Sbrt For Cardiac And Paracardiac Tumors

SBRT is an effective and well tolerated procedure. In this study we analyzed the outcome of patients suffering from relapsed cardiac sarcoma or cardiac and paracardiac metastases treated by SBRT using data from prior PET for detection of target movement. 17 patients (4 with relapsed cardiac sarcoma, 13 with cardiac or paracardiac metastases) were evaluated. "Paracardiac” was defined as directly adjacent to the pericardium. All patients underwent data-driven 4D FDG- PET (acquired on PET/CT or PET/MRI devices) for detection of target movements. A total of > 100 Gy BED was delivered in 3 to 5 fractions using a gantry linear accelerator or a robotic arm linear accelerator. Examinations before, during and after SBRT included ECG and heart enzymes daily during SBRT, echocardiography before and after the whole SBRT session; MRI and echocardiography 6 and 12 weeks after SBRT, followed by MRI scans every 3/6 month. Systemic therapy were paused at a minimum of 3 weeks before and after SBRT. All patients completed SBRT as intended. No toxicity >°1 (CTCAE v_3.0) has been observed. During a mean observing time of 12.4 months (3 to 25) following SBRT no in-field relapses were observed. One patient developed a borderline elevation of troponin (+ 1.1% of upper normal value) without clinical symptoms for one time, no other symptoms or pathological results occurred during follow-up. SBRT is well tolerated in this setting and should therefore be considered for the treatment of relapsed cardiac sarcoma or oligometastatic cardiac/paracardiac metastases.