Test No.1: Can we save the life of the World’s eighth Cardiac Angiosarcoma Patient?
On 18th and 19th of April, 2003, the "Yangcheng Evening News" published a news article that carried a headline: "First patient with cardiac angiosarcoma to survive" with the sub-title: "Applying hand pressure for four hours to stop bleeding during surgery, 8000 ml of blood transfusion and three-months’ Hospitalization for observation"; the Nanfang Daily’s headline was:" the world's eighth case of successful treatment of a rare Disease” with the subtitle: First Cardiac angiosarcoma Patient in China Discharged”. The Guangzhou Daily carried the headline: “Heart Squeezed into Cucumber Shape” with the subtitle: Eighth World’s Cardiac Angiosarcoma Patient Rescued in Guangzhou”.
The story goes back to November 2002. Our hospital received an e-mail that read: "Wang Qian Qian, female, 16years old suffering from cardiac angiosarcoma for half a year. Undergone an operation in Beijing now relapses and pleading a helping hand from medical experts.”
Among various malignant tumors, cardiac tumors rarely occur. Occurrence of cardiac tumors outside of the pericardium is even rarer. The rarest is cardiac angiosarcoma, which is much more malignant than any other cancer. I immediately searched the Internet for the "Medline" site, and found that from 1978 till present, there were only seven cases of cardiac angiosarcoma detected in the world; all the seven patients died from it within a period of three months after diagnosis.
If we decided to treat Wang Qian Qian, it would be the eighth case in the world. Can we cure her? We carefully studied and analyzed a variety of conditions and came to an agreement that application of the latest technology available might work. We immediately responded and said, “We may not have the experience to treat cardiac angiosarcoma, but we are willing to try!”
On 3rd January 2003, Qianqian, accompanied by her parents, came to our hospital. We were astounded to see that her actual condition was much more serious than we had imagined. Chest X-ray and CT showed that there were numerous tumors within the pericardium; the largest was about 13.4cm long. The heart was being squeezed into the shape of a cucumber. She was panting non-stop, unable to lay flat on her back. Her head was down and was coughing badly. All this indicated that she had severe cardiac tamponade.
Qianqian’s parents told us that sometime in September 2002, while Qianqian was a senior 2 student in the affiliated high school of Beijing Normal University, she suddenly experienced chest tightness, palpitations, shortness of breath and vomited frequently. She was sent to a local hospital for ultrasound and CT. A big lump was detected by the side of her heart. She was referred to a cardiology hospital in Beijing. The hospital conducted examinations on her immediately and diagnosed her of pericardial growth. She underwent surgery a week later and it was confirmed that she had cardiac angiosarcoma. The doctor told the parents that there was almost 100% chance of recurrence.
As predicted, a month later, Qianqian experienced shortness of breath again. On 1st November, her shortness of breath intensified and she was admitted into the same hospital. A group consultation by doctors ruled out the option to perform another surgery. The father was adamant and unwilling to accept this harsh reality. He visited all the major hospitals in Shanghai, Shenyang, Wuhan, and Tianjin but got the same answer.
Qianqian's father was the CEO of a Beijing-based transport company. In tears he told us: “We find hope in you. For the sake of my daughter and that of other patients who are suffering from the same sickness, I urge you to give it a try boldly. Even if it turns up to be a failure, it will serve as a contribution to mankind.”
We studied Qianqian's condition over and over again and came up with a treatment plan: A combination of surgery, cryoablation, brachytherapy and local immunization. We were all prepared to sit for an unprecedented “Test”.
6th January 2003, the chief surgeon, Dr. Niu Lizhi conducted an exploratory thoracotomy. It was found that the entire pericardial cavity was filled with tumors! Should we proceed with the operation or stop the operation? If we chose not to proceed, there would be no risk and the patient’s family members would not blame us but it was likely that she would die of heart failure just like all the former seven patients. If we chose to proceed, it was expected that we would not be able to remove all the tumors. However, how were we to deal with the problem of unstoppable bleeding? The young 16 years old patient might die on the operating table. Though the family members might be mentally prepared for this consequence, we would not be willing to accept such fate! None of us would accept it!
After obtaining the consent of Qianqian’s next of kin, we proceeded with the scheduled surgery. Firstly, we removed patches of tumors carefully from the pericardial cavity. The residual tumors were frozen by cryoablation. 125iodine seeds were then implanted into the tumors followed by capsule implantation at tumor bed. After operation, Qianqian’s condition improved. Two weeks later, she was able to walk. Re-examination using ultrasound and CT detected that liquefaction necrosis occurred within the residual tumors, which showed significant shrinkage.
3rd March 2003 was Qianqian’s 17th birthday. Since the time of her birth was 3:30p.m. , the nurses and other medical staff brought in a bouquet of flowers at 3:30p.m and wished her a happy birthday. The ward was filled with songs and words of good wishes to Qianqian lingered in the heart of everyone.
The evening of 17 April 2003, the hospital held a thanksgiving dinner for the recovery of Qianqian who would be discharged for recuperation at home. Her parents and reporters came with bouquets of flowers and wish her a happy recovery and recommencement of her life journey.
Qianqian died of pulmonary infection seventeen months later. Although she managed to live much longer than any of the post-operative survival time recorded in medical literature, we were very much saddened and full of regret. For this ‘test’, we can only give ourselves a marginal pass. However, the experience we gained from treating Qianqian has enabled us attain success on other patients. About a year later, a patient with mesothelioma of pericardium from Hubei came to our hospital for treatment after she had read newspapers’ reports on the treatment we provided to Qianqian. An account of her treatment in our hospital appears in our book “Cryosurgery for Cancer” as below:
Female, 57 years old. Pain at chest and back. Went to a local hospital for CT and MRI and discovered to have heart lesions. Physical examination: Heart beat felt at 2cm from the fifth intercostal space at left midclavicular line. Heart rales extending to left side. Regular rhythm, heart beat 90/min, heart sound distant away. Exploration of chest under full anesthesia, found mesothelioma of pericardium around front of heart touching part of diaphragm, difficult to separate and remove. Direct view cryoablation; 2mm and 3mm cryo-probes were inserted into tumors consecutively; 2 cycles of freezing and thawing. 20 iodine-125 seeds implanted at rims of cryoablation areas. Post-operative pathological report: Malignant mesothelioma of pericardium. 3 follow-ups after discharge. Final follow-up 35 months later. Ultrasound and CT examinations, no recurrence detected. Patient led a normal life did house chores. Patient died 49 months later due to cancer recurrence and lung infection. The patients had survived far longer than any other patients with the same disease ever recorded in medical literature.