Introduction: Cardiac metastasis from NET are rare with little information to guide management strategies. Previous case reports discuss varying strategies including observation, somatostatin analogues (SSA), chemotherapy, radiotherapy and resection. We present a single institution experience of managing such cardiac metastases.
Methods: We retrospectively searched the NET multidisciplinary database at a single centre in Queensland, Australia over the period of 2007 to 2015.
Results: Out of 194 patients we found 4 with intra-cardiac metastases and 8 others with para-cardiac metastases. Of the intra-cardiac metastasis, all patients had a grade 1 small bowel primary NET with multiple sites of metastases. Cardiac metastasis was always diagnosed on routine imaging with gallium-68 DOTATATE PET imaging. Of the four patients, one patient did not receive SSA and was managed with observation alone. One patient, who had progressive peritoneal metastases on SSA, received four cycles of Peptide Receptor Radionucleotide Therapy (PRRT) with lutetium-177 DOTATATE without cardiac complications. No patients underwent resection of the cardiac metastases. With a median duration of 2 years post diagnosis of cardiac metastasis, all patients are alive with stable disease and no cardiac complications.
Conclusion: With better diagnostic techniques cardiac metastases from NET are more likely to be diagnosed incidentally. Our experience suggests they can be managed with observation, SSA or PRRT without cardiac sequelae.