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

Abstract

Abstract. Lung cancer presenting with a giant atrial tumor thrombus is particularly rare. Surgical resection, aided by a cardiopulmonary bypass, is the standard treatment of choice if there is no distant metastasis. However, this form of surgery carries a high risk, with the subsequent patient prognosis being extremely poor. The current study describes the case of a 52-year-old man presenting with left lung squamous cell carcinoma that had extended into the left atrium. The patient was treated with stereotactic radiotherapy, and regarding the atrial disease, a complete response was achieved within 12 months. The present case demonstrates that stereotactic radiotherapy may be a beneficial palliative treatment for patients with stage IV lung cancer invading the left atrium. IntroductionAdvanced 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). Furthermore, an associated intra-atrial tumor thrombus is particularly rare, with tumor thrombi potentially leading to widespread systemic embolization and/or outflow tract obstruction (4-6). As a result, treatment is always warranted. If there is no presentation of distant metastasis, surgical resection is considered as the gold-standard therapy. However, chemotherapy may also be administered. Cases of non-small cell lung cancer with associated intra-atrial tumor thrombi are usually diagnosed using enhanced computed tomography (CT).Due to the rarity of this condition, incidence and mortality rates remain unknown, however, patient prognosis is extremely poor with an overall survival time of 4-17 months (1,7). The present study reports the case of a patient with stage IV lung cancer with invasion into the left atrium, for which a complete response was achieved following treatment with stereotactic radiotherapy. Case reportIn April 2012, a 52-year-old man was admitted to the Center of Radiation Oncology, Wujing Hospital (Shanghai, China) presenting with a 3-month history of progressive dyspnea and coughing. The patient also had a history of hypertension and smoking. An enhanced CT scan (Optima CT660 FREEdom; GE Healthcare, Piscataway, NJ, USA) revealed a left hilar tumor wrapped around the left pulmonary artery and vein, along with a large mass in the left atrium (Fig. 1A). A transbronchial biopsy was performed. Subsequently, tissue was formalin-fixed (Shanghai Ziyi Reagent Factory, Shanghai, China) paraffin-embedded (Leica Microsystems, Ltd., Milton Keynes, UK) and cut into 4 µm sections for hematoxylin and eosin (Baso Diagnostics Inc., Zhuhai, China) staining and immunohistochemistry. The biopsy revealed that the primary site was consistent with nests and trabecula of carcinoma cells proliferating with necrotic debris and intercellular bridges structures ( Fig. 2A and B)...

Silent Neoplastic Cardiac Invasion in Small Cell Lung Cancer: A Case Report and Review of the Literature

“…The patient had no acute complications from radiation, and in fact had complete resolution of her intra-cardiac disease within 3 months. Similarly, Li et al reported the use of SBRT to deliver a 40 Gy total dose in 10 fractions for an atrial tumor thrombus from NSCLC [ 2 ]. A complete response was achieved within 12 months and no cardiac toxicity was noted.…”

“…Autopsy reports have demonstrated that up to 7% of all cancer cases have cardiac metastases and up to 10% of bronchogenic tumors have atrial invasion [ 1 ]. However, the literature shows limited reports of small cell lung cancer (SCLC) patients with neoplastic cardiac invasion [ 2 – 7 ]. In addition to cardiac invasion, brain metastasis is another fatal complication that occurs in up to 70% of SCLC patients with advanced disease [ 8 ].…”

“…In such cases, radiotherapy is an alternative local treatment option. Recent studies reported the use of radiotherapy in non-small cell lung cancer (NSCLC) invaded into the heart [ 1 , 2 ]. Treatment outcomes were very promising and treatment-related cardiac complications are not common.…”

Resection of Lung Cancer with Left Atrium Extension via the Pulmonary Vein: Case Report

“…Although several studies have demonstrated potentially beneficial palliative effects of stereotactic radiotherapy in patients with stage IV lung cancer invading the left atrium [8] [9], surgical resection remains the historical gold standard treatment. The 5-year survival rate among 44 patients receiving left atrium resection was 22%, including six cases without distant metastasis who experienced long-term survival over 5 years [10].…”

“…LA Open Journal of Thoracic Surgery [8], surgery combined with chemotherapy was the most common treatment for this condition, with survival times ranging from 4 -17 months.…”