RESULTS:
On initial search of the medical records, 100 patients were identified.
Of these, only 50 met the study criteria. A total of 50 patients were
included in the final analyses. The remaining patients either did not
meet the age criteria (below 21 years) or on further detailed review of
the imaging, did not have a tumor thrombus. Patient characteristics are
summarized in Table 1. Most patients (n=13, 26%) had hepatoblastoma,
followed by osteosarcoma (n=7, 14%) (Figure 1). Eighteen patients
(36%) had tumor thrombus confined to the inferior vena cava (IVC) and
12 patients (24%) had tumor thrombus extending beyond the IVC to the
heart. For the remaining patients, tumor thrombus was limited to the
invasion of local draining vessels. The diagnostic imaging modalities
most frequently identifying tumor thrombus were CT (48%) and MRI
(40%). Echocardiogram was performed for all patients who had an IVC or
intracardiac tumor thrombus. Seventy percent (35/50) of tumor thrombus
cases on imaging were confirmed by pathological examination. 31 of these
35 patients underwent surgical resection, and for the remaining
patients, tissue for pathology was obtained on tumor biopsy (n=3) or
during thrombectomy (n=1).
Overall, 5 patients received upfront surgery and 6 did not receive any
cancer-directed therapy due to relapsed terminal disease. All others
received pre-operative chemotherapy (n=39, 78%). Cardiac bypass was
required in 5 of the 12 patients with intracardiac tumor thrombus at the
time of surgical resection of the primary tumor and tumor thrombus.