title: Improved Outcomes With the Evolution of a Neoadjuvant Chemotherapy Approach to Right Heart Sarcoma.
abstract: BACKGROUND
  Right-side heart sarcomas tend to be bulky, infiltrative, and difficult to treat. We have previously examined our outcomes with right heart sarcomas. Surgical resection with R0 margins showed better survival than positive margins but in only one third of cases could R0 status be achieved. The hypothesis for this study was that preoperative neoadjuvant chemotherapy would shrink the tumor margins and allow an increase in R0 resection, and hence, better survival.
  
  
  METHODS
  Review of our cardiac tumor database from 1990 to 2015 yielded 133 primary cardiac sarcoma cases. Of these, we identified 44 patients with primary right-side heart sarcomas. Prospective database and retrospective data collection and clinical outcomes were evaluated for all 44 patients. Primary outcomes included 30-day mortality and morbidity and long-term survival. We used univariate and multivariate analyses to identify independent predictors of overall survival.
  
  
  RESULTS
  There were 27 male and 17 female patients with a mean age of 41 ± 12.7 years (range, 15 to 67). Seventy-three percent of the patients (32 of 44) received neoadjuvant chemotherapy. The most common tumor histology was angiosarcoma in 30 of 44 (68%). Thirty-day mortality was 4.5%, and statistically similar between the two groups. The median survival of patients who had R0 resection was 53.5 months compared with 9.5 months for R1. Neoadjuvant chemotherapy led to a doubling of survival (20 versus 9.5 months).
  
  
  CONCLUSIONS
  Neoadjuvant chemotherapy followed by radical surgery is a safe and effective strategy in patients with primary right-side heart sarcoma. This multimodality treatment enhances resectability (R0 resection) that translates into improved patient survival.
authors.affiliation: Department of Surgery, University of Texas Health Science Center, San Antonio, Texas.
authors.forename: Walid K
authors.initials: WK
authors.lastname: Abu Saleh
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Vascular Center, Valley Health System, Winchester, Virginia.
authors.forename: Basel
authors.initials: B
authors.lastname: Ramlawi
authors.affiliation: Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Oz M
authors.initials: OM
authors.lastname: Shapira
authors.affiliation: Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Odeaa
authors.initials: O
authors.lastname: Al Jabbari
authors.affiliation: Department of Sarcoma Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Vinod
authors.initials: V
authors.lastname: Ravi
authors.affiliation: Department of Sarcoma Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Robert
authors.initials: R
authors.lastname: Benjamin
authors.affiliation: Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Durand
authors.affiliation: Department of Internal Medicine and Cardiology, University of Michigan, Northville, Michigan.
authors.forename: Monika J
authors.initials: MJ
authors.lastname: Leja
authors.affiliation: Department of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Shanda H
authors.initials: SH
authors.lastname: Blackmon
authors.affiliation: Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Bruckner
authors.affiliation: Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas. Electronic address: mreardon@houstonmethodist.org.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Reardon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000379:methods; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006338:Heart Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents