Sarcoma: Cardiovascular and Oncologic Considerations

Sarcomas are a heterogeneous group of connective tissue tumors that can occur at any anatomical site. This includes the heart and great vessels, where angiosarcoma, leiomyosarcoma, intimal sarcoma, and undifferentiated sarcomas are the dominant histologic subtypes. These presentations are as complex as treatment planning, which often requires a multimodality approach. For these tumors, as well as sarcomas in other sites, multiple treatments carry risks of cardiotoxicity. Crucially, treatment universally includes high cumulative doses of anthracyclines, requiring risk modification using dexrazoxane, infusional administration, or liposomal formulations. Furthermore, multiple other therapies for sarcoma are associated with cardiovascular side effects. This review highlights the unique aspects of care for cardiac sarcomas, cardiovascular considerations of systemic agents used to treat sarcoma, the pediatric sarcoma population, and how cardiac surveillance of sarcoma patients can be approached.