials of programmed death receptor-1 (PD-1)/PD-L1 inhibitors have demonstrated durable responses with long-term survival, and five immune checkpoint inhibitors have received FDA approval in this disease, including atezolizumab [ 7 - 10 ]. Radiation has rarely been used with success in the treatment of cardiac metastases, and only a limited number of successfully treated cases and techniques have been documented [ 2 , 4 - 5 ]. Additionally, radiotherapy increases the presentation of antigens to immune cells, potentially enhancing T-cell killing of tumor cells [ 11 ].…”

“…Cardiac metastases almost always indicate systemic disease and are seldom a solitary event [ 1 - 2 ]. Management is generally directed toward symptom control and maintaining cardiac function; however, long-term survival is rare, with a median survival around 3.5 months without treatment [ 1 , 3 - 4 ]. Here, we report a case of isolated metastatic urothelial cell carcinoma to the right ventricle.…”