Induction chemoradiotherapy prior to surgery for non-small cell lung cancer invading the left atrium

Abstract

We present a case of a 58-year-old man with diagnosis of lung adenocarcinoma invading the left atrium. He was treated with induction chemoradiotherapy for T4N1M0 disease, showing objective response. Then, a left upper lobectomy with a partial resection of the left atrium was performed without cardiopulmonary bypass. No residual tumor cells existed in the resected specimens, showing pathological complete response. Our case suggests that induction chemoradiotherapy prior to surgery can be an appropriate strategy among carefully selected patients with nonsmall cell lung cancer invading the left atrium. #

Bilateral Trans-Septal Approach to Right Lung Cancer Invading the Left Atrium

“…3) Although the use of chemotherapy is usually reserved for patients with N2 or chest wall involvement, the role of induction or neoadjuvant chemotherapy or chemoradiotherapy in T4-NSCLC patients remains unclear. Induction chemoradiotherapy 2) is reported to be useful for management of locally advanced NSCLC invading the LA and may enable CPB to be avoided during surgery, and we could not find a report of tumor thrombus developed after induction therapy. However, tumor thrombus was reported in the cases with the tumor extended into the LA, [4][5][6] and the fatal case was reported.…”

“…Tumor invasion to the LA may occur as a result of direct invasion of a primary tumor or lymph node metastasis, or invasion of a contiguous tumor through the PV draining from the primary site. 2) Although the latter type is less frequent, special attention must be paid to tumor emboli during surgery, especially when the tumor exhibits polypoid extrusion. Surgery for non-small-cell lung carcinoma (NSCLC) including LA resection usually 4involves vascular clamping, but when the tumor is growing in the LA, resection of the LA by clamping, and simple manipulation is considered inappropriate in terms of the completeness of resection and safety.…”

Remarkable Response to Cisplatin Doublet Chemotherapy in Pulmonary Metastasis With Left Atrial Extension From a Nasopharyngeal Cancer

“…Modern induction chemotherapy has been shown to bring left atrial extension from lung cancer into remission successfully and make complete resection of residual pulmonary tumor possible without the aid of cardiopulmonary bypass, reducing the surgical risk to a great degree [15]. It seems confident to say that shrinkage of tumors invading left atrium with intensive systemic chemotherapy should also be the first step of treatment prior to surgical procedures of curative intent for chemotherapy-sensitive metastasis from other primary sites including nasopharyngeal carcinoma.…”

An aberrant case of rapidly progressing lung adenocarcinoma in a Ukrainian refugee

“…Lung adenocarcinoma with ALK gene rearrangement is a specific molecular subtype of lung adenocarcinoma [1] characterized by a high ability to give rise to distant metastases, including heart cavities. Mechanisms by which LA involvement occurs may be direct invasion by the primary tumor, involvement of lymph nodes, or, the least common, pulmonary venous transfer of the original lesion [2]. The condition requires surgery, which, however, may involve the risk of neoplastic dissemination, hemorrhage, and a higher probability of infection [3,4].…”