Neuroendocrine neoplasms (NENs) are rare malignancies with intra-cardiac metastases (ICMs) considered to be uncommon entities with a reported incidence of approximately 0.7-4%. With the increasing use of DOTATATE PET CT to characterise NENs, ICMs are now more commonly detected but clinical implications of such detection remain largely unknown. Here, we report the real-life incidence and prognosis in a series of patients managed at a major tertiary centre subspecialising in the treatment of NENs.
We performed a retrospective audit of patients discussed at the NEN multidisciplinary team meeting (MDMs) at the Royal Brisbane and Women’s Hospital between January 2014 and June 2020. Patients were identified from the database used to record MDMs. Eligibility criteria were: age >/=18 years; histologically confirmed NEN and radiologically confirmed intra-cardiac NEN metastases.
Amongst 647 patients, 21 patients (3.2%) had ICMs from NENs. Location of these ICMs were: septal (42.9%); pericardial (23.8%); and within the atrium or ventricle (33.3%). Within our cohort, all patients were investigated using a DOTATATE PET CT. However, only 95.2% of ICMs were identified on DOTATATE PET CT; one was identified using FDG PET CT. Amongst the 21 patients, 10 had further characterisation using a cardiac MRI, whilst 4 patients had ICMs visible on echocardiography. 47.6% of patients with ICM received treatment with Peptide Receptor Radionuclide Therapy (PRRT) with no post-treatment cardiac complications noted.
Median survival from time of diagnosis of ICMs to death or end of audit period was 40 months. In total, 4 deaths occurred during the audit period with all deaths secondary to progression of systemic disease.
The real-life incidence of ICMs in NENs is similar to that reported in the literature. The presence of ICMs do not appear to influence prognosis for patients with NENs nor have major cardiovascular sequelae occurring post PRRT.