Abstract
Cardiac tamponade complicating malignant pericardial effusion from non-small cell lung cancer (NSCLC) is generally associated with extremely poor prognosis. With improved systemic chemotherapy and molecular targeted therapy for NSCLC in recent years, the prognosis of such patients and the value of invasive cardiothoracic surgery in this setting have not been adequately examined. We report outcomes from a contemporary case series of eight patients who presented with malignant cardiac tamponade due to NSCLC to an Australian academic medical institution over an 18 months period. Two cases of cardiac tamponade were de novo presentations of NSCLC and six cases were presentations following previous therapy for NSCLC. The median survival was 4.5 months with a range between 9 days to alive beyond 17 months. The two longest survivors are still receiving active therapy at 17 and 15 months after invasive surgical pericardial window respectively. One survivor had a histological subtype of large cell neuroendocrine carcinoma and the other received targeted therapy for epidermal growth factor receptor mutation. These results support the consideration of active surgical palliation to treating this oncological emergency complicating NSCLC, including the use of urgent drainage, surgical creation of pericardial window followed by appropriate systemic therapy in suitably fit patients.
Highlights
Cardiac metastasis from cancer is not uncommon but cardiac tamponade complicating malignant pericardial effusion is a rare presentation of any malignancy [1]
We present the treatment and survival outcomes from a case series of eight patients who presented to an Australian academic medical institution with malignant cardiac tamponade secondary to non-small cell lung cancer (NSCLC) between October 2012 and
Case 3 had a large cell neuroendocrine carcinoma, an aggressive form of NSCLC [11], and responded to aggressive combined modality therapy; case 2 responded to targeted therapy for epidermal growth factor receptor (EGFR) mutation
Summary
Cardiac metastasis from cancer is not uncommon but cardiac tamponade complicating malignant pericardial effusion is a rare presentation of any malignancy [1]. The incidence of malignant pericardial effusion was found to be 2.7% of cancer cases in one large autopsy series [2]. Malignant cardiac tamponade is a rare presentation of non-small cell lung cancer (NSCLC). Is generally associated with extremely poor prognosis and recognized as a pre-terminal event Median survival in this setting is approximately 3 months or less despite interventions [6,7,8]. The prognosis of patients with malignant cardiac tamponade in the era of molecular targeted therapy and the appropriateness of invasive surgery in this setting have not been adequately examined. We present the treatment and survival outcomes from a case series of eight patients who presented to an Australian academic medical institution with malignant cardiac tamponade secondary to NSCLC between October 2012 and. Three cases are described in detail, including two patients who presented de novo with cardiac tamponade and two longest survivors who were still alive and functioning well at the time of manuscript submission
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