Radiation therapy and the heart

Factors involved in irradiating primary and secondary cardiac neoplasms have received increasing consideration in recent years. Antemortem diagnosis of tumor involvement of the various structures of the heart has been made possible through the development of sophisticated noninvasive echocardiography and nuclear medicine procedures so that various surgical approaches may now be considered as viable therapeutic methods using modern cardiopulmonary bypass technology. Advances in chemotherapy of soft tissue sarcomas have now made it possible to consider the application of general principles learned with this method for treatment of primary malignant tumors of the heart, most of which are sarcomas of one variety or another. Although primary neoplasms of the heart are being diagnosed with increasing frequency, they are still considered unusual in the general practice of oncology. Primary cardiac neoplasms usually have been approached as a surgical disease thus far. The histologically malignant tumors of mesodermal origin have a propensity for local recurrence and are considered to be invariably fatal. It is this group of tumors that should be considered for clinical trials using surgery, radiotherapy, and chemotherapy. The primary challenge of radiotherapy in these tumors rests with the ability to deliver effective doses of radiation without producing serious toxicity to the tissues of the heart