Intimal sarcoma of the pulmonary artery treated with neoadjuvant radiation prior to pulmonary artery resection and reconstruction

Alexander Allen; Steven C Smith; Raghavendra Pillappa; Sosipatros Boikos; Benjamin Medalion; John Grizzard; Anthony Cassano; Timothy Harris

doi:10.1016/j.rmcr.2021.101414

Intimal sarcoma of the pulmonary artery treated with neoadjuvant radiation prior to pulmonary artery resection and reconstruction

Respir Med Case Rep. 2021 Apr 27:33:101414. doi: 10.1016/j.rmcr.2021.101414. eCollection 2021.

Authors

Alexander Allen¹, Steven C Smith², Raghavendra Pillappa³, Sosipatros Boikos⁴, Benjamin Medalion⁵, John Grizzard⁶, Anthony Cassano⁵, Timothy Harris⁷

Affiliations

¹ Department of Radiation Oncology, Virginia Commonwealth University School of Medicine, 401 College Street, Richmond, VA, 23298-0037, USA.
² Department of Pathology, Division of Anatomic Pathology, Virginia Commonwealth University School of Medicine, 1200 East Marshall Street, Gateway Building, 6th Floor, Room 205, Box 980662, Richmond, VA, 23298-0662, USA.
³ Department of Pathology, Division of Anatomic Pathology, Virginia Commonwealth University School of Medicine, 1200 East Marshall Street, Gateway Building, 6th Floor, Room 204, Box 980662, Richmond, VA, 23298-0662, USA.
⁴ Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University School of Medicine, 1201, East Marshall Street, 11th Floor, Suite 11-206, Box 980070, Richmond, VA, 23298-0230, USA.
⁵ Department of Surgery, Division of Cardiothoracic Surgery, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, 7th Floor, Box 980645, Richmond, VA, 23298-0068, USA.
⁶ Department of Radiology, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, North Wing, Room 2-013, Box 980470, Richmond, VA, 23298-0470, USA.
⁷ Department of Radiation Oncology, Virginia Commonwealth University School of Medicine, 401 College Street, Box 980058, Richmond, VA, 23298-0037, USA.

Abstract

Intimal sarcoma (IS) is a rare malignancy arising in the great vessels or heart, most commonly in the pulmonary artery, primarily treated with surgical intervention. We report a case of IS of the pulmonary artery diagnosed after an endarterectomy to remove a suspected pulmonary embolism. The tumor could not be entirely resected and showed interval growth at post-operative follow up. Neoadjuvant radiotherapy was then delivered to improve resectability. Imaging confirmed decreased tumor size, and a surgical resection with pulmonary artery reconstruction and right upper lobectomy was then successfully performed. Adjuvant gemcitabine and docetaxel was later initiated. Four months post-operatively, the patient is alive without disease recurrence. While prior reports in the literature document use of adjuvant chemotherapy and radiotherapy for treatment of IS of the pulmonary artery, no prior experience has documented utility of neoadjuvant radiotherapy for improvement of resectability. Our experience suggests that neoadjuvant radiation should be considered to improve resectability in cases of borderline resectable IS of the pulmonary artery.

Keywords: Endarterectomy; Intimal sarcoma; Neoadjuvant; Pulmonary artery; Radiation.

Publication types

Case Reports