Change of heart.

Inoperable primary cardiac sarcoma historically has been viewed as a death sentence. But in the era of SBRT for V-tach, is there more on the table for these patients than open heart surgery? This retrospective case series suggests, why yes, these patients can also hop on the table for definitive radiation. The only small caveat to widespread adoption was the universal use of a 0.35-Tesla MR linac for initial and on-treatment adaptive planning at the two institutions in Munich and Rome where these four patients were treated between May-September 2020. What’s more, they used automated cardiac (that’s right, cardiac) gating with real-time anatomy structure tracking via 4-D MRI capturing four frames per second. All patients had recurrences salvaged after surgery and received 6-7 Gy x 5 to a 3-5 mm expansion off gross tumor. Granted, the efficacy of such an amazingly high-tech approach remains to be seen, but at least we know we can do it. | Corradini, Radiat Oncol 2021

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