title: Role of palliative radiotherapy in the management of mural cardiac metastases: who, when and how to treat? A case series of 10 patients.
abstract: Cardiac metastases (CM), although a rare manifestation of metastatic cancer, are increasing in incidence with the improved prognosis and increased longevity of many patients with cancer. This condition may be life-threatening, especially for bulky rapidly growing tumors. Such cancer presentations may be amenable to palliative radiotherapy to improve symptoms and to prevent further cardiac function decline. Here, we report on our experience with 10 patients with mural CM who received radiotherapy (RT) to the heart with palliative intent. The radiation treatment was given in different clinical situations using different dose and fractionation, and with a variety of outcomes. Palliative RT was a reasonably effective treatment, leading to good radiographic response in five patients who were evaluable for radiologic response. The mean duration of response in responding patients was 6.3 months (range: 3-11 months). This report describing clinical dilemmas around CM radiation therapy summarizes the previous experiences with radiation in treatment of CM and may assist in the considerations of palliative treatment for these patients.
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.|Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Alireza
authors.initials: A
authors.lastname: Fotouhi Ghiam
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.|Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Dawson
authors.affiliation: Division of Cardiology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Wael
authors.initials: W
authors.lastname: Abuzeid
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.|Peel Regional Cancer Centre, Credit Valley Hospital, Mississauga, Ontario, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Rauth
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Jang
authors.affiliation: Division of Cardiology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Horlick
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.|Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bezjak
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D019468:Disease Management; D018450:Disease Progression; D019583:Dose Fractionation, Radiation; D005260:Female; D006338:Heart Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010166:Palliative Care; D011879:Radiotherapy Dosage; D016896:Treatment Outcome
keywords: Heart; heart neoplasms; neoplasm metastasis; palliative medicine; radiotherapy