Adjuvant Radiation Therapy For Wedge-Resected Non-Small Cell Lung Cancer Adjacent To A Large Thoracic Aortic Aneurysm: A Case Report And Review Of The Literature

C. E. Miles, C. Strange
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Abstract

Lung cancer is the leading cause of cancer death in the United States, with an estimated 222,500 new cases diagnosed in 2010; non-small cell lung cancer (NSCLC) accounted for approximately 85% of these malignancies. Treatment for early stage NSCLC in an operable patient involves lobar resection. Thoracic aortic aneurysms form as a result of exposure to smoking, hypertension, atherosclerosis, and genetic connective tissue disorders. The literature is silent on the optimum course of action when the anatomic lobar resection for NSCLC is limited by a thoracic aortic aneurysm, particularly when a close surgical margin indicates consideration of adjuvant radiation therapy. Although there is some literature documenting the radiation injury pattern to intact great blood vessels, the literature is silent on the potential for further injury to the wall of the great vessels in the presence of an existing aneurysm. With the increase in the use of definitive stereotactic body radiotherapy for early stage NSCLC in medically inoperable patients, there is a potential for an increased risk of vascular injury secondary to radiation in patients whose vessels already have baseline atherosclerotic damage. Herein, we report a case of a patient diagnosed with wedge-resected early stage NSCLC with close margin in the immediate vicinity of a pre-existing large thoracic aortic aneurysm.
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楔形切除非小细胞肺癌伴大胸主动脉瘤的辅助放射治疗:1例报告及文献复习
肺癌是美国癌症死亡的主要原因,2010年估计有222,500例新确诊病例;非小细胞肺癌(NSCLC)约占这些恶性肿瘤的85%。可手术的早期非小细胞肺癌患者的治疗包括肺叶切除术。胸主动脉瘤的形成是由于暴露于吸烟、高血压、动脉粥样硬化和遗传性结缔组织疾病。当非小细胞肺癌的解剖性肺叶切除术受到胸主动脉瘤的限制时,特别是当手术切缘较近时,需要考虑辅助放射治疗,文献对最佳行动方案保持沉默。虽然有一些文献记录了辐射对完整大血管的损伤模式,但这些文献对存在动脉瘤的大血管壁进一步损伤的可能性保持沉默。随着医学上不能手术的早期非小细胞肺癌患者明确立体定向放射治疗的使用增加,对于血管已经有基线动脉粥样硬化损伤的患者,放射继发血管损伤的风险可能增加。在此,我们报告一例患者被诊断为楔形切除的早期非小细胞肺癌,其邻近已存在的大胸主动脉瘤。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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