Walid K Abu Saleh1, Basel Ramlawi2, Oz M Shapira3, Odeaa Al Jabbari4, Vinod Ravi5, Robert Benjamin5, Jean-Bernard Durand6, Monika J Leja7, Shanda H Blackmon8, Brian A Bruckner4, Michael J Reardon9. 1. Department of Surgery, University of Texas Health Science Center, San Antonio, Texas. 2. Department of Cardiothoracic Surgery, Heart and Vascular Center, Valley Health System, Winchester, Virginia. 3. Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel. 4. Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas. 5. Department of Sarcoma Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas. 6. Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas. 7. Department of Internal Medicine and Cardiology, University of Michigan, Northville, Michigan. 8. Department of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota. 9. Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas. Electronic address: mreardon@houstonmethodist.org.
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.
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: Brittany L Siontis; Lili Zhao; Monika Leja; Jonathan B McHugh; Maryann M Shango; Laurence H Baker; Scott M Schuetze; Rashmi Chugh Journal: Sarcoma Date: 2019-03-10