Because of the small incidence of primary
cardiac neoplasms there have been no randomized clinical trials to establish rational therapeutic strategies. Surgery is the first choice of
therapy in all patients with small
cardiac neoplasms. But it is not known whether
adjuvant chemotherapy may be benefitial in patients in whom "curative" surgery has been performed.
Chemotherapy must be considered as the first choice of
therapy in primary
cardiac tumors with extracardiac
metastases. Combination of several agents is more effective than single-agent
therapy. Radiation should be applied in less sensitive
tumors only if surgery is not feasible and prior
chemotherapy has failed. In patients in whom cardiac surgery was performed with a curative aim,
chemotherapy but not radiation is the adjuvant
therapy of choice. Patients with metastatic
tumors to the heart should be treated according to the established rules for the involved
tumor. Therapeutic strategy depends on the kind of
tumor and the cardiac structure involved.
Tumor spread to the pericardium will cause
pericarditis or
pericardial effusion up to
pericardial tamponade. Instillation of
tetracyclines,
isotopes and chemotherapeutic agents in the pericardial space have been successfully applied to prevent recurrent effusion. Radiation did prolong life in patients with pericardial
metastases as compared with repeated pericardiocentesis. Additional cardiac damage may be induced by radiation as well as by drugs. A trial with
chemotherapy can be useful in all sensitive
cardiac tumors.