TY - JOUR
T1 - Cardiac Angiosarcomas Risk of Brain Metastasis and Hemorrhage Warrants Frequent Surveillance Imaging and Early Intervention
AU - Bishop, Andrew J.
AU - Zheng, Jing
AU - Subramaniam, Aparna
AU - Ghia, Amol J.
AU - Wang, Chenyang
AU - McGovern, Susan L.
AU - Patel, Shreyaskumar
AU - Guadagnolo, B. Ashleigh
AU - Mitra, Devarati
AU - Farooqi, Ahsan
AU - Reardon, Michael J.
AU - Kim, Betty
AU - Guha-Thakurta, Nandita
AU - Li, Jing
AU - Ravi, Vinod
N1 - Publisher Copyright:
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022
Y1 - 2022
N2 - Purpose: We evaluated a cohort of patients with cardiac angiosarcomas (CA) who developed brain metastases (BM) to define outcomes and intracranial hemorrhage (IH) risk. Methods: We reviewed 26 consecutive patients with BM treated between 1988 and 2020 identified from a departmental CA (n = 103) database. Causes of death were recorded, and a terminal hemorrhage (TH) was defined as an IH that caused death or prompted a transfer to hospice. Results: The prevalence of BM was 25% (n = 26/103). A total of 23 patients (88%) had IH, including 21 (81%) at initial BM diagnosis, of which 18 (86%) required hospitalization. The median platelet count at the time of IH was 235k (interquartile range, 108 to 338k). Nearly all patients died of disease (n = 23, 88%) and most patients died from TH (n = 13, 57%). TH occurred at BM presentation in 6 (46%) patients, whereas 3 (23%) had TH from known but untreated lesions, 2 (15%) had continued uncontrolled IH during radiation therapy, and 2 (15%) from new BM. Platelet count <50k was not associated with TH (P = 0.25). Subsequent IH occurred in 9 patients (35%), and importantly, no patients who completed radiation therapy (n = 10) for BM died from TH. Conclusion: Patients with CA frequently develop BM, and the risk of IH is high, resulting in an alarming rate of TH despite normal platelet counts. Therefore, early diagnosis and intervention are warranted. We recommend surveillance brain imaging, and importantly, once BM is detected, prompt local therapy is warranted to try and mitigate the risk of TH.
AB - Purpose: We evaluated a cohort of patients with cardiac angiosarcomas (CA) who developed brain metastases (BM) to define outcomes and intracranial hemorrhage (IH) risk. Methods: We reviewed 26 consecutive patients with BM treated between 1988 and 2020 identified from a departmental CA (n = 103) database. Causes of death were recorded, and a terminal hemorrhage (TH) was defined as an IH that caused death or prompted a transfer to hospice. Results: The prevalence of BM was 25% (n = 26/103). A total of 23 patients (88%) had IH, including 21 (81%) at initial BM diagnosis, of which 18 (86%) required hospitalization. The median platelet count at the time of IH was 235k (interquartile range, 108 to 338k). Nearly all patients died of disease (n = 23, 88%) and most patients died from TH (n = 13, 57%). TH occurred at BM presentation in 6 (46%) patients, whereas 3 (23%) had TH from known but untreated lesions, 2 (15%) had continued uncontrolled IH during radiation therapy, and 2 (15%) from new BM. Platelet count <50k was not associated with TH (P = 0.25). Subsequent IH occurred in 9 patients (35%), and importantly, no patients who completed radiation therapy (n = 10) for BM died from TH. Conclusion: Patients with CA frequently develop BM, and the risk of IH is high, resulting in an alarming rate of TH despite normal platelet counts. Therefore, early diagnosis and intervention are warranted. We recommend surveillance brain imaging, and importantly, once BM is detected, prompt local therapy is warranted to try and mitigate the risk of TH.
KW - angiosarcoma
KW - brain metastasis
KW - cardiac
KW - cardiac sarcoma
KW - hemorrhage
KW - intracranial hemorrhage
KW - radiation
KW - terminal hemorrhage
UR - http://www.scopus.com/inward/record.url?scp=85129867402&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85129867402&partnerID=8YFLogxK
U2 - 10.1097/COC.0000000000000913
DO - 10.1097/COC.0000000000000913
M3 - Article
C2 - 35588225
AN - SCOPUS:85129867402
SN - 0277-3732
VL - 45
SP - 258
EP - 263
JO - American Journal of Clinical Oncology: Cancer Clinical Trials
JF - American Journal of Clinical Oncology: Cancer Clinical Trials
IS - 6
ER -