Brain metastasis, haemorrhage common in cardiac angiosarcoma, require early intervention

Brain metastasis usually develops in patients with cardiac angiosarcoma (CA), and their risk of intracranial haemorrhage (IH) is high, results of a study have shown. This leads to an alarming rate of terminal haemorrhage (TH) despite normal platelet counts.

Early diagnosis and intervention are needed, according to the authors.

Twenty-six consecutive patients with brain metastases treated between 1988 and 2020 were identified from a departmental CA (n=103) database and subsequently evaluated. The authors recorded the causes of death. TH was defined as an IH that caused death or prompted a transfer to a hospice.

Brain metastases developed in 26 of 103 patients (25 percent). Of these, 23 (88 percent) had IH, including 21 (81 percent) at initial diagnosis, of which 18 (86 percent) were hospitalized. The median platelet count was 235 k at the time of IH.

Majority of the patients succumbed to the disease (n=23, 88 percent), and more than half died from TH (n=13, 57 percent). TH occurred in six patients at brain metastasis presentation, while three (23 percent) had TH from known but untreated lesions, two (15 percent) had continued uncontrolled IH during radiation therapy, and two (15 percent) from new brain metastasis. Platelet count <50 k did not correlate with TH (p=0.25).

Moreover, nine patients (35 percent) had subsequent IH. None of those who completed radiation therapy (n=10) for brain metastasis died from TH.

“We recommend surveillance brain imaging, and importantly, once BM is detected, prompt local therapy is warranted to try and mitigate the risk of TH,” the authors said.