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Al-Ostoot FH, Salah S, Khanum SA. An Overview of Cancer Biology, Pathophysiological Development and It's Treatment Modalities: Current Challenges of Cancer anti-Angiogenic Therapy. Cancer Invest 2024; 42:559-604. [PMID: 38874308 DOI: 10.1080/07357907.2024.2361295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 11/22/2021] [Accepted: 05/25/2024] [Indexed: 06/15/2024]
Abstract
A number of conditions and factors can cause the transformation of normal cells in the body into malignant tissue by changing the normal functions of a wide range of regulatory, apoptotic, and signal transduction pathways. Despite the current deficiency in fully understanding the mechanism of cancer action accurately and clearly, numerous genes and proteins that are causally involved in the initiation, progression, and metastasis of cancer have been identified. But due to the lack of space and the abundance of details on this complex topic, we have emphasized here more recent advances in our understanding of the principles implied tumor cell transformation, development, invasion, angiogenesis, and metastasis. Inhibition of angiogenesis is a significant strategy for the treatment of various solid tumors, that essentially depend on cutting or at least limiting the supply of blood to micro-regions of tumors, leading to pan-hypoxia and pan-necrosis inside solid tumor tissues. Researchers have continued to enhance the efficiency of anti-angiogenic drugs over the past two decades, to identify their potential in the drug interaction, and to discover reasonable interpretations for possible resistance to treatment. In this review, we have discussed an overview of cancer history and recent methods use in cancer therapy, focusing on anti-angiogenic inhibitors targeting angiogenesis formation. Further, this review has explained the molecular mechanism of action of these anti-angiogenic inhibitors in various tumor types and their limitations use. In addition, we described the synergistic mechanisms of immunotherapy and anti-angiogenic therapy and summarizes current clinical trials of these combinations. Many phase III trials found that combining immunotherapy and anti-angiogenic therapy improved survival. Therefore, targeting the source supply of cancer cells to grow and spread with new anti-angiogenic agents in combination with different conventional therapy is a novel method to reduce cancer progression. The aim of this paper is to overview the varying concepts of cancer focusing on mechanisms involved in tumor angiogenesis and provide an overview of the recent trends in anti-angiogenic strategies for cancer therapy.
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Affiliation(s)
- Fares Hezam Al-Ostoot
- Department of Chemistry, Yuvaraja's College, University of Mysore, Mysuru, India
- Department of Biochemistry, Faculty of Education & Science, Albaydha University, Al-Baydha, Yemen
| | - Salma Salah
- Faculty of Medicine and Health Sciences, Thamar University, Dhamar, Yemen
| | - Shaukath Ara Khanum
- Department of Chemistry, Yuvaraja's College, University of Mysore, Mysuru, India
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Gishto T, Simoni L, Kacani A, Methoxha S, Mehmeti A. A Rare Case of Undifferentiated Pleomorphic Cardiac Sarcoma. Cureus 2024; 16:e59183. [PMID: 38807801 PMCID: PMC11130600 DOI: 10.7759/cureus.59183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 05/30/2024] Open
Abstract
We present a case of a patient with a four-month history of gradual-onset dyspnea and generalized body weakness. During the clinical evaluation, a mass was found in the left atrium. Coronary angiography was performed and showed normal coronary arteries. We proceeded with a complete surgical excision of the tumoral mass, and histopathology confirmed it as undifferentiated cardiac sarcoma. Six months after the surgical intervention and adjuvant chemotherapy, the patient is in complete remission, with no evidence of a recurrence of the malignant pathology. Cardiac sarcoma is a rare clinical finding and a diagnostic and therapeutic challenge due to its numerous non-specific clinical presentations.
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Affiliation(s)
- Taulant Gishto
- Cardiovascular Disease, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Leonard Simoni
- Cardiovascular Disease, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Andi Kacani
- Cardiac Surgery, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Silvia Methoxha
- Cardiovascular Disease, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Alessia Mehmeti
- Cardiac Surgery, University Hospital Center "Mother Teresa", Tirana, ALB
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Zeng Z, Mei Z, Chen M, Cao H, Xiang Q, Cai H, Lu Z, Qiu H. Cadonilimab plus anlotinib effectively relieve rare cardiac angiosarcoma with multiple metastases: a case report and literature review. Clin Res Cardiol 2024; 113:358-365. [PMID: 37405482 PMCID: PMC10850283 DOI: 10.1007/s00392-023-02251-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/19/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Ziyue Zeng
- Department of Cardiology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Zijie Mei
- Department of Gynecological Tumor Radiotherapy and Chemotherapy, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Min Chen
- Department of Gynecological Tumor Radiotherapy and Chemotherapy, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Hong Cao
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Qingming Xiang
- Department of Gynecological Tumor Radiotherapy and Chemotherapy, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Huanhuan Cai
- Department of Cardiology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Zhibing Lu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, China.
| | - Hui Qiu
- Department of Gynecological Tumor Radiotherapy and Chemotherapy, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, China.
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Subramaniam A, Ravi V. The 7 Pillars of Nonsurgical Oncology Approaches to Primary Cardiac Sarcoma. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:8-10. [PMID: 38439185 DOI: 10.1177/15569845241228604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Affiliation(s)
- Aparna Subramaniam
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Rahouma M, Baudo M, Khairallah S, Lau C, Gaudino M, El-Sayed Ahmed MM, Kumar A, Lorusso R, Mick SL. Surgically Resected Cardiac Angiosarcoma: Survival Analysis from the National Cancer Database. J Clin Med 2023; 12:7764. [PMID: 38137833 PMCID: PMC10744152 DOI: 10.3390/jcm12247764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Angiosarcoma is a rare type of soft-tissue sarcoma arising from endothelial cells. It is considered 'high-grade' by definition, reflecting its aggressive behavior. We sought to investigate the role of surgery in cardiac angiosarcoma, identify late mortality predictors, and identify interactions with other modalities in its treatment using a national dataset. The 2004-2017 National Cancer Database was reviewed for patients with primary cardiac angiosarcoma. Late mortality predictors were evaluated with Kaplan-Meier curves and Cox regression analysis. Surgery in primary cardiac angiosarcoma was performed in 130 patients (median age 50.5 years; female sex 36.9%). The median follow up was 72.02 months, with a median overall survival (OS) of 14.32 months. In patients treated with surgery in combination with other modalities compared with those treated with surgery alone, median OSs were 17.28 and 2.88 months, respectively (log-rank = 0.018). Older patients (age > 57 years) experienced lower OS compared to those with an age < 57 (log-rank = 0.012). This may be partially explained by the difference in treatment strategies among age groups: those with increasing age, less surgery (p = 0.037), and less chemotherapy (p < 0.001) were chosen. With multivariable Cox regression analysis, age and race other than white or black were identified to be significant independent predictors of late mortality. Cardiac angiosarcoma has poor overall survival, and our findings should further encourage the use of surgery in combination with other therapeutic modalities in treating such an aggressive disease whenever possible.
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Affiliation(s)
- Mohamed Rahouma
- Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York, NY 10065, USA; (M.B.); (S.K.); (C.L.); (M.G.); (S.L.M.)
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Massimo Baudo
- Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York, NY 10065, USA; (M.B.); (S.K.); (C.L.); (M.G.); (S.L.M.)
- Cardiac Surgery Department, Spedali Civili di Brescia, University of Brescia, 25121 Brescia, Italy
| | - Sherif Khairallah
- Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York, NY 10065, USA; (M.B.); (S.K.); (C.L.); (M.G.); (S.L.M.)
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Christopher Lau
- Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York, NY 10065, USA; (M.B.); (S.K.); (C.L.); (M.G.); (S.L.M.)
| | - Mario Gaudino
- Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York, NY 10065, USA; (M.B.); (S.K.); (C.L.); (M.G.); (S.L.M.)
| | - Magdy M. El-Sayed Ahmed
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, FL 55905, USA;
- Department of Surgery, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Akshay Kumar
- Department of Cardiothoracic Surgery, Heart and Lung Transplantation, Mechanical Circulatory Support and ECMO, New York University Langone Health, New York, NY 10016, USA;
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht University, 6211 LK Maastricht, The Netherlands;
- Cardiovascular Research Institute Maastricht, 6229 ER Maastricht, The Netherlands
| | - Stephanie L. Mick
- Cardiothoracic Surgery Departments, Weill Cornell Medicine, New York, NY 10065, USA; (M.B.); (S.K.); (C.L.); (M.G.); (S.L.M.)
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Stergioula A, Kokkali S, Pantelis E. Multimodality treatment of primary cardiac angiosarcoma: A systematic literature review. Cancer Treat Rev 2023; 120:102617. [PMID: 37603906 DOI: 10.1016/j.ctrv.2023.102617] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Primary cardiac angiosarcoma (PCA) is the most prevalent histological type of cardiac sarcoma but its rarity poses a challenge for standardizing treatment protocols. Moreover, published studies are limited by small patient numbers and lack of randomization, making it challenging to establish evidence-based treatment strategies. This systematic review aims to consolidate the heterogeneous published data and identify factors related to the treatment outcome of PCA patients. METHODS The PubMed and Scopus bibliographic databases were systematically searched for original articles reporting clinical, treatment and outcome data for PCA patients. Kaplan-Meier analysis was used to calculate the time to progression and survival. The Log-Rank test was used to compare progression-free and overall survival data. The Cox proportional hazards regression model was used for univariate and multivariate analysis of survival data. RESULTS A total of 127 studies containing data for 162 patients were analyzed. The median age of the patient cohort was 45 years, with males being 1.5 times more frequently affected than females. Tumors were primarily located on the right side of the heart, with a median size of 6 cm. Median progression-free and overall survival of 5 months and 12 months, respectively, were calculated. Age, sex, and resection margins did not have a significant impact on PCA survival, as determined by both univariate and multivariate analyses. The presence of metastases at diagnosis was associated with lower overall survival in univariate analysis, although this effect was not significant in multivariate analysis. Multimodality treatment that incorporated surgery and adjuvant chemo-radiotherapy was associated with a statistically significant survival benefit. Median overall survival increased from 6 months with surgery alone to 13 months and 27 months with adjuvant chemotherapy and chemo-radiotherapy, respectively. CONCLUSION Multimodality treatment including surgery and chemo-radiotherapy was found to offer the greatest survival benefit for PCA patients.
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Affiliation(s)
- Anastasia Stergioula
- Radiotherapy Department, Iatropolis Clinic, Athens, Greece; Center of Radiotherapy, IASO General Hospital, Athens, Greece.
| | - Stefania Kokkali
- Oncology Unit, Department of Internal Medicine, Hippocratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evaggelos Pantelis
- Radiotherapy Department, Iatropolis Clinic, Athens, Greece; Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Cho H, Song I, Jo U, Jeong J, Koo HJ, Yang DH, Jung S, Song JS, Cho K. Primary cardiac sarcomas: A clinicopathologic study in a single institution with 25 years of experience with an emphasis on MDM2 expression and adjuvant therapy for prognosis. Cancer Med 2023; 12:16815-16828. [PMID: 37395142 PMCID: PMC10501235 DOI: 10.1002/cam4.6303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 06/04/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Primary cardiac sarcomas are rare and their clinicopathologic features are heterogeneous. Among them, particularly intimal sarcoma is a diagnostic challenge due to nonspecific histologic features. Recently, MDM2 amplification reported to be a characteristic genetic event in the intimal sarcoma. In this study, we aimed to identify the types and incidence of primary cardiac sarcomas that occurred over 25 years in tertiary medical institutions, and to find clinicopatholgical significance through reclassification of diagnoses using additional immunohistochemistry (IHC). METHODS We reviewed the primary cardiac sarcoma cases between January 1993 and June 2018 at Asan Medical Center, South Korea, with their clinicopathologic findings, and reclassified the subtypes, especially using IHC for MDM2 and then, analyzed the significance of prognosis. RESULTS Forty-eight (6.8%) cases of a primary cardiac sarcoma were retrieved. The tumors most frequently involved the right atrium (n = 25, 52.1%), and the most frequent tumor subtype was angiosarcoma (n = 23, 47.9%). Seven cases (53.8%) were newly reclassified as an intimal sarcoma by IHC for MDM2. Twenty-nine (60.4%) patients died of disease (mean, 19.8 months). Four patients underwent a heart transplantation and had a median survival of 26.8 months. This transplantation group tended to show good clinical outcomes in the earlier stages, but this was not statistically significant (p = 0.318). MDM2 positive intimal sarcoma showed the better overall survival (p = 0.003) than undifferentiated pleomorphic sarcoma. Adjuvant treatment is beneficial for patient survival (p < 0.001), particularly in angiosarcoma (p < 0.001), but not in intimal sarcoma (p = 0.154). CONCLUSION Our study supports the use of adjuvant treatment in primary cardiac sarcoma, as it was associated with a significantly better overall survival rate. Further consideration of tumor histology may be important in determining the optimal use of adjuvant treatment for different types of sarcomas. Therefore, accurate diagnosis by MDM2 test is important condsidering patient's prognosis and treatment.
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Affiliation(s)
- Haeyon Cho
- Department of PathologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulRepublic of Korea
| | - In‐Hye Song
- Department of PathologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulRepublic of Korea
| | - Uiree Jo
- Department of PathologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulRepublic of Korea
| | - Ji‐Seon Jeong
- Department of PathologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulRepublic of Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulRepublic of Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulRepublic of Korea
| | - Sung‐Ho Jung
- Department of Thoracic and Cardiovascular SurgeryUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulRepublic of Korea
| | - Joon Seon Song
- Department of PathologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulRepublic of Korea
| | - Kyung‐Ja Cho
- Department of PathologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulRepublic of Korea
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Bae DH, Park S, Kim M, Kim S, Choi WG, Bae JW, Hwang KK, Kim DW, Cho MC, Lee JH. Cardiac osteosarcoma: a case report and literature review. Front Cardiovasc Med 2023; 10:1215389. [PMID: 37492160 PMCID: PMC10364321 DOI: 10.3389/fcvm.2023.1215389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/16/2023] [Indexed: 07/27/2023] Open
Abstract
Background Primary cardiac tumors are rare, and malignant primary cardiac tumors are even rarer. Cardiac osteosarcoma is a very rare type of malignant primary cardiac tumor with limited reported cases. We present a case report of cardiac osteosarcoma and review its characteristics and the related literature. Case summary A 44-year-old female patient without a specific medical history presented with intermittent dyspnea that started 1 month prior to presentation. A heterogeneous mass was observed in the left atrium on echocardiography and a large mass was observed in the left atrium on computed tomography. Surgery was performed under the suspicion of atypical cardiac myxoma, and the tumor was successfully removed. However, postoperative histopathological examination revealed cardiac osteosarcoma. The patient underwent chemotherapy and has been well maintained without recurrence for 10 years. Conclusion We present a case report of the echocardiographic features and treatment strategies for cardiac osteosarcoma, an extremely rare cardiac tumor. Multimodal imaging can be helpful; however, a histological diagnosis through surgical resection is essential. Appropriate treatment and follow-up based on histological findings are necessary.
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Affiliation(s)
- Dae-Hwan Bae
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sangshin Park
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Min Kim
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sangmin Kim
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Cardiology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Woong Gil Choi
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Cardiology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jang-Whan Bae
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Cardiology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kyung-Kuk Hwang
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Cardiology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Dong-Woon Kim
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Cardiology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Myeong-Chan Cho
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Ju-Hee Lee
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
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Ali T, Ali N, Khan L, Minhas K. Postoperative radiotherapy for high-grade primary cardiac spindle cell sarcoma: a rare entity. BMJ Case Rep 2023; 16:e255438. [PMID: 37399348 PMCID: PMC10314421 DOI: 10.1136/bcr-2023-255438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
A patient in her early 20s presented with blood-stained sputum and shortness of breath. Initially, she was treated for pneumonia. Later, upon exacerbation of symptoms, further investigations were done which exhibited a left atrial mass causing compression of contralateral atrium. She underwent surgical resection of the mass, which was initially mistaken as myxoma. However, histopathological correlation revealed spindle cell sarcoma with focal myogenic differentiation. This case report highlights the role of Radiation Therapy in adjuvant setting with promising impact on improving local control after R2 resection. Cardiac spindle cell sarcoma, being one of the rarest cardiac tumours reported to date, warrants establishment of a Rare Tumour Multidisciplinary Team for management of such malignancies.
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Affiliation(s)
- Tooba Ali
- Department of Oncology, Section Radiation Oncology, Aga Khan University, Karachi, Pakistan
| | - Nasir Ali
- Department of Oncology, Section Radiation Oncology, Aga Khan University, Karachi, Pakistan
| | - Laraib Khan
- Department of Oncology, Section Radiation Oncology, Aga Khan University, Karachi, Pakistan
| | - Khurram Minhas
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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Yoshitake M, Bando K. Commentary: Improving Surgical Outcomes for Pulmonary Artery Sarcoma: The Challenge Remains. Semin Thorac Cardiovasc Surg 2023; 35:67-68. [PMID: 34952155 DOI: 10.1053/j.semtcvs.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/14/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Michio Yoshitake
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ko Bando
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan.
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Montoya-Beltran JS, Herrera LR, Marín PO, Navajas AN, Manrique Espinel FT. Atrial Fusocellular Sarcoma: An Uncommon Presentation. CASE 2023; 7:105-108. [PMID: 37065836 PMCID: PMC10103005 DOI: 10.1016/j.case.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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12
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Bishop AJ, Zheng J, Subramaniam A, Ghia AJ, Wang C, McGovern SL, Patel S, Guadagnolo BA, Mitra D, Farooqi A, Reardon MJ, Kim B, Guha-Thakurta N, Li J, Ravi V. Cardiac Angiosarcomas: Risk of Brain Metastasis and Hemorrhage Warrants Frequent Surveillance Imaging and Early Intervention. Am J Clin Oncol 2022; 45:258-263. [PMID: 35588225 PMCID: PMC9179017 DOI: 10.1097/coc.0000000000000913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluated a cohort of patients with cardiac angiosarcomas (CA) who developed brain metastases (BM) to define outcomes and intracranial hemorrhage (IH) risk. METHODS We reviewed 26 consecutive patients with BM treated between 1988 and 2020 identified from a departmental CA (n=103) database. Causes of death were recorded, and a terminal hemorrhage (TH) was defined as an IH that caused death or prompted a transfer to hospice. RESULTS The prevalence of BM was 25% (n=26/103). A total of 23 patients (88%) had IH, including 21 (81%) at initial BM diagnosis, of which 18 (86%) required hospitalization. The median platelet count at the time of IH was 235k (interquartile range, 108 to 338k).Nearly all patients died of disease (n=23, 88%) and most patients died from TH (n=13, 57%). TH occurred at BM presentation in 6 (46%) patients, whereas 3 (23%) had TH from known but untreated lesions, 2 (15%) had continued uncontrolled IH during radiation therapy, and 2 (15%) from new BM. Platelet count <50k was not associated with TH (P=0.25).Subsequent IH occurred in 9 patients (35%), and importantly, no patients who completed radiation therapy (n=10) for BM died from TH. CONCLUSION Patients with CA frequently develop BM, and the risk of IH is high, resulting in an alarming rate of TH despite normal platelet counts. Therefore, early diagnosis and intervention are warranted. We recommend surveillance brain imaging, and importantly, once BM is detected, prompt local therapy is warranted to try and mitigate the risk of TH.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
| | | | | | - Jing Li
- Departments of Radiation Oncology
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Rahouma M, Baudo M, Shmushkevich S, Chadow D, Mohamed A, Girardi L, Gaudino M, Lorusso R. Sex differences in primary malignant cardiac tumors: A multi-institutional cohort study from National Cancer Database. J Card Surg 2022; 37:1275-1286. [PMID: 35226369 DOI: 10.1111/jocs.16359] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/17/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Despite the significant clinical importance of sex among factors affecting cancer progression and survival, it remains one of the least studied factors. Therefore, we sought to examine these differences in relation to primary malignant cardiac tumors (PMCTs) using a national data set. METHODS The 2004-2017 National Cancer Database was queried for patients with PMCTs. Annual trend of females' percent was assessed. Overall survival predictors were evaluated with Kaplan-Meier and Cox-regression. Subgroup analysis was done based on histology, comorbidity index, race, insurance, and surgical treatment. RESULTS PMCTs were identified in 736 patients (median age 52, female [47.8%]). Most of them were high-grade (49.2%). About 60% underwent surgery. Angiosarcoma (43%), fibrosarcoma (5.2%), and leiomyosarcoma (5.2%) were the most common pathologies. Based on multivariate Cox-regression, higher income, higher comorbidity index, angiosarcoma, and Stage III/IV were associated with higher late mortality, while year of diagnosis and use of surgery or chemotherapy were associated with lower mortality. Among the surgical group, age, higher income, higher comorbidity index, angiosarcoma, and Stage III/IV were independent predictors of higher late mortality, while private insurance and year of diagnosis were associated with lower late mortality. No difference was seen between males and females in 30-day and late mortality (p = .71). Subgroup analysis based on Cox-regression showed no differences in late mortality between males and females. CONCLUSION PMCTs have poor overall survival. Surgery and chemotherapy were associated with longer survival benefits. On the contrary, the associated risk factors for mortality were advanced age, higher comorbidity index, angiosarcoma histology, and Stage III/IV.
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Affiliation(s)
- Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.,Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Massimo Baudo
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.,Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Shon Shmushkevich
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - David Chadow
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Abdelrahman Mohamed
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Leonard Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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14
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Villanueva C, Brienesse S, Collins N, Seah PW. Concomitant anomalous coronary artery and a large primary myxofibrosarcoma of the heart. ANZ J Surg 2022; 92:2336-2337. [PMID: 35043521 DOI: 10.1111/ans.17455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/11/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Claudia Villanueva
- Cardiothoracic Surgery Unit, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Stephen Brienesse
- Cardiology Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Nicholas Collins
- Cardiology Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Peng W Seah
- Cardiothoracic Surgery Unit, John Hunter Hospital, Newcastle, New South Wales, Australia.,Faculty of Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Primary Soft Tissue Sarcoma of the Heart: An Emerging Chapter in Cardio-Oncology. Biomedicines 2021; 9:biomedicines9070774. [PMID: 34356838 PMCID: PMC8301302 DOI: 10.3390/biomedicines9070774] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022] Open
Abstract
Primary malignant cardiac tumors are rare, with a prevalence of about 0.01% among all cancer histotypes. At least 60% of them are primary soft tissue sarcomas of the heart (pSTS-h) that represent almost 1% of all STSs. The cardiac site of origin is the best way to classify pSTS-h as it is directly linked to the surgical approach for cancer removal. Indeed, histological differentiation should integrate the classification to provide insights into prognosis and survival expectancy of the patients. The prognosis of pSTS-h is severe and mostly influenced by the primary localization of the tumor, the difficulty in achieving complete surgical and pharmacological eradication, and the aggressive biological features of malignant cells. This review aims to provide a detailed literature overview of the most relevant issues on primary soft tissue sarcoma of the heart and highlight potential diagnostic and therapeutic future perspectives.
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Stevens RM, Silverman A, Pascasio J, Sun J, Throckmorton A, Mulinari L, Cusimano RJ. Multi-disciplinary frameworks for the treatment of primary cardiac sarcoma. J Card Surg 2021; 36:3456-3457. [PMID: 34131956 DOI: 10.1111/jocs.15742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Randy M Stevens
- Division of Pediatric Cardiac Surgery, Pediatric Cardiac Surgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Ayaka Silverman
- Department of Pathology, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Judy Pascasio
- Department of Pathology, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Jie Sun
- Division of Pediatric Cardiology, Pediatric Cardiology, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Amy Throckmorton
- BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Leonardo Mulinari
- Pediatric and Congenital Cardiac Surgery, DeWitt Daughtry Family Department of Surgery, Congenital Heart Center, Holtz Children's Hospital, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA
| | - Robert James Cusimano
- Division of Cardiac Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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Torabi S, Arjomandi Rad A, Vardanyan R, Lopuszko AT, Van den Eynde J, Zubarevich A, Sá MPBO, Szczechowicz M, Weymann A. Surgical and multimodality treatment of cardiac sarcomas: A systematic review and meta-analysis. J Card Surg 2021; 36:2476-2485. [PMID: 33797789 DOI: 10.1111/jocs.15538] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Primary cardiac sarcomas (PCSs) are an extremely rare and aggressive type of malignancies that have been described only by a limited number of observational studies. This study aimed to evaluate the currently existing evidence comparing surgical to multimodality treatment of PCS. METHODS We systematically reviewed Embase, MEDLINE, Cochrane Database, and Google Scholar, from inception to December 2020, for original articles about surgical and multimodality treatment of PCS. The outcomes included were mortality at various time points, resection margin status, and mean estimated survival. The pooled treatment effects were calculated using a random-effects model. RESULTS Ten studies including a total of 1570 patients met our inclusion criteria. Surgery was associated with significantly lower mortality when compared to conservative treatment at 1, 2, and 3 years, whereas no significant difference was found at 5 years. Furthermore, multimodality treatment showed significantly lower mortality at 1 year when compared to surgery alone, but not at 2 and 5 years. We found no difference in mortality between angiosarcomas and other PCS subtypes. CONCLUSION Overall, surgery was found to provide a significant mortality advantage to PCS patients up to 3 years following treatment. Multimodality treatment might be of additional benefit, although only within the first year. Prospective randomized studies are needed to further explore these differences in the treatment of PCS.
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Affiliation(s)
- Saeed Torabi
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Aleksandra T Lopuszko
- Faculty of Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jef Van den Eynde
- Department of Cardiovascular Sciences, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Michel P B O Sá
- Division of Cardiovascular Surgery-PROCAPE, Universidade de Pernambuco (UPE), Recife, Brazil
| | - Marcin Szczechowicz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
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18
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Putnam JB. Commentary: Adjuvant therapy for cardiac sarcomas: Slowly evolving beyond resection. J Thorac Cardiovasc Surg 2021; 161:121-122. [PMID: 31982118 DOI: 10.1016/j.jtcvs.2019.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
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Andrei V, Scheggi V, Stefàno PL, Marchionni N. Primary cardiac sarcoma: a case report of a therapeutic challenge. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33629020 PMCID: PMC7891279 DOI: 10.1093/ehjcr/ytaa404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/23/2020] [Accepted: 10/01/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Primary cardiac sarcomas are very rare and the prognosis is poor both because the diagnosis is typically made at an advanced stage of the disease and because data are insufficient to identify a standard treatment. Surgical resection is the cornerstone of therapy with the need to develop new therapeutic strategies. CASE SUMMARY We present a case of a young man admitted to the emergency department due to worsening dyspnoea. A left-sided sarcoma was diagnosed and treated with surgery, chemo- and radiation therapy, and subsequently with heart transplant for local recurrence of the disease. Endomyocardial biopsy made during the routine follow-up period was complicated by pericardial tamponade and cardiogenic shock and the patient was managed with veno-arterial extracorporeal membrane oxygenation, until recovery of left ventricular function (left ventricular ejection fraction of 55%). After 1 year a kidney transplant was performed. After 42 months from diagnosis, the patient is in good general condition. DISCUSSION Primary cardiac sarcomas are treated with surgery to reach R0 (free resection margins) and with chemo- and radiation therapy with adjuvant purposes. Auto-transplantation is also performed, while conventional heart transplant must be customized on an individual basis, after excluding metastases. A multidisciplinary assessment should be performed and the single patient treated with a personalized approach, in relation to his performance status, location of the mass, and stage of the disease.
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Affiliation(s)
- Valentina Andrei
- Division of General Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Valentina Scheggi
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
- Division of Cardiovascular and Perioperative Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Pier Luigi Stefàno
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
- Division of Cardiac Surgery, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Niccolò Marchionni
- Division of General Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
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Abstract
OBJECTIVE This study aimed to understand the population-level treatment modalities and to evaluate the survival benefits of surgical resection in primary cardiac lymphoma. METHODS We queried the Surveillance, Epidemiology, and End Results Program database, which covers 35% of the US population. Patients with a histologic diagnosis of primary cardiac lymphoma from 1973 to 2015 were included. Multivariable accelerated failure time regression was performed to evaluate the associations between clinical factors and overall survival. RESULTS A total of 184 patients were identified. The median age was 68 years, 80% were White, and 46% were women. Diffuse large B-cell lymphoma (80%) was the most common histology, and the majority (65%) was low-stage lymphoma (Ann Arbor stage I or II). Median survival was 2.2 years. Seventy-three percent of patients received chemotherapy. Only 10% of patients received local resection or debulking. Multivariable analysis demonstrated that local resection or debulking was not independently associated with overall survival (adjusted hazard ratio, 0.67; 95% confidence interval, 0.30-1.48; P = .32). Instead, chemotherapy (adjusted hazard ratio, 0.4; 95% confidence interval, 0.23-0.69; P < .001) was independently associated with improved survival, whereas increasing age (adjusted hazard ratio of 5-year increment, 1.13; 95% confidence interval, 1.04-1.22; P <.001) and advanced stage (adjusted hazard ratio, 2.18; 95% confidence interval, 1.33-3.56; P < .001) were independently associated with worse survival. CONCLUSIONS Surgical resection was not independently associated with survival in patients with primary cardiac lymphoma. Chemotherapy was the predominant treatment option and associated with improved survival, whereas increasing age and advanced stage were independently associated with worse outcomes.
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Ravi V, Reardon MJ. Commentary: Primary cardiac sarcoma-Systemic disease requires systemic therapy. J Thorac Cardiovasc Surg 2019; 161:120-121. [PMID: 31780067 DOI: 10.1016/j.jtcvs.2019.10.087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Vinod Ravi
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Tex.
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