Session Item

To present a systematic review - based on a case report - on patients with cardiac metastasis from cervical cancer.

A systematic literature search employing PRISMA guidelines focused on case reports about cardiac metastases from cervical cancer. PubMed was queried using the following search terms: (((*card* OR heart) AND metast*) AND ((cervic* OR uter*) AND cancer)); Scopus, using ("cardiac metastasis" AND  "cervical cancer"), Web of Science with ((TS=(uter* AND cervi*)) AND (TS=(card* AND metast*))),  CENTRAL with (Disease: cervical cancer/cervix cancer/cervix dysplasia/cervical dysplasia/; Additional terms: card* metast*) and ClinicalTrials.gov via “Disease: cervical cancer/cervix cancer/cervix dysplasia/cervical dysplasia; Additional terms: card* metast*”. Searches were conducted in December 2019, an e-mail-alert was created for PubMed and Web of Science that was followed until May 2022. Based on the search results, a title search was conducted, followed by an abstract search and a full text search. The search was supplemented by cross-referencing the cited references of relevant papers.

Eighty-one papers were identified describing 86 cases in total. Cardiac metastasis occurred at all stages of cervical cancer and in all age groups. Median time from initial diagnosis to diagnosis of cardiac metastasis was 12 months, ranging from no time to more than ten years. Dyspnea (69%), chest pain (31%), deteriorating general condition and arrhythmias (both 11%) were the main reported symptoms due to cardiac metastasis, whilst 9% of patients had no symptoms. ECG findings were reported in 51 cases and were pathologic in 31 patients. The cardiac mass was most frequently detected by transthoracic echography. The most common tumor histology was squamous cell carcinoma. Chemotherapy and surgical interventions were the main treatment modalities. Median time of survival after diagnosis of cardiac metastasis was 3 months, with 14% of patients surviving for more than 1 year and 21% of patients surviving for less than a month. Of the cases with known survival time (n=63), median survival was 5 months in patients who had cardiac surgery (n=25) versus 2.5 months in those who had no cardiac surgery (n=38).

This largest review on cardiac metastases from cervical cancer confirmed the heart as a very infrequent site of metastasis. There are <100 cases described in the literature with very poor prognosis and undefined clinical management.