Peri-operative nab-paclitaxel with sequential radiotherapy in cardiac angiosarcoma: A single-center retrospective cohort study.

Abstract

e23549 Background: Primary cardiac angiosarcoma (PCA) is an extremely rare and highly aggressive soft-tissue sarcoma. Due to the anatomical complexity of the heart, complete surgical resection is almost impossible, rendering adjuvant therapy critical for improving postoperative outcomes. Currently, there is no consensus on the optimal adjuvant strategy. While paclitaxel-based chemotherapy has demonstrated promising efficacy in recurrent or metastatic settings, its role in the adjuvant setting remains undefined. Here, we report our initial experience using adjuvant albumin-bound paclitaxel (nab-paclitaxel) and sequential regional radiotherapy in a small cohort of PCA patients. Methods: We retrospectively included six patients with the definite diagnosis of PCA who underwent surgical resection followed by adjuvant nab-paclitaxel at Peking Union Medical College Hospital between 2023 and 2025. Results: The cohort included 4 females and 2 males, with a median age of 33.5 years (range: 25–43). All tumors were localized to the right atrium or adjacent structures, with stage T1-3N0M0. The median maximum diameter was 6.85 cm (range: 4.6–10.2). Five patients (P01-5) received adjuvant nab-paclitaxel, while P06 received neoadjuvant and adjuvant nab-paclitaxel. In addition, 3 patients (P01, P02, P04) received adjuvant radiotherapy. At a median follow-up of 14 months, the median progression-free survival (PFS) was 8 months (range: 2 to 30+; 2 patients censored), and the median overall survival (OS) was 24 months (range: 6+ to 30+; 3 patients alive). Treatment was generally well tolerated, with no serious adverse events leading to discontinuation. Conclusions: This small series suggests that adjuvant nab-paclitaxel and sequential regional radiotherapy is a feasible strategy for patients with resected PCA. The addition of neoadjuvant nab-paclitaxel appears safe in selected cases. Multi-institutional collaboration and prospective studies are urgently needed to validate the safety and efficacy of perioperative nab-paclitaxel in this ultra-rare malignancy. Individual baseline characteristics and treatment. Patient Sex Age (y) Stage Maximum diameter (cm) Primary site Chemotherapy Radiotherapy PFS (m) OS (m) P01 M 31 T2N0M0 8 Lateral wall of right atrium Nab-paclitaxel (adjuvant) Spiral tomography radiotherapy (TOMO) 5 (liver metastases) 24 (hepatic failure) P02 F 35 T1-2N0M0 8 Anterior wall of right atrium Nab-paclitaxel (adjuvant) Radiotherapy 30+ 30+ P03 M 25 T2N0M0 4.6 Right atrium Nab-paclitaxel (adjuvant) 2 (local recurrence, lung metastases, bone metastases?) 10 (progression) P04 F 34 T2N0M0 5.6 Right atrium Nab-paclitaxel (adjuvant) Radiotherapy 11 (local recurrence) 18+ P05 F 43 T2N0M0 5.7 Right atrium Nab-paclitaxel (adjuvant) 5+ 6+ P06 F 33 T2-3N0M0 10.2 Right atrium Nab-paclitaxel (neoadjuvant and adjuvant) 4 (lung metastases) 6+