Take it to heart.

How would you treat a cardiac metastasis? That’s a great question. Hepatocellular carcinoma has a propensity, albeit still rare, for tumor thrombus to the right atrium via direct inferior vena cava drainage. This report out of Harvard hobbles together a full 10 patients receiving palliative treatment for hepatocellular tumor thrombus to the right atrium. And these thrombi ain’t small, here at an average size of 7.5 cm. Most were treated with 45 Gy in 15 fractions to the entire tumor thrombus. While outcomes were poor, likely owing to the population, atrial tumor control was favorable and radiation toxicity was mild. TBL: In case it ever comes up, 45 Gy in 15 fractions appears fairly safe and effective at short-term palliation of right atrial tumor thrombus from HCC. | Bitterman, Pract Radiat Oncol 2020