Role of palliative radiotherapy in cardiac metastasis: A review
Cardiac metastasis (CM) is a rare but clinically significant manifestation of advanced cancer, occurring when malignant cells originating from a primary tumor in a distant organ infiltrate and colonize the heart. This condition presents unique challenges in both diagnosis and treatment, often necessitating a multidisciplinary approach involving cardiology, oncology, and surgical teams. Understanding the mechanisms, clinical presentation, and management of CM is vital for health-care professionals to provide effective care and improve the quality of life for patients facing this challenging condition. Radiotherapy can be utilized as a primary treatment option for localized cardiac metastases or as part of a multimodal approach, often combined with surgery, chemotherapy, or other systemic therapies. In this review, we delve into the intricacies of CM, from its underlying causes to its clinical implications, and discuss the role of radiotherapy as a therapeutic option.
- Smith JA, Johnson RK. Cardiac metastasis in advanced cancer: A comprehensive review. J Oncol Res. 2023;25(3): 123-137.
- Catton C. The management of malignant cardiac tumors: Clinical considerations. Semin Diagn Pathol. 2008;25:69-75. doi: 10.1053/j.semdp.2007.10.007
- Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol. 2007;60(1):27-34. doi: 10.1136/jcp.2005.035105
- Al-Mamgani A, Baartman L, Baaujens M, de Pree I, Incrocci L, Levendag PC. Cardiac metastases. Int J Clin Oncol. 2008;13(4):369-372. doi: 10.1007/s10147-007-0749-8
- Roberts WC. Primary and secondary neoplasms of the heart. Am J Cardiol. 1997;80:671-682. doi: 10.1016/s0002-9149(97)00587-0
- Vlachostergios PJ, Daliani DD, Papandreou CN. Basic concepts in metastatic cardiac disease. Cardiol Res. 2012;3(2):47-48. doi: 10.4021/cr155w
- Goldberg AD, Blankstein R, Padera RF. Tumors metastatic to the heart. Circulation. 2013;128:1790-1794. doi: 10.1161/CIRCULATIONAHA.112.000790
- Orcurto MV, Delaloye AB, Letovanec I, Martins Favre M, Prior JO. Detection of an asymptomatic right-ventricle cardiac metastasis from a small-cell lung cancer by F-18- FDG PET/CT. J Thorac Oncol. 2009;4:127-130. doi: 10.1097/JTO.0b013e318189f60e
- Chen KH, Chou YH, Cheng AL. Primary squamous cell carcinoma of the thyroid with cardiac metastases and right ventricle outflow tract obstruction. J Clin Oncol. 2012;30:e260-e263. doi: 10.1200/JCO.2011.39.9808
- Takenaka S, Hashimoto N, Araki N, et al. Eleven cases of cardiac metastases from soft-tissue sarcomas. Jpn J Clin Oncol. 2011;41:514-518. doi: 10.1093/jjco/hyq246
- Burazor I, Aviel-Ronen S, Imazio M, et al. Metastatic cardiac tumors: From clinical presentation through diagnosis to treatment. BMC Cancer. 2018;18:202. doi: 10.1186/s12885-018-4070-x
- Ayyala SS, Urcuyo DM, Kannarkatta PT, Kovacs JE, Terrigno NJ. A rare case of atrial metastasis from a rectal adenocarcinoma. J Clin Med Res. 2017;9(10):886-888. doi: 10.14740/jocmr3123w
- Bilani N, Elson L, Martinez F, et al. A multimodal approach to evaluate for cardiac metastasis in a case of non-small cell lung cancer. Case Rep Oncol. 2020;13(1):212-218. doi: 10.1159/000505534
- Gambril JA, Chum A, Goyal A, et al. Cardiovascular imaging in cardio-oncology: The role of echocardiography and cardiac MRI in modern cardio-oncology. Heart Fail Clin. 2022;18(3):455-478. doi: 10.1016/j.hfc.2022.02.007
- Zitzelsberger T, Eigentler TK, Krumm P, et al. Imaging characteristics of cardiac metastases in patients with malignant melanoma. Cancer Imaging. 2017;17(1):19. doi: 10.1186/s40644-017-0122-8
- Lichtenberger JP 3rd, Reynolds DA, Keung J, Keung E, Carter BW. Metastasis to the heart: A radiologic approach to diagnosis with pathologic correlation. Am J Roentgenol. 2016;207(4):764-772. doi: 10.2214/ajr.16.16148
- Stokes MB, Nerlekar N, Moir S, Teo KS. The evolving role of cardiac magnetic resonance imaging in the assessment of cardiovascular disease. Aust Fam Physician. 2016;45(10): 761-764.
- Ekmekçioğlu Ö, Arıcan P, Meşe Ş, et al. PET/CT findings of a patient with cardiac metastasis of subungual malignant melanoma. Mol Imaging Radionucl Ther. 2019;28(3): 126-128. doi: 10.4274/mirt.galenos.2018.59251
- Marsico S, Orellana-Fernandez R, Tizon-Marcos H, Mas- Stachurska A, Solano A, Zuccarino F. Multimodality imaging evaluation of a primary cardiac epithelioid hemangioendothelioma. Acta Cardiol. 2022;77(6):557-559. doi: 10.1080/00015385.2021.1908704
- Lestuzzi C, De Paoli A, Baresic T, Miolo G, Buonadonna A. Malignant cardiac tumors: Diagnosis and treatment. Future Cardiol. 2015;11(4):485-500. doi: 10.2217/fca.15.10
- Lewis MA, Hendrickson AW, Moynihan TJ. Oncologic emergencies: Pathophysiology, presentation, diagnosis, and treatment. CA Cancer J Clin. 2011;61:287-314. doi: 10.3322/caac.20124
- Kwong KF, Nguyen DM. Malignant effusions of the pleura and the pericardium. In: Vincent T, DeVita J, Lawrence TS, Rosenberg SA, editors. Devita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. Philadelphia, PA: Lippincott Williams & Wilkins; 2011.
- Casella M, Carbucicchio C, Dello Russo A, et al. Radiofrequency catheter ablation of life-threatening ventricular arrhythmias caused by left ventricular metastatic infiltration. Circ Arrhythm Electrophysiol. 2011;4:e7-e10. doi: 10.1161/CIRCEP.110.961193
- Garg N, Moorthy N, Agrawal SK, Pandey S, Kumari N. Delayed cardiac metastasis from phyllodes breast tumor presenting as cardiogenic shock. Tex Heart Inst J. 2011;38:441-444.
- Cham WC, Freiman AH, Carstens PH, Chu FC. Radiation therapy of cardiac and pericardial metastases. Radiology. 1975;114:701-704. doi: 10.1148/114.3.701
- Lee P, Kishan AU. Radiotherapy is effective for a primary lung cancer invading the left atrium. BMJ Case Rep. 2012;2012:bcr2012006667. doi: 10.1136/bcr-2012-006667
- Fotouhi Ghiam A, Dawson LA, Abuzeid W, et al. Role of palliative radiotherapy in the management of mural cardiac metastases: Who, when and how to treat? A case series of 10 patients. Cancer Med. 2016;5(6):989-996. doi: 10.1002/cam4.619
- Jumeau R, Vincenti MG, Pruvot E, et al. Curative management of a cardiac metastasis from lung cancer revealed by an electrical storm. Clin Transl Radiat Oncol. 2020;21:62-65. doi: 10.1016/j.ctro.2019.10.005
- Bonomo P, Livi L, Rampini A, et al. Stereotactic body radiotherapy for cardiac and paracardiac metastases: University of Florence experience. Radiol Med. 2013;118:1055-1065. doi: 10.1007/s11547-013-0932-0
- Lemus JF, Abdulhay G, Sobolewski C, Risch VR. Cardiac metastasis from carcinoma of the cervix: Report of two cases. Gynecol Oncol. 1998;69:264-268. doi: 10.1006/gyno.1998.5009
- Magnuson WJ, Halligan JB. Successful treatment of melanoma metastatic to the left atrium using external beam radiation therapy. Oncology (Williston Park). 2010;24:650-653.
- Balinski AM, Vasbinder AL, Kerndt CC, et al. Metastatic melanoma of the heart: Retrospective cohort study and systematic review of prevalence, clinical characteristics, and outcomes. Cancer Med. 2023;12(3):2356-2367. doi: 10.1002/cam4.5058
- Dasgupta T, Barani IJ, Roach M 3rd. Successful radiation treatment of anaplastic thyroid carcinoma metastatic to the right cardiac atrium and ventricle in a pacemaker-dependent patient. Radiat Oncol. 2011;6:16. doi: 10.1186/1748-717X-6-16
- Dhar A, Donovan E, Leong D, Hotte SJ, Swaminath A. Stereotactic body radiation therapy (SBRT) for a patient with a myocardial metastasis: A case report. Curr Oncol. 2021;28:390-395. doi: 10.3390/curroncol28010041
- Aoki H, Utsumi M, Kimura Y. Solitary cardiac metastasis of hepatocellular carcinoma. Acta Med Okayama. 2020;74(6):525-530. doi: 10.18926/AMO/61212
- Butany J, Nair V, Naseemuddin A, Nair GM, Catton C, Yau T. Cardiac tumours: Diagnosis and management. Lancet Oncol. 2005;6:219-228. doi: 10.1016/S1470-2045(05)70093-0
- Reynen K, Köckeritz U, Strasser RH. Metastases to the heart. Ann Oncol. 2004;15:375-381. doi: 10.1093/annonc/mdh086
- Nakamura-Horigome M, Koyama J, Eizawa T, et al. Successful treatment of primary cardiac angiosarcoma with docetaxel and radiotherapy. Angiology. 2008;59:368-371. doi: 10.1177/0003319707308212
- Heidenreich PA, Kapoor JR. Radiation induced heart disease: Systemic disorders in heart disease. Heart. 2009;95:252-258. doi: 10.1136/hrt.2008.149088
- Dess RT, Sun Y, Matuszak MM, et al. Cardiac events after radiation therapy: Combined analysis of prospective multicenter trials for locally advanced non-small-cell lung cancer. J Clin Oncol. 2017;35:1395-1402. doi: 10.1200/JCO.2016.71.6142
- Wang K, Eblan MJ, Deal AM, et al. Cardiac toxicity after radiotherapy for stage III non-small-cell lung cancer: Pooled analysis of dose-escalation trials delivering 70 to 90 Gy. J Clin Oncol. 2017;35:1387-1394. doi: 10.1200/JCO.2016.70.0229
- Cuculich PS, Schill MR, Kashani R, et al. Noninvasive cardiac radiation for ablation of ventricular tachycardia. N Engl J Med. 2017;377:2325-2336. doi: 10.1056/NEJMoa1613773