Radiotherapy and chemotherapy are usually reserved for inoperable patients or given adjuvantly for those with residual tumor and/or metastatic disease. Elsayad and coworkers describe a novel treatment modality with adaptive radiotherapy using tumor-volume tracking in a 37-year-old woman who presented with unresectable primary cardiac angiosarcoma. Prior to radiotherapy, transthoracic echocardiography, exploratory computed tomography (CT), and PET/MRI identified a rapidly progressive tumor (515 cm³). The patient was treated using positron emission tomography/magnetic resonance imaging (PET/MRI)-guided adaptive radiotherapy with 55.8 Gray (delivered in 31 daily fractions) simultaneous to paclitaxel chemotherapy. During the course of radiochemotherapy, image-guidance using cone-beam CT (CBCT) examinations demonstrated disease remission. Therefore, a new weekly planning CT had been undertaken until the completion of RT (Fig. 1b-d). No moderate or severe acute effects developed during the treatment period. Significant tumor volume reduction was achieved on the order of 57% (299 cm³) during radiation (Fig. 1f). Further shrinkage of the cardiac tumor was observed in the follow-up CT scans with 71% volume reduction in comparison to initial imaging studies. This patient survived for 9.5 months after the initial diagnosis to date of publication, and no evidence of cardiac disease progression was detected at her 6-month follow-up appointment post-radiation.

Fig. 1 (a) Dose distribution in the radiation field using intensity-modulated radiation therapy (IMRT)-based plan prescribed to 50%-isodose line; (b-e) Chest-CT scans during chemoradiotherapy on days 14, day 28, and day 35, at 8 weeks after radiation. (f) Tumor volume during and after radiation treatment (This patient survives 12 months with 92% Tumor volume reduction to date).

In conclusion, adaptive radiotherapy was well tolerated and a marked tumor volume reduction was achieved by ~57% during radiotherapy, suggesting the effectiveness and tolerability of ART in combination with taxol-based chemotherapy. In this study, PET/MRI images were beneficial for accurate tumor delineation and to exclude tumor recurrence.

Publication

Primary Cardiac Angiosarcoma Treated With Positron Emission Tomography/Magnetic Resonance Imaging-Guided Adaptive Radiotherapy.
Elsayad K, Lehrich P, Yppaerilae-Wolters H, Dieckmann C, Kriz J, Haverkamp U, Eich HT.
Can J Cardiol. 2015 Jul 17

Read offline:     

Related Articles:

	How PET ameliorates 90-Yttrium therapy in inoperable… Increased synthesis of blood vessels and blood supply are essential characteristics of a tumor to secure nutrient delivery and growth. One of the treatment options for inoperable liver cancer (hepatocellular carcinoma,…
	Tracking mRNA in living cells using Pepper RNA aptamer Messenger RNAs (mRNAs) are a class of biomolecules that are generated in the nucleus to carry genetic information from the nucleus to different parts of the cells for making functional…
	Defects in mismatch repair increase cancer risk and… Microsatellites are formed by 1-6 nucleotide base pairs that are repeated in direct order 5-50 times. Repetitive DNA including microsatellites are mainly present in non-coding DNA regions that occupy more…
	Rabbits with mammary carcinomas as a model for… Within a breeding colony of rabbits, the American pathologist Harry Greene (1904-1969) observed that mammary carcinomas were restricted to certain families. This is suggestive of a familiar predisposition as it…
	A novel digital nasoalveolar molding approach for… Presurgical nasoalveolar molding (PNAM) is a widely accepted approach applied before cheiloplasty for infants with unilateral cleft lip and palate (UCLP), which can effectively reduce the width of the cleft…
	Cerebral venous hemodynamic in a rat model of acute… Traumatic brain injury (TBI) is currently one of the most serious public-health problems, with an annual global incidence rate of 319/100,000. TBI includes primary injuries directly caused by mechanical stress…