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Case report of a patient with left ventricular assistance device undergoing chemotherapy for a new diagnosis of lung cancer.

Khan M, Wasim A, Mirrakhimov AE, McMahon BA, Judge DP, Chu LC, Banavali A, Zeidan AM - Case Rep Oncol Med (2015)

Bottom Line: The optimal management of cancer in patients with severe heart failure is not defined.With mechanical left ventricular devices to provide cardiac support, treatment options for cancer in the setting of advanced heart failure may be improved.Here we discuss the therapeutic dilemma involving a patient with severe cardiomyopathy and left ventricular assistant device (LVAD) who was found to have limited-stage SCLC during the evaluation process for cardiac transplantation.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL 60657, USA.

ABSTRACT
The optimal management of cancer in patients with severe heart failure is not defined. This issue is particularly challenging when a diagnosis of limited-stage small cell lung cancer (SCLC) is made incidentally in the context of evaluating patient for candidacy for cardiac transplantation. Limited-stage SCLC is typically managed on a curative therapeutic paradigm with combined modality approach involving chemotherapy and radiation. Even with excellent performance status and good organ function, the presence of severe cardiomyopathy poses significant challenges to the delivery of even single modality approach with chemotherapy or radiotherapy, let alone the typical curative combined modality approach. With mechanical left ventricular devices to provide cardiac support, treatment options for cancer in the setting of advanced heart failure may be improved. Here we discuss the therapeutic dilemma involving a patient with severe cardiomyopathy and left ventricular assistant device (LVAD) who was found to have limited-stage SCLC during the evaluation process for cardiac transplantation.

No MeSH data available.


Related in: MedlinePlus

Axial IV contrast-enhanced CT image shows marked right paratracheal and anterior mediastinal lymphadenopathy (arrow) with marked compression of the superior vena cava (arrowhead).
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fig1: Axial IV contrast-enhanced CT image shows marked right paratracheal and anterior mediastinal lymphadenopathy (arrow) with marked compression of the superior vena cava (arrowhead).

Mentions: We report a 57-year-old male with history of extensive prior tobacco use, nonischemic cardiomyopathy, and an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 3. After successfully completing his initial evaluation, he was deemed cancer-free and eligible for cardiac transplantation. Due to severe heart failure despite standard medications, he received mechanical cardiac support with an LVAD. Three months after surgery for the LVAD, he was noted to have mediastinal widening on a chest X-ray performed for dyspnea and cough. CT scans showed mediastinal lymphadenopathy without evidence of disease outside the chest (Figures 1 and 2). Renal and liver functions were within normal limits. The patient underwent mediastinoscopy and the pathologic examination was consistent with SCLC. Due to headaches and distended neck veins, he was evaluated for superior vena cava syndrome. The patient was removed from active consideration for cardiac transplantation. After extensive discussion with patient and his family, chemotherapy was administered while hospitalized for close monitoring. He received carboplatin (area under the curve (AUC) 5) on day 1 and intravenous (IV) etoposide 100 mg/m2 on days 1–3. Patient received IV dolasetron 100 mg for 30 minutes on days 1–3 and IV prochlorperazine 10 mg every 6 hours as needed. The patient did not receive any prophylactic antibiotics. Carboplatin was used instead of cisplatin due to concerns over aggressive hydration and inducing volume overload. The radiation oncologist had an extensive discussion with the patient and the multidisciplinary team including the LVAD manufacturer and provided the information about the risks, benefits, and complications of concurrent radiation treatments. The patient ultimately decided not to pursue any radiation treatment.


Case report of a patient with left ventricular assistance device undergoing chemotherapy for a new diagnosis of lung cancer.

Khan M, Wasim A, Mirrakhimov AE, McMahon BA, Judge DP, Chu LC, Banavali A, Zeidan AM - Case Rep Oncol Med (2015)

Axial IV contrast-enhanced CT image shows marked right paratracheal and anterior mediastinal lymphadenopathy (arrow) with marked compression of the superior vena cava (arrowhead).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4385621&req=5

fig1: Axial IV contrast-enhanced CT image shows marked right paratracheal and anterior mediastinal lymphadenopathy (arrow) with marked compression of the superior vena cava (arrowhead).
Mentions: We report a 57-year-old male with history of extensive prior tobacco use, nonischemic cardiomyopathy, and an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 3. After successfully completing his initial evaluation, he was deemed cancer-free and eligible for cardiac transplantation. Due to severe heart failure despite standard medications, he received mechanical cardiac support with an LVAD. Three months after surgery for the LVAD, he was noted to have mediastinal widening on a chest X-ray performed for dyspnea and cough. CT scans showed mediastinal lymphadenopathy without evidence of disease outside the chest (Figures 1 and 2). Renal and liver functions were within normal limits. The patient underwent mediastinoscopy and the pathologic examination was consistent with SCLC. Due to headaches and distended neck veins, he was evaluated for superior vena cava syndrome. The patient was removed from active consideration for cardiac transplantation. After extensive discussion with patient and his family, chemotherapy was administered while hospitalized for close monitoring. He received carboplatin (area under the curve (AUC) 5) on day 1 and intravenous (IV) etoposide 100 mg/m2 on days 1–3. Patient received IV dolasetron 100 mg for 30 minutes on days 1–3 and IV prochlorperazine 10 mg every 6 hours as needed. The patient did not receive any prophylactic antibiotics. Carboplatin was used instead of cisplatin due to concerns over aggressive hydration and inducing volume overload. The radiation oncologist had an extensive discussion with the patient and the multidisciplinary team including the LVAD manufacturer and provided the information about the risks, benefits, and complications of concurrent radiation treatments. The patient ultimately decided not to pursue any radiation treatment.

Bottom Line: The optimal management of cancer in patients with severe heart failure is not defined.With mechanical left ventricular devices to provide cardiac support, treatment options for cancer in the setting of advanced heart failure may be improved.Here we discuss the therapeutic dilemma involving a patient with severe cardiomyopathy and left ventricular assistant device (LVAD) who was found to have limited-stage SCLC during the evaluation process for cardiac transplantation.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL 60657, USA.

ABSTRACT
The optimal management of cancer in patients with severe heart failure is not defined. This issue is particularly challenging when a diagnosis of limited-stage small cell lung cancer (SCLC) is made incidentally in the context of evaluating patient for candidacy for cardiac transplantation. Limited-stage SCLC is typically managed on a curative therapeutic paradigm with combined modality approach involving chemotherapy and radiation. Even with excellent performance status and good organ function, the presence of severe cardiomyopathy poses significant challenges to the delivery of even single modality approach with chemotherapy or radiotherapy, let alone the typical curative combined modality approach. With mechanical left ventricular devices to provide cardiac support, treatment options for cancer in the setting of advanced heart failure may be improved. Here we discuss the therapeutic dilemma involving a patient with severe cardiomyopathy and left ventricular assistant device (LVAD) who was found to have limited-stage SCLC during the evaluation process for cardiac transplantation.

No MeSH data available.


Related in: MedlinePlus