Süheyla AYTAÇ ARSLAN, İpek Pınar ARAL, Yılmaz TEZCAN, Karabekir ERCAN, Gonca ALTINIŞIK İNAN, Hüseyin Furkan ÖZTÜRK

Chemoradiotherapy in the Management of Cardiac Metastases: A Case Report and Brief Review

Dear Editor, Metastatic cardiac tumors are rare clinical situations; however, its incidence increases due to the increment in survival of cancer patients and improvement in imaging techniques.[1] The incidence of cardiac metastasis data was mostly obtained from autopsy series. The incidence rates vary from 1.5 to 25%.[2,3] All cancers have the potential for cardiac metastasis. Tumors with the highest tendency to metastasize to the heart are melanomas, mesotheliomas, and mediastinal malignancies.[4,5] Although the pericardium is the most frequently involved site, the development of metastasis could be observed in other structures of the heart.[4,6] There are 4 different ways defined for the development of cardiac metastasis: Hematological, lymphatic, transvenous, and direct invasion.[7,8] Cardiac metastasis development pathway may also be determinative in the gotten hold of cardiac structure. Lung cancers have a high tendency to metastasis and are among the primary cancers that metastasize to the heart. Cardiac metastases are not considered in the differential diagnosis since their different presentations. In the selection of treatment, the presence of symptoms, the control status of the primary tumor and the involved cardiac region are determinant and there is no standard treatment.

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1. Yusuf SW, Bathina JD, Qureshi S, Kaynak HE, Banchs J, Trent JC, et al. Cardiac tumors in a tertiary care cancer hospital: Clinical features, echocardiographic findings, treatment and outcomes. Heart Int 2012;7(1):e4.
2. Al-Mamgani A, Baartman L, Baaijens M, de Pree I, Incrocci L, Levendag PC. Cardiac metastases. Int J Clin Oncol 2008;13(4):369–72.
3. Reynen K, Köckeritz U, Strasser RH. Metastases to the heart. Ann Oncol 2004;15(3):375–81.
4. Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol 2007;60(1):27–34.
5. Tesolin M, Lapierre C, Oligny L, Bigras JL, Champagne M. Cardiac metastases from melanoma. Radiographics 2005;25(1):249–53.
6. Butany J, Leong SW, Carmichael K, Komeda M. A 30- year analysis of cardiac neoplasms at autopsy. Can J Cardiol 2005;21(8):675–80.
7. Lichtenberger JP 3rd, Reynolds DA, Keung J, Keung E, Carter BW. Metastasis to the heart: A radiologic approach to diagnosis with pathologic correlation. AJR Am J Roentgenol 2016;207(4):764–72.
8. Goldberg AD, Blankstein R, Padera RF. Tumors metastatic to the heart. Circulation 2013;128(16):1790– 4.
9. Burazor I, Aviel-Ronen S, Imazio M, Goitein O, Perelman M, Shelestovich N, et al. Metastatic cardiac tumors: From clinical presentation through diagnosis to treatment. BMC Cancer 2018;18(1):202.
10. Silvestri F, Bussani R, Pavletic N, Mannone T. Metastases of the heart and pericardium. G Ital Cardiol 1997;27(12):1252–5.
11. Husain A. Thoracic Pathology. Philadelphia, PA: Saunders; 2012. p. 557–8.
12. Maleszewski JJ, Anavekar NS, Moynihan TJ, Klarich KW. Pathology, imaging, and treatment of cardiac tumours. Nat Rev Cardiol 2017;14(9):536–49.
13. Hoey ET, Mankad K, Puppala S, Gopalan D, Sivananthan MU. MRI and CT appearances of cardiac tumours in adults. Clin Radiol 2009;64(12):1214–30.
14. O’Donnell DH, Abbara S, Chaithiraphan V, Yared K, Killeen RP, Cury RC, et al. Cardiac tumors: Optimal cardiac MR sequences and spectrum of imaging appearances. AJR Am J Roentgenol 2009;193(2):377–87.
15. Rosas D, Raez LE. Cardiac tumors are not always myxomas. Ann Clin Case Rep 2020;5:1781.
16. Jumeau R, Vincenti MG, Pruvot E, Schwitter J, Vallet V, Zeverino M, et al. Curative management of a cardiac metastasis from lung cancer revealed by an electrical storm. Clin Transl Radiat Oncol 2020;21:62–5.
17. Frakulli R, Cammelli S, Salvi F, Balestrini D, Baldissera A, Degli Esposti C, et al. Unusual case of spindle cell sarcoma metastases to right ventricle: A case report and a literature review. Ann Transl Med 2017;5(17):344.
18. Lee P, Kishan AU. Radiotherapy is effective for a primary lung cancer invading the left atrium. BMJ Case Rep 2012;2012:bcr2012006667.
19. 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.
20. Fukuda A, Saito T, Imai M, Ishii K, Miwa K. Metastatic cardiac papillary carcinoma originating from the thyroid in both ventricles with a mobile right ventricular pedunculated tumor. Jpn Circ J 2000;64(11):890–2.
21. Yamana N, Sueyama H, Hamada M. Cardiac metastasis from Merkel cell skin carcinoma. Int J Clin Oncol 2004;9(3):210–2.
22. Fotouhi Ghiam A, Dawson LA, Abuzeid W, Rauth S, Jang RW, Horlick E, 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):989–96.
23. Takenaka S, Hashimoto N, Araki N, Hamada K, Naka N, Joyama S, et al. Eleven cases of cardiac metastases from soft-tissue sarcomas. Jpn J Clin Oncol 2011;41(4):514–8.