Systematic Review: Cardiac Metastasis of Lingual Squamous Cell Carcinoma

INTRODUCTION: Lingual squamous cell carcinoma (LSCC) is an aggressive malignancy that carries significant mortality risk and the potential for cardiac metastasis. The authors performed a systematic review designed to characterize disease progression of LSCC cardiac metastasis by evaluating patient demographics, characteristics, management, and clinical outcomes. METHODS: Two authors independently screened articles in Embase, PubMed, and Cochrane Database of Systematic Reviews up until December 2019 for study eligibility. Demographic data, patient symptomatology, imaging findings, management strategies, and patient outcomes were obtained and analyzed. The Oxford Centre for Evidence Based Medicine (OCEBM) Levels of Evidence categorization was implemented to determine the quality of studies selected in this review. RESULTS: From this review, a total of 28 studies met inclusion criteria and received an OCEBM Level 4 evidence designation. Thirty-one patients were identified with cardiac metastasis from LSCC. Shortness of breath (29.0%) and chest pain (29.0%) were the most common presenting symptoms, and pericardial effusion (29.2%) and right ventricular outflow tract obstruction (25.0%) were the predominant echocardiogram findings. Cardiac metastases most often presented in the right ventricle (56.7%), followed by the left ventricle (43.3%). Palliative intervention (68.2%) or chemotherapy (40.9%) were typically implemented as treatments. All sample patients expired within one year of metastatic cancer diagnosis in cases that reported mortality outcomes. CONCLUSIONS: Patients presenting with shortness of breath, tachycardia, and a history of squamous cell carcinoma of the tongue may indicate evaluation for LSCC cardiac metastasis. Although LSCC cardiac metastases typically favor the right and left ventricles, they are not exclusive to these sites. Palliative care may be indicated as treatment due to high mortality and overall poor outcomes from current interventions.