Objective: Therapeutic options for patients with non-small cell lung cancer (NSCLC) and compromised hearts are limited. Such individuals are not often included in randomized trials. Therefore, optimal therapy in this particular group of people is unclear. We present our experience using radiotherapy for NSCLC in eight patients with cardiac compromise because few reports of patient outcomes exist.
Methods: Between 1993 and 2003, eight individuals with compromised hearts (necessitating pacemaker assistance, coronary artery bypass surgery, or cardiac valve replacement) were treated by radiation alone (7 patients) or with chemotherapy (1 patient) for lung cancer. The mean follow-up period was 12.5 months.
Results: At diagnosis, the average patient age was 62 years. In most patients, tumor histology was non-small cell cancer, the disease stage was advanced (stage III, 5 patients or IV, 3 patients), and a long history of smoking was documented. The survival rates at 6 months, 1 year, and 2 years were 50%, 25%, and 25% respectively. The median survival was longer in patients with stage III compared to that of persons with stage IV disease (11 months and 3 months respectively, p=0.04). There were no adverse cardiac events during and after irradiation.
Conclusion: The presence of cardiac compromise in lung cancer patients should not be viewed as a general contraindication for radiotherapy. Management of these neoplasms by radiation deserves consideration because this treatment could favorably influence survival in select patients with advanced, non-disseminated malignancy.
Although most patients with advanced lung cancer and coexisting, significant cardiac disorders may not live long enough to develop delayed cardiovascular sequelae, radiotherapy should be administered with great caution to these individuals.
Federico Ampil, None.