Capecitabine Plus Bevacizumab for Cardiac Metastasis of Sigmoid Colon Cancer: Case Report and Literature Review

Abstract

Background/aim: Right ventricular cardiac metastasis from colorectal cancer (CRC) is rare and clinically silent. There is no standardised treatment. To date, only twelve cases have been reported in the literature. This is a case report and literature review of right ventricular cardiac metastasis from CRC.

Case report: A 75-year-old woman with a history of CRC treated with sigmoidectomy followed by liver and lung metastasectomy presented with a right ventricle tumour. Biopsy showed metastatic adenocarcinoma not suitable for resection because multiple lung metastases coexisted. The metastases were controlled for a prolonged duration by chemotherapy with capecitabine plus bevacizumab. According to the review of 13 cases, the median age of metastatic CRC that involves the right ventricle is 71 years and the primary site is half the colon and rectum. Half of cases have non-cardiac metastases at cardiac metastasis diagnosis. Chemotherapy is more suitable than resection in cases with metastases other than heart because resection of the right ventricle has a high risk.

Conclusion: Cardiac right ventricular metastasis from CRC can be controlled by capecitabine plus bevacizumab.

Keywords: Bevacizumab; capecitabine; cardiac metastasis; colorectal cancer; right ventricle.

Figure 1. (A, B) Computed tomography (CT) showing a tumour, measuring approximately 20 mm, in the right ventricle of the heart. (C, D) CT showing two small lesions, suspected to be metastasis from the colorectal cancer in the left lung. (E) 18F-Fluorodeoxyglucose positron emission tomography showing a significant fluorodeoxyglucose uptake in the right ventricular mass (SUVmax: 3.2). (F) T1-weighted magnetic resonance imaging (MRI) showing a slightly high intense mass, measuring 20 mm, compared to the intact myocardium. (G) T2-weighted MRI showing the right ventricle with an irregular, isointense mass

Figure 2. Changes in metastatic lesions evaluated by computed tomography (CT) during capecitabine plus bevacizumab chemotherapy. The metastatic lesions remained approximately the same size. (A-C) CT findings of cardiac ventricular metastasis, (D-F) CT findings of one of the left lung metastases. (A, D) Baseline CT findings at the start of chemotherapy. (B, E) CT findings at 9 months after starting chemotherapy. (C, F) CT findings at 17 months after starting chemotherapy

Figure 3. The clinical course of the patient and the carcinoembryonic antigen level