Cardiac angiosarcoma treated with 1.5 Tesla MR-guided adaptive stereotactic body radiotherapy – Case report and review of the literature. (September 2022)

• Record Type: Journal Article
• Authors: Noyan, Asli; Yavas, Guler; Efe, Esma; Arslan, Gungor; Yavas, Cagdas; Onal, Cem
• Is Part Of: International journal of surgery case reports. Volume 98(2022)
• Publication Date: 2022-09
• Subjects: Cardiac tumor -- Angiosarcoma -- Radiotherapy -- MR-guided radiotherapy -- Stereotactic body radiotherapy; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2022.107521
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction: Cardiac angiosarcoma is a very rare disease. As a result of their nonspecific presentation symptoms, and the lack of consensus in treatment, caution should be taken in both diagnosis and treatment. The role of radiotherapy (RT) is debatable due to the continuous movement of the heart, which makes it difficult to safely deliver high radiation doses to the target volume. Presentation of case: The case of a 16-year-old boy with cardiac angiosarcoma that recurred one year after surgery and was treated with chemotherapy is presented. The patient received high field 1.5-Tesla (magnetic resonance) MR-Linac treatment in 5 fractions with a dosage of 25 Gy to the tumor bed and 30 Gy to the recurrent nodules using the simultaneous integrated boost technique. The patient tolerated the treatment well and had stable disease two months later. Discussion: MR-guided radiotherapy, particularly in the case of cardiac malignancies, allows for direct tumor visualization with high soft tissue image resolution capacity. Furthermore, modern RT techniques allow for the full therapeutic window to be used by achieving superior dose distributions, allowing for dose escalation strategies with tolerable toxicity rates. Conclusion: Magnetic resonance guided RT allows direct visualization of the target during treatment delivery, allowing for higher-dose administration with less damage to healthy tissue near the tumor. This treatment strategy is a viable option in selected patients with cardiac angiosarcoma. Highlights: Cardiac angiosarcoma is a rare, difficult-to-diagnose and -treat disease. The role of radiotherapy is debatable due to the continuous movement of the heart. MRgRT allows direct target visualization during treatment delivery. This is the youngest case of cardiac sarcoma treated with adaptive MRgRT. Ultra-hypofractionated MRgRT is a viable treatment option for cardiac tumors.