Radiotherapy is effective for a primary lung cancer invading the left atrium

Abstract

Atrial involvement is an uncommon feature of advanced non-small-cell lung cancer, occurring in up to 10% of patients with bronchogenic carcinoma. Additionally, cardiac metastases from other sources are documented in up to 7% of cancer patients at autopsy. Because atrial invasion can lead to systemic embolisation and/or outflow obstruction, it is treated regardless of the overall prognosis. While the gold standard treatment has historically been surgical resection, advances in radiotherapy allow for the safe treatment of cardiac disease. Here we present the case of a woman with pulmonary adenocarcinoma of the left lower lobe that progressed to invade the pulmonary vein and left atrium while maintained on standard chemotherapy. She was treated with intensity-modulated radiotherapy and had a complete response in terms of her atrial disease within 3 months. She suffered no acute toxicity or complications as a result of the radiation therapy.

Stereotactic radiotherapy for the treatment of lung cancer with a giant left atrial tumor thrombus: A case report and literature review

“…In particular, the risk of pericardial and coronary artery disease is significantly limited with strategies such as a deep inspiratory breath hold. Improved dose-delivery techniques also increase the utility of radiation (1,25). The 18 previous cases (1,(5)(6)(7)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) show that surgery combined with chemotherapy is the most common treatment for this condition, however, prognosis remains extremely poor, with overall survival times ranging between 4 and 17 months.…”

“…To the best of our knowledge, there have only been 18 cases published in the English literature over the last two decades. In these 18 cases, squamous cell carcinoma was the most common pathological type and was present in 5 cases (7,9-12), followed by 4 neuroendocrine carcinoma cases (13-16), 3 adenocarcinoma cases (1,17,18), 3 sarcoma cases (5,6,19), 1 large cell carcinoma case (20) and 1 neuroectodermal tumor case (21). The pathology of a further case was reported as sarcoma mixed with squamous carcinoma (16); although histopathological examination demonstrated that the primary tumor was poorly-differentiated, the cardiac and intravascular portions of each tumor were less differentiated and more necrotic than the primary focus in the lung (3).…”

“…In a previous case, intensity-modulated radiotherapy (50-Gy dose) was delivered to a lung tumor and intra-atrial lesion, with the patient experiencing no acute side effects from the radiation and a complete response of the intracardiac disease within 3 months (1). Modern radiation oncology techniques, including stereotactic and intensity-modulated radiotherapy, have greatly reduced the risk of radiation-associated heart disease by delivering a high dose directly to the tumor, and a sharp dose-gradient to the adjacent normal heart and other organs (1,25). Furthermore, due to the increased precision of modern radiotherapy, a smaller margin is applied to the gross tumor volume to overcome daily set-up or tumor motion uncertainty.…”

“…Advanced non-small cell lung cancer with associated atrial involvement is uncommon, occurring in ~10% of patients presenting with bronchogenic carcinoma (1,2). Patients with the disease usually possess circulatory and respiratory symptoms, and coughing, hemoptysis, dyspnea, weight loss and an extremely poor performance status are the typical associated features (3).…”

Non Small-Cell Lung Cancer Metastatic to the Mitral Valve: Case Report and Review of the Literature

“…In all cancer patients, somewhere between 10% and 15% of patients have been found to have cardiac metastases on pathologic examination [8]. This number holds true with NSCLC, which has been estimated to invade the cardiac atria in up to 10% of cases [9]. To our knowledge, however, the specific incidence of mitral valve involvement with NSCLC is unknown.…”