Classification of malignant cardiac tumors with respect to oncological treatment.

Because of the small incidence of primary cardiac neoplasms there have been no randomized clinical trials to establish rational therapeutic strategies. Surgery is the first choice of therapy in all patients with small cardiac neoplasms. But it is not known whether adjuvant chemotherapy may be benefitial in patients in whom "curative" surgery has been performed. Chemotherapy must be considered as the first choice of therapy in primary cardiac tumors with extracardiac metastases. Combination of several agents is more effective than single-agent therapy. Radiation should be applied in less sensitive tumors only if surgery is not feasible and prior chemotherapy has failed. In patients in whom cardiac surgery was performed with a curative aim, chemotherapy but not radiation is the adjuvant therapy of choice. Patients with metastatic tumors to the heart should be treated according to the established rules for the involved tumor. Therapeutic strategy depends on the kind of tumor and the cardiac structure involved. Tumor spread to the pericardium will cause pericarditis or pericardial effusion up to pericardial tamponade. Instillation of tetracyclines, isotopes and chemotherapeutic agents in the pericardial space have been successfully applied to prevent recurrent effusion. Radiation did prolong life in patients with pericardial metastases as compared with repeated pericardiocentesis. Additional cardiac damage may be induced by radiation as well as by drugs. A trial with chemotherapy can be useful in all sensitive cardiac tumors.