1
|
Tortorelli I, Navarria F, Maggio AD, Banzato A, Lestuzzi C, Nicosia L, Chiusole B, Galiano A, Sbaraglia M, Zagonel V, Brunello A. Trabectedin and Radiation Therapy for Cardiac Metastasis From Leiomyosarcoma: A Case Report and Review of the Literature. Front Oncol 2022; 12:838114. [PMID: 35574369 PMCID: PMC9097915 DOI: 10.3389/fonc.2022.838114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Leiomyosarcoma (LMS) is one of the most frequent subtypes of soft-tissue sarcomas (STSs). Metastatic spread to the heart in cancer patients carries a poor prognosis and there is no known effective treatment. Cardiac metastases of STSs are very rare. Here we present the case of a 55-year-old patient who underwent surgical resection of a retroperitoneal leiomyosarcoma and then developed widespread metastatic disease, treated with a combination of local treatment and systemic therapy. Three years after surgical resection she presented with a cardiac intraventricular mass, which was treated with radiation therapy, while receiving systemic therapy with trabectedin. Such combination therapy was well-tolerated and effective, allowing a substantial dimensional reduction which is perduring to date, 18 months after diagnosis of cardiac metastasis. Available literature and data point to the feasibility and good tolerability of radiation therapy and trabectedin in metastatic sarcoma, yet this is the first report on the effectiveness of the combination for the treatment of cardiac disease. The extended survival since a metastatic relapse (more than 3 years) is likely the result of integrated systemic and loco-regional treatment, which should be always discussed within the framework of a multiprofessional and multidisciplinary setting.
Collapse
Affiliation(s)
- Ilaria Tortorelli
- Oncology 1 Unit, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Federico Navarria
- Radiation Oncology Department, National Cancer Institute (CRO)- IRCCS, Aviano, Italy
| | - Antonio Di Maggio
- Oncologic Radiology Unit, Department of Radiology and Medical Physics, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Alberto Banzato
- Cardiology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Chiara Lestuzzi
- Cardiology and Cardio-Oncology Rehabilitation S.D.S, Department of Cardio-Cerebro-Vascular Physiopathology, Azienda Sanitaria Friuli Occidentale (AS FO), Aviano, Italy
| | - Luca Nicosia
- Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital IRCCS, Negrar, Italy
| | - Benedetta Chiusole
- Oncology 1 Unit, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Antonella Galiano
- Oncology 1 Unit, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Marta Sbaraglia
- Department of Pathology, Azienda Ospedale Università Padova, Padua, Italy
| | - Vittorina Zagonel
- Oncology 1 Unit, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Antonella Brunello
- Oncology 1 Unit, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| |
Collapse
|
2
|
Park S, Kim H. Unusual Cardiac Metastasis of Nonvisceral Soft Tissue Leiomyosarcoma in the Right Ventricle: A Case Report and Literature Review. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:219-224. [PMID: 36237458 PMCID: PMC9432410 DOI: 10.3348/jksr.2020.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/19/2020] [Accepted: 05/13/2020] [Indexed: 11/30/2022]
Abstract
Leiomyosarcoma (LMS) is a soft tissue sarcoma that originates from smooth muscle cells. It is commonly found in the uterus but can occur throughout the body, including the retroperitoneal space, abdominal cavity, and any vascular structure. Although there are many case reports of uterine or vascular LMS metastasizing to the heart, cardiac metastasis from nonvisceral lesions has only been reported in two cases. Herein we report a rare case of a patient presenting metastatic LMS from the left flank in the right ventricle observed with echocardiography and enhanced computed tomography.
Collapse
Affiliation(s)
- Sangmin Park
- Department of Radiology, Eulji University Hospital, Daejeon, Korea
| | - Heekyung Kim
- Department of Radiology, Eulji University Hospital, Daejeon, Korea
| |
Collapse
|
3
|
Abstract
RATIONALE Owing to the unique structure and function of the heart, tumor metastasis in the heart is rare. Accordingly, no unique symptoms have yet been identified for cardiac metastasis. PATIENT AND CONCERNS A patient presented with cardiac metastasis 3 years after surgical resection of alveolar soft tissue sarcomas in their late stage. DIAGNOSIS Ultrasonography showed a middle-high echo clump on the left surface of the mid-upper interventricular septum, which had an unclear boundary with the myocardium. Meanwhile, blood flow was found in the clump, with no blockage of blood flow having been observed. LESSONS Although cardiac metastasis in terminal cancer patients always carries a poor prognosis, there is still no effective treatment for cardiac metastasis. In the clinic, it is important to improve the patient's quality of life, reduce symptoms and signs, and extend the duration of survival.
Collapse
Affiliation(s)
- Jun Xiao
- Department of Oncology (5th ward), Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences
| | - Jiaguang Song
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong University
| | - Hui Liu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University
| | - Yindi Sun
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Chuanxi Wang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| |
Collapse
|
4
|
Under-reporting of cardiovascular findings on chest CT. Radiol Med 2015; 121:190-9. [DOI: 10.1007/s11547-015-0595-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/12/2015] [Indexed: 12/14/2022]
|
5
|
Calissendorff J, Maret E, Sundin A, Falhammar H. Ileal neuroendocrine tumors and heart: not only valvular consequences. Endocrine 2015; 48:743-55. [PMID: 25319177 DOI: 10.1007/s12020-014-0446-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/01/2014] [Indexed: 12/11/2022]
Abstract
Ileal neuroendocrine tumors (NETs) often progress slowly, but because of their generally nonspecific symptoms, they have often metastasized to local lymph nodes and to the liver by the time the patient presents. Biochemically, most of these patients have increased levels of whole blood serotonin, urinary 5-hydroxyindoleacetic acid, and chromogranin A. Imaging work-up generally comprises computed tomography or magnetic resonance imaging and somatostatin receptor scintigraphy, or in recent years positron emission tomography with 68Ga-labeled somatostatin analogs, allowing for detection of even sub-cm lesions. Carcinoid heart disease with affected leaflets, mainly to the right side of the heart, is a well-known complication and patients routinely undergo echocardiography to diagnose and monitor this. Multitasking surgery is currently recognized as first-line treatment for ileal NETs with metastases and carcinoid heart disease. Open heart surgery and valve replacement are advocated in patients with valvular disease and progressive heart failure. When valvulopathy in the tricuspid valve results in right-sided heart failure, a sequential approach, performing valve replacement first before intra-abdominal tumor-reductive procedures are conducted, reduces the risk of bleeding. Metastases to the myocardium from ileal NETs are seen in <1-4.3% of patients, depending partly on the imaging technique used, and are generally discovered in those affected with widespread disease. Systemic treatment with somatostatin analogs, and sometimes alpha interferon, is first-line medical therapy in metastatic disease to relieve hormonal symptoms and stabilize the tumor. This treatment is also indicated when heart metastases are detected, with the addition of diuretics and fluid restriction in cases of heart failure. Myocardial metastases are rarely treated by surgical resection.
Collapse
Affiliation(s)
- Jan Calissendorff
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden,
| | | | | | | |
Collapse
|
6
|
Gujral DM, Bhattacharyya S. Cardiac manifestations of gastrointestinal carcinoid tumor. Future Cardiol 2014; 9:479-88. [PMID: 23834689 DOI: 10.2217/fca.13.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Carcinoid tumors are rare, slow-growing tumors found primarily in the GI tract. Carcinoid syndrome develops when vasoactive substances (particularly serotonin) released by carcinoid tumors gain access to the systemic circulation. Carcinoid heart disease develops in patients with carcinoid syndrome and is commonly associated with the development of right-sided valve dysfunction and signs of symptoms of right heart failure. Timely surgical intervention provides relief from symptoms and may improve survival. Management of these patients should be undertaken in a specialized center by a multidisciplinary team with appropriate expertise.
Collapse
Affiliation(s)
- Dorothy M Gujral
- The Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ, UK
| | | |
Collapse
|
7
|
Choy G, Kröpil P, Scherer A, El-Sherief AH, Chung J, Rojas CA, Abbara S. Pertinent reportable incidental cardiac findings on chest CT without electrocardiography gating: review of 268 consecutive cases. Acta Radiol 2013; 54:396-400. [PMID: 23436832 DOI: 10.1177/0284185113475918] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pertinent reportable cardiac findings on non-electrocardiography (ECG)-gated chest CT examinations have become easier to detect given recent advancements in multidetector CT technology. However, those findings are easily overlooked on routine chest CT without ECG gating given residual inherent cardiac motion artifact and non-cardiac indications. PURPOSE To describe and quantify the types of pertinent reportable cardiac findings that can be detected on chest CT examinations without ECG gating and evaluate how often they were reported. MATERIAL AND METHODS Two radiologists retrospectively reviewed (blinded to the original interpretation) 268 consecutive routine adult chest CT examinations without ECG gating for the presence of pertinent reportable cardiac findings. Retrospective interpretations were then compared with the original radiological reports. RESULTS One hundred and sixty-three patients (61%) had pertinent reportable cardiac findings. The findings encountered included: coronary artery disease (n = 131; 80.0%), coronary artery bypass grafts (n = 10; 6.1%), left ventricular aneurysm (n = 1; 0.6%), valve calcification (n = 131; 80.0%), valve repair/replacement (n = 5; 3.1%), pericardial effusion (n = 33; 20.2%), left atrial appendage thrombus (n = 1; 0.6%), cardiac mass (n = 1; 0.6%), and cardiac chamber enlargement (n = 29; 17.8%). On the original radiological reports 22.3% of the pertinent reportable cardiac findings, detected by the two radiologists retrospectively, were not reported. CONCLUSION Detection of pertinent reportable cardiac findings on routine chest CT examinations without ECG gating is possible. The high volume of chest CT examinations without ECG gating represents an opportunity for radiologists to comment on the presence or absence of cardiac disease which may influence future clinical decisions.
Collapse
Affiliation(s)
- Garry Choy
- Cardiac Imaging Section, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Patric Kröpil
- Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany
| | - Axel Scherer
- Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany
| | - Ahmed H El-Sherief
- Cardiac Imaging Section, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Chung
- Cardiac Imaging Section, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Carlos A Rojas
- Cardiac Imaging Section, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Suhny Abbara
- Cardiac Imaging Section, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
8
|
Stickel JS, Mayer F, Vollmer JP, Zürn CS, Gawaz M, Kanz L, Bauer A. Ventricular thrombus and thrombocytopenia as first presentation of anaplastic thyroid carcinoma. J Clin Oncol 2013; 31:e194-6. [PMID: 23478056 DOI: 10.1200/jco.2012.43.4894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
|
9
|
Allen BC, Mohammed TL, Tan CD, Miller DV, Williamson EE, Kirsch JS. Metastatic melanoma to the heart. Curr Probl Diagn Radiol 2012; 41:159-64. [PMID: 22818836 DOI: 10.1067/j.cpradiol.2011.09.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Melanoma is a common neoplasm with a propensity to metastasize to the heart. Although cardiac metastasis is rarely diagnosed ante mortem, using a multimodality approach, several imaging findings may be seen. Echocardiography is often the initial imaging method used to detect cardiac metastases and their complications. On computed tomography, intraluminal filling defects and myocardial/pericardial nodules may be seen. On magnetic resonance imaging, metastatic melanoma is classically hyperintense on T1 images and hypointense on T2 images, a result of the T1 shortening of melanin; however, this is seen in a minority of cases. As melanoma metastases are fluorine-18-fluorodeoxyglucose avid, fluorine-18-fluorodeoxyglucose positron emission tomography may also be used to detect cardiac metastases.
Collapse
Affiliation(s)
- Brian C Allen
- Department of Radiology, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, USA.
| | | | | | | | | | | |
Collapse
|
10
|
Abstract
Carcinoid tumors are rare, indolent neuroendocrine tumors that are often associated with a syndrome characterized by episodic flushing, secretory diarrhea, bronchospasm, and hypotension-the carcinoid syndrome. Cardiac involvement occurs in one-half to two-thirds of patients with carcinoid syndrome and is associated with a worse clinical outcome. Carcinoid heart disease is characterized by endocardial plaque-like deposits found predominantly on right-sided heart valves, leading to the combination of valvular stenosis and regurgitation. Left-sided cardiac involvement can also occur in <10% of patients. Somatostatin analogs form the therapeutic cornerstone in the medical management of these patients. Cytotoxic chemotherapy has had only limited success in the treatment of metastatic carcinoid tumors. Hepatic resection or palliative cytoreduction may be of benefit in patients with limited hepatic disease. Hepatic artery embolization is usually applied if a patient is not eligible for surgical debulking. The development and progression of carcinoid heart disease are associated with an unfavorable outcome. In those patients having severe cardiac involvement and well-controlled systemic disease, valve replacement surgery has been found to be an effective treatment that can both relieve intractable symptoms and contribute to improved clinical outcomes.
Collapse
|
11
|
Monsuez JJ, Charniot JC, Vignat N, Artigou JY. Cardiac side-effects of cancer chemotherapy. Int J Cardiol 2010; 144:3-15. [PMID: 20399520 DOI: 10.1016/j.ijcard.2010.03.003] [Citation(s) in RCA: 288] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 02/27/2010] [Accepted: 03/06/2010] [Indexed: 12/21/2022]
Abstract
The spectrum of cardiac side-effects of cancer chemotherapy has expanded with the development of combination, adjuvant and targeted chemotherapies. Their administration in multiple regimens has increased greatly, including in older patients and in patients with cardiovascular and/or coronary artery disease (CAD). Cardiac toxicity of anthracyclines involves oxidative stress and apoptosis. Early detection combines 2D-echocardiography and/or radionuclide angiography and recent methods such as tissue Doppler imaging, strain rate echocardiography and sampling of serial troponin and/or NT-proBNP levels. Dexrazoxane has proven effective in the prevention of dose-related toxicity in children and adults. High doses of the alkylating drugs cyclophosphamide and ifosfamide may result in a reversible heart failure and in life-threatening arrhythmias. Myocardial ischemia induced by the antimetabolites 5-fluorouracil and capecitabine impacts prognosis of patients with prior CAD. Severe arrhythmias may complicate administration of microtubule inhibitors. Targeted therapies with the antibody-based tyrosine kinases (TK) inhibitors trastuzumab and, to a lesser extent, alemtuzumab induce heart failure or asymptomatic LV dysfunction in 1-4% and 10%, respectively. Cetuximab and rituximab induce hypotension, whereas bevacizumab may promote severe hypertension and venous thromboembolism. Small molecule TK inhibitors may also elicit LV dysfunction, in only few patients treated with imatinib mesylate, but in a substantially higher proportion of those receiving the multitargeted TK inhibitor sunitinib or the recently approved drugs erlotinib, lapatinib and dasatinib. Management of patients at increased cardiovascular risk associated with advancing age, previous CAD or targeted therapies may be optimized by referral to a cardiologist in a cross-specialty teamwork.
Collapse
Affiliation(s)
- Jean-Jacques Monsuez
- AP-HP, Hôpital René Muret, Cardiologie, Policlinique médicale, Université Paris-13, Faculté de Médecine de Bobigny, 93270 Sevran, France.
| | | | | | | |
Collapse
|