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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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6/2019
vol. 11
 
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abstract:
Case report

Endovascular brachytherapy for extensive right-heart and pulmonary artery sarcoma – a case report

Gal Aviel
1
,
Amichay Meirovitz
2
,
David Planer
3
,
Dotan Cohen
4
,
Dan Gilon
3
,
Jon Feldman
2
,
Oz M. Shapira
1

  1. Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
  2. Department of Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
  3. Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
  4. Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
J Contemp Brachytherapy 2019; 11, 6: 579–583
DOI: https://doi.org/10.5114/jcb.2019.91226
Online publish date: 2019/12/25
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Purpose
Primary sarcoma of the heart is a rare but devastating tumor. Median survival with conventional treatment is 8-12 months. When resection is not feasible, patients often succumb to heart failure secondary to obstruction of blood flow, valve dysfunction, chamber compression or conduction abnormalities. Palliative treatment options include systemic chemotherapy and external beam irradiation. We herein describe a novel technique using endovascular brachytherapy, aiming at reducing tumor mass, alleviating right ventricular pressure overload and at the same time keeping the option of R0 resection viable.

Material and methods
A 35-year-old man was diagnosed with a non-resectable high-grade intimal sarcoma of the right ventricle (RV), main pulmonary artery (PA) and right PA. After three cycles of doxorubicin and ifosfamide, the patient’s symptoms of right heart failure worsened. Imaging documented tumor progression and supra-systemic pulmonary artery pressure. Through a trans-femoral venous access, a brachytherapy sleeve was placed in the RV and main and right PA. A dose of 20 Gy was delivered over a period of ten minutes.

Results
The patient had an uneventful course and was discharged home 24 hours after the procedure. Ten months after brachytherapy, repeat imaging demonstrated a significant reduction in tumor volume and an increase in pulmonary artery cross-sectional area with a marked reduction of pulmonary artery pressure, leading to a complete resolution of heart failure symptoms.

Conclusions
Endovascular brachytherapy is a novel, safe and effective therapeutic modality for non-resectable primary cardiac sarcomas either for palliation of obstruction, or tumor mass reduction to allow complete resection.

keywords:

brachytherapy, right heart sarcoma, pulmonary artery sarcoma

  
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