Advanced cardiac imaging (CMR and PET-CT) and standardized frailty scores can successfully guide and monitor chemotherapy and radiotherapy in elderly patients with primary cardiac lymphoma.
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May support imaging- and frailty-guided therapy in elderly cardiac lymphoma; hypothesis-generating, prospective validation required.
A tumour encasing the right coronary was identified on computed tomography pulmonary embolism protocol in an 81-year-old man. Concerns regarding tolerability of chemotherapy in an octogenarian were addressed using cardiac magnetic resonance imaging to monitor a trial of modified-chemotherapy for his primary cardiac B-cell lymphoma. Residual activity on positron emission tomography computed tomography mandated consolidation with radiotherapy to achieve a tumor-free return to health. Despite advanced age, successful therapy in this, the oldest case of primary cardiac lymphoma reported, was facilitated by monitoring treatment effectiveness with advanced cardiac imaging and the use of standardized frailty scores in communicating his appropriate level of robustness for tolerating chemotherapy.
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Pollak et al. (2019) studied this question.
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