Preview

Russian Journal of Cardiology

Advanced search

Primary cardiac angiosarcoma: modern methods of diagnosis and treatment

https://doi.org/10.15829/1560-4071-2020-3824

Abstract

The review is dedicated to such a rare disease as primary cardiac angiosarcoma (PCA). The following imaging methods are used for its diagnosing: transthoracic and transesophageal echocardiography, computed tomography, positron emission tomography and magnetic resonance imaging. To verify the diagnosis, a biopsy with cytological and immunohistochemical analysis is performed. The symptoms of PCA is non-specific and often manifests itself only in the late stages, which leads to a significant deterioration of prognosis. Treatment of PCA requires a multifaceted approach. It mainly involves the achievement of a curative resection (R0 resection). Regarding chemotherapy, neoadjuvant therapy with doxorubicin and ifosfamide is effective. In addition to these agents, cyclophosphamide, anthracycline, vincristine and others are used. Today, the use of targeted therapy with imatinib, sorafenib, pazopanib, and bevacizumab is promising. However, it requires further analysis. The article also describes other therapy methods using a beta-blockers and radiation exposure.

About the Authors

D. A. Sarachan
V.I. Vernadsky Crimean Federal University, S.I. Georgievsky Medical Academy
Russian Federation

Simferopol



A. V. Skrebtsov
V.I. Vernadsky Crimean Federal University, S.I. Georgievsky Medical Academy
Russian Federation

Simferopol



E. A. Zakharyan
V.I. Vernadsky Crimean Federal University, S.I. Georgievsky Medical Academy
Russian Federation

Simferopol



D. S. Sobinov
N.A. Semashko Republican Clinical Hospital

Simferopol



References

1. Basso C, Rizzo S, Valente M, et. al. Cardiac masses and tumours. Heart. 2016;102(15), 1230–1245. DOI:10.1136/heartjnl-2014-306364.

2. Linfeng Q, Xingjie X, Henry D, et. al. Cardiac angiosarcoma: A case report and review of current treatment. Medicine (Baltimore). 2019;98(49):e18193. DOI: 10.1097/MD.0000000000018193.

3. Singhal P, Luk A, Rao V, et. al. Molecular basis of cardiac myxomas. Int J Mol Sci. 2014;15(1):1315-1337. DOI: 10.3390/ijms15011315.

4. Ali MU, Finkel J. Atrial Myxoma. N Eng J Med. 2018;379(16):e26. DOI:10.1056/nejmicm1802693

5. Siontis BL, Zhao L, Leja M, et. al. Primary Cardiac Sarcoma: A Rare, Aggressive Malignancy with a High Propensity for Brain Metastases. Sarcoma. 2019;2019:1960593. DOI: 10.1155/2019/1960593.

6. Lestuzzi C. Primary tumors of the heart. Curr Opin Cardiol. 2016;31(6):593-598. DOI:10.1097/hco.0000000000000335.

7. Kim CH, Dancer JY, Coffey D, et. al. Clinicopathologic study of 24 patients with primary cardiac sarcomas: a 10-year single institution experience. Hum Pathol. 2008;39(6):933-938. DOI: 10.1016/j.humpath.2007.12.018.

8. Hamidi M, Moody JS, Weigel TL, et. al. Primary cardiac sarcoma. Ann Thorac Surg. 2010;90(1):176-81. DOI: 10.1016/j.athoracsur.2010.03.065.

9. Pigott C, Welker M, Khosla P, et. al. Improved outcome with multimodality in primary cardiac angiosarcoma. Nat Clin Pract Onco. 2008;5(2):112–115. DOI: 10.1038/ncponc1023.

10. Patel SD, Peterson A, Bartczak A, et. al. Primary cardiac angiosarcoma— a review. Med Sci Monit. 2014;20:103-109. DOI: 10.12659/MSM.889875.

11. Ducis K, Tucker S, et. al. Metastatic Cardiac Angiosarcoma to the Lung, Spine, and Brain: A Case Report and Review of the Literature. World Neurosurgery, 2007; 107:1049.e9–1049.e12. DOI: 10.1016/j.wneu.2017.08.023.

12. Ploner F, Rigler B. Familial Cardiac Angiosarcoma. Ann Thorac Surg. 2006;82(4):1576. DOI:10.1016/j.athoracsur.2006.03.006.

13. Casha AR, Davidson LA, Roberts P, et. al. Familial angiosarcoma of the heart. J of Thorac and Cardiovasc Surg. 2002;124(2):392–394. DOI:10.1067/mtc.2002.122314.

14. Calvete O, Martinez P, Garcia-Pavia P, et. al. A mutation in the POT1 gene is responsible for cardiac angiosarcoma in TP53-negative Li-Fraumeni-like families. Nat Commun. 2015;6:8383. DOI: 10.1038/ncomms9383.

15. Bunch JT, Bae NS, Leonardi J, et. al. Distinct requirements for Pot1 in limiting telomere length and maintaining chromosome stability. Mol Cell Biol. 2005;25(13):5567-5578. DOI: 10.1128/MCB.25.13.5567-5578.2005.

16. Robles-Espinoza CD, Harland M, Ramsay AJ, et. al. POT1 loss-of-function variants predispose to familial melanoma. Nat Genet. 2014;46(5):478-481. DOI: 10.1038/ng.2947.

17. Vogel WH. Li-Fraumeni Syndrome. J Adv Pract Oncol. 2017;8(7):742-746. PMID: 30333936.

18. Ognjanovic S, Olivier M, Bergemann T, et. al. Sarcomas in TP53 germline mutation carriers. Cancer. 2011;118(5):1387–1396. DOI:10.1002/cncr.26390.

19. Ramlawi B, Leja MJ, Abu Saleh WK, et al. Surgical treatment of primary cardiac sarcomas: review of a single-institution experience. Ann Thorac Surg. 2016;101(2):698–702. DOI:10.1097/COC.0000000000000106.

20. Randhawa JS, Budd GT, Randhawa M, et al. Primary cardiac sarcoma: 25-year cleveland clinic experience. Am J Clin Oncol. 2016;39(6):593–599. DOI: 10.1097/coc.0000000000000106.

21. Сorso RB, Kraychete N, Nardeli S, et al. Spontaneous rupture of a right atrial angiosarcoma and cardiac tamponade. Arquivos Brasileiros de Cardiologia. 2003;81(6):611–613. DOI: 10.1590/s0066-782x2003001400008.

22. Butany J, Yu W. Cardiac angiosarcoma: two cases and a review of the lit-erature. Can J Cardiol. 2000;16(2):197–205 PMID: 10694590.

23. Hart J, Mandavilli S. Epithelioid angiosarcoma: a brief diagnostic review and differential diagnosis. Arch Pathol Lab Med. 2011;135(2):268-272. DOI: 10.1043/1543-2165-135.2.268.

24. Geller RL, Hookim K, Sullivan, et. al. Cytologic features of angiosarcoma: A review of 26 cases diagnosed on FNA. Cancer Cytopathology. 2016;124(9):659–668. DOI: 10.1002/cncy.21726.

25. Leduc C, Jenkins SM, Sukov WR, et. al. Cardiac angiosarcoma: histopathologic, immunohistochemical, and cytogenetic analysis of 10 cases. Human Pathology. 2017; 60: 199–207. DOI: 10.1016/j.humpath.2016.10.014.

26. Riles E, Gupta S, Wang DD, et. al. Primary cardiac angiosarcoma: A diagnostic challenge in a young man with recurrent pericardial effusions. Exp Clin Cardiol. 2012;17(1):39-42. PMID: 23204900.

27. Huang J, Bouvette MJ, Zhou J, et. al. A large angiosarcoma of the right atrium. Anesth Analg. 2009;108:1755–1757. DOI: 10.1213/ane.0b013e3181a1c631.

28. Kupsky DF, Newman DB, Kumar G, et al. Echocardiographic features of cardiac angiosarcomas: the mayo clinic experience (1976-2013). Echocardiography. 2016;33(2):186–92. DOI:10.1111/echo.13060.

29. Pazos-Lуpez P, Pozo E, Siqueira ME, et al. Value of CMR for the differential diagnosis of cardiac masses. JACC Cardiovasc Imaging. 2014;7(9):896–905. DOI: 10.1016/j.jcmg.2014.05.009

30. Akkaya Z, Gursoy A, Erden A. The disastrous “sun ray” sign in cardiac magnetic resonance: an indicator of angiosarcoma. Cardiol Young. 2014;24(5):929-931. DOI:10.1017/S1047951113001455.

31. Rahbar K, Seifarth H, Schдfers M, et al. Differentiation of malignant and benign cardiac tumors using 18F-FDG PET/CT. J Nucl Med. 2012;53(6):856–863. DOI: 10.2967/jnumed.111.095364.

32. Kavakbasi E, Scheld HH, Kessler T, et. al. Postoperative Complications and Long-Term Results after Primary Cardiac Sarcoma Resection. J. Thorac. Cardiovasc. Surg. 2018; 66(8):637-644. DOI:10.1055/s-0037-1603790.

33. Isambert N, Ray-Coquard I, Italiano A, et. al. Primary cardiac sarcomas: A retrospective study of the French Sarcoma Group. Eur. J. Cancer, 2014;50(1), 128–136. DOI: 10.1016/j.ejca.2013.09.012.

34. Ramlawi B, Al-Jabbari O, Blau LN, et al. Autotransplantation for the resectionof complex left heart tumors. Ann Thorac Surg. 2014;98(3):863–868. DOI: 10.1016/j.athoracsur.2014.04.125.

35. Li H, Yang S, Chen H, et. al. Survival after heart transplantation for non-metastatic primary cardiac sarcoma. J Thorac Cardiovasc Surg. 2016;11(1):145. DOI: 10.1186/s13019-016-0540-x.

36. Pandalai PK, Hornick JL, et al. Cardiac angiosarcoma management and outcomes: 20-year single-institution experience. Ann Surg Oncol. 2012;19(8):2707–2715. DOI: 10.1245/s10434-012-2334-2.

37. Truong PT, Jones SO, Martens B, et al. Treatment and outcomes in adult patients with primary cardiac sarcoma: the British Columbia Cancer Agency experience. Ann Surg Oncol. 2009;16:3358–3365.doi:10.1245/s10434-009-0734-8

38. Maurel J, López-Pousa A, de las Peñas R, et. al. Efficacy of Sequential High-Dose Doxorubicin and Ifosfamide Compared With Standard-Dose Doxorubicin in Patients With Advanced Soft Tissue Sarcoma: An Open-Label Randomized Phase II Study of the Spanish Group for Research on Sarcomas. J Clin Oncol. 2009;27(11):1893–1898.DOI:10.1200/jco.2008.19.2930.

39. Abu Saleh WK, Ramlawi B, Shapira OM, et al. Improved outcomes with the evolution of a neoadjuvant chemotherapy approach to right heart sarcoma. Ann Thorac Surg. 2017 ;104(1):90–96. DOI: 10.1016/j.athoracsur.2016.10.054.

40. Young RJ, Natukunda A, Litière S, et al. First-line anthracycline-based chemotherapy for angiosarcoma and other soft tissue sarcoma subtypes: pooled analysis of eleven European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group trials. Eur J Cancer 2014;50(18):3178–3186. DOI:10.1016/j.ejca.2014.10.004.

41. Agulnik M, Yarber JL, Okuno SH, et. al. An open-label, multicenter, phase II study of bevacizumab for the treatment of angiosarcoma and epithelioid hemangioendotheliomas. Ann Oncol. 2013;24(1):257–263. DOI: 10.1093/annonc/mds237.

42. Ray-Coquard IL, Domont J, Tresch-Bruneel E, et al. Paclitaxel given once per week with or without bevacizumab in patients with advanced angiosarcoma: a randomized phase II trial. J Clin Oncol. 2015;33(25):2797–2802. DOI: 10.1200/JCO.2015.60.8505.

43. Nespereira-Jato MV, Peña-Panabad C, Quindós-Varela M, et. al. Unresectable angiosarcoma treated with bevacizumab and paclitaxel. Actas Dermosifiliogr. 2014;105(5):520–522. DOI: 10.1016/j.adengl.2014.04.008.

44. Yang P, Zhu Q, Jiang F. Combination therapy for scalp angiosarcoma using bevacizumab and chemotherapy: a case report and review of literature. Chin J Cancer Res. 2013;25(3):358-361. DOI: 10.3978/j.issn.1000-9604.2013.06.09.

45. Stiles JM, Amaya C, Rains S, et. al. Targeting of beta adrenergic receptors results in therapeutic efficacy against models of hemangioendothelioma and angiosarcoma. PLoS One. 2013;8(3):e60021. DOI: 10.1371/journal.pone.0060021.

46. Amaya CN, Perkins M, Belmont A, et. al. Non-selective beta blockers inhibit angiosarcoma cell viability and increase progression free- and overall-survival in patients diagnosed with metastatic angiosarcoma. Oncoscience. 2018; 5(3-4):109-119. DOI: 10.18632/oncoscience.413.

47. Galván DC, Ayyappan AP, Bryan BA. Regression of primary cardiac angiosarcoma and metastatic nodules following propranolol as a single agent treatment. Oncoscience. 2018;5(9-10):264-268. DOI: 10.18632/oncoscience.472.

48. Pasquier E, André N, Street J, et. al. Effective Management of Advanced Angiosarcoma by the Synergistic Combination of Propranolol and Vinblastine-based Metronomic Chemotherapy: A Bench to Bedside Study. EBioMedicine. 2016;6:87-95. DOI: 10.1016/j.ebiom.2016.02.026.

49. De Yao JT, Sun D, Powell AT, et. al. Scalp angiosarcoma remission with bevacizumab and radiotherapy without surgery: A case report and review of the literature. Sarcoma. 2011;2011:160369. DOI:10.1155/2011/160369.

50. Aoka Y, Kamada T, Kawana M, et. al. Primary cardiac angiosarcoma treated with carbon-ion radiotherapy. Lancet Oncol. 2004;5:636–638. DOI: 10.1016/S1470-2045(04)01600-6.


Review

For citations:


Sarachan D.A., Skrebtsov A.V., Zakharyan E.A., Sobinov D.S. Primary cardiac angiosarcoma: modern methods of diagnosis and treatment. Russian Journal of Cardiology. 2020;25(4):3824. (In Russ.) https://doi.org/10.15829/1560-4071-2020-3824

Views: 3243


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1560-4071 (Print)
ISSN 2618-7620 (Online)