RS18. Influence of Malignant Disease and Chemoradiation on Aortic Aneurysmal Progression: A 12-Year, Single-Center Series

Abstract

Aortic aneurysms occur concomitantly with malignant neoplasms in approximately 4% to 14% of patients. However, there is little information about the effects of malignant neoplasms, chemotherapeutics, and radiation treatment on the natural progression of abdominal aortic aneurysms (AAAs), thoracic aortic aneurysms, and thoracoabdominal aortic aneurysms. The aims of this study were to determine the effects that malignant neoplasms and their associated chemoradiation therapies impart on the progression and outcomes of aortic aneurysms. Patients diagnosed with malignant disease with concomitant AAAs or thoracic aortic aneurysms from 2005 to 2017 were reviewed. Inclusion criteria included complete neoadjuvant or adjuvant therapy documentation with multiplanar axial and coronal imaging or ultrasound before, during, and after therapy. Patients with repairs before malignant diagnosis and therapies were excluded. Multivariate risk factor and survival analysis were performed. Of 340 included aneurysms from 288 patients, 193 aortic aneurysms coexisted with malignant neoplasms necessitating chemoradiation (MAA), and 147 were aneurysms alone (AA). Average demographics were as follows: 75.4 ± 8.2 years old, white (60.8%), male (57.6%), hypertension (81.5%), history of smoking (77.9%), coronary atherosclerotic disease (62.6%), and AAA (73.8%). The most common malignant neoplasm was lung cancer (47.9%), with an initial chemotherapy regimen including a platinum-based alkylating agent and concurrent antimetabolite (67.5%). The overall median follow-up time and MAA group chemotherapy durations were 20.9 and 7.5 months, respectively. The AA group had a significantly older mean age of aneurysm discovery (78.0 vs 73.3 years; P < .001) and demonstrated overall increased comorbid states (hypertension, coronary artery disease, chronic kidney disease; P < .020), but with significantly decreased smoking and chronic obstructive pulmonary disease incidence (both P < .001) compared with the MAA group. Overall, the MAA group presented with smaller aneurysms (Fig 1; P = .044) and a slower median growth in the anteroposterior axis compared with the AA group (0.11 vs 0.17 cm/y; P = .070), which approached significance. Multivariate analysis demonstrated aneurysm size ≥4.0 cm on presentation as an independent predictor for requiring repair for any reason (odds ratio, 3.861; confidence interval, 2.261-6.591; P < .001; Fig 2). There were no associations with chemotherapy, radiation, duration of chemotherapeutic treatment, and growth rates or need for repair on analysis. There were no differences in complications between groups. Aortic aneurysms with concomitant malignant neoplasms necessitating chemotherapeutics are discovered earlier and at smaller sizes, and they exhibit decreased rates of growth compared with aortic aneurysms alone. Patients with coexisting malignant neoplasms do not appear to be at increased risk of aneurysm-associated adverse events compared with patients without malignant disease and should subscribe to standard institutional surveillance protocols.Fig 2Proportion of aneurysms not meeting repair criteria. AA, Aneurysm alone; MAA, aortic aneurysm with malignant neoplasm necessitating chemoradiation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)