Salvage Radiosurgery for Recurrent Cardiac Sarcoma: A Case Report

Area of Science:

• Oncology
• Cardiovascular Medicine
• Radiation Oncology

Background:

• Primary cardiac sarcoma is a rare and aggressive malignancy originating in the heart's muscle.
• Surgical resection is the primary treatment, but median survival remains limited (6-12 months).
• The efficacy of salvage therapies like chemotherapy and radiation for recurrent cardiac sarcoma is not well-established.

Observation:

• A patient with undifferentiated pleomorphic sarcoma of the left atrium experienced recurrence after surgery and adjuvant chemotherapy.
• Initial treatment with fractionated robotic radiation therapy (72 Gy in 15 fractions) failed to control local disease, showing progression on MRI.
• Salvage treatment with single-fraction robotic radiosurgery (25 Gy in one fraction) achieved local disease control for 12 months without cardiac toxicity.

Findings:

• Fractionated stereotactic body radiation therapy (SBRT) was ineffective in controlling the patient's cardiac sarcoma.
• Single-fraction radiosurgery demonstrated significant efficacy in achieving long-term local control of unresectable cardiac sarcoma.
• The patient tolerated the high-dose single-fraction radiosurgery well, with no acute toxicity observed.

Implications:

• Single-fraction radiosurgery may be a viable palliative strategy for achieving durable local control in patients with unresectable cardiac sarcomas.
• This approach could improve quality of life by managing local tumor burden in advanced cardiac malignancies.
• Further research is warranted to explore the role and optimal fractionation of radiosurgery in cardiac sarcoma management.