[Treatment of nonresectable cardiac cancer]

Methods and strategies for the treatment of surgically nonresectable cardiac cancer are discussed. Among the 185 patients with cardiac cancer encountered to date in our department, five (2.7%) had nonresectable disease. All of these patients had at least two unfavorable prognostic factors, and chemotherapy was administered but with poor results. In one patient with Barrett's esophageal cancer including the cardiac region, a self-expandable metallic stent (SEMS) was applied temporarily. The patient progressed from being unable to swallow saliva to being able to ingest food orally. Patients with surgically nonresectable progressive cardiac cancer generally have a poor general condition and are immunodeficient. In the case of surgical bypass surgery for highly invasive cancer, complications often occur and great care must be exercised. However, because of the improvements made in and increasingly widespread use of stenting devices and delivery systems, early introduction of SEMS is considered to be an effective strategy against the symptoms caused by obstruction and development of aspiration pneumonia. There have also been reports of the effectiveness of laser therapy, local injection of immunotherapeutic agents, and radiotherapy to the tumor. A good outcome can also be expected using a multidisciplinary treatment involving a combination of systemic chemotherapy and immunotherapy. However, because of the poor prognosis, timely introduction of home total parenteral nutrition and palliative therapy after receiving informed consent from the patient and/or the family is necessary to avoid prolonged and unnecessary hospitalization.