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.