Intracardiac Metastasis From Non-Small Cell Lung Cancer

Prognostic Implication of Direct Cardiac Invasion from Lung Cancer in Non-Operatively Treated Patients Based on Lung Computed Tomography Imaging

BACKGROUND

Lung cancer with direct cardiac invasion (LCCI⁺) exerts a significant influence on the survival of patients. There is a paucity of comparative research into the prognosis of advanced lung cancer with and without direct cardiac invasion.

METHOD

In this study, 50 LCCI⁺ patients and 50 sex-, age-, and TNM stage-matched patients without direct cardiac invasion (LCCI^-) were retrospectively analysed. LCCI⁺ was defined as lung cancer directly invading the heart by penetrating mediastinum or extending into the atrium via the pulmonary vein. The study endpoint was all-cause death. In this study, the survival time was defined as the time from the first detection of direct cardiac invasion to the end of the event.

RESULTS

During a median follow-up period of 31 months, all-cause death occurred in 44 patients (88.0%) in the LCCI⁺ group and in 36 patients (72.0%) in the LCCI^- group; the overall survival (OS) time among patients in the LCCI⁺ group was significantly lower compared with those in the LCCI^- group (5.0 [interquartile range (IQR), 2.0-12.0] vs 13.8 [IQR, 4.0-18.4] months; p<0.001); the OS rate in the LCCI⁺ group was significantly lower compared with patients in the LCCI^- group (log-rank, p=0.0002). Multivariate Cox regression analysis showed that direct cardiac invasion was an independent predictor of survival in patients with advanced lung cancer (hazard ratio, 2.255; 95% confidence interval, 1.443-3.524). Further analysis indicated that in patients with small cell lung cancer, the survival rate between the LCCI⁺ group and LCCI^- group was insignificant (log-rank, p=0.075; survival time: 4.0 [IQR, 2.0-11.5] vs 11.5 [IQR, 5.0-18.3] months); in patients with non-small cell lung cancer (NSCLC), the survival rate in the LCCI⁺ group was lower than that of the LCCI^- group (log-rank, p=0.01; survival time: 6.0 [IQR, 3.0-13.3] vs 16.3 [IQR, 10.4-27.2] months).

CONCLUSIONS

Direct cardiac invasion from lung cancer was an independent prognostic factor for survival time in patients with lung cancer. Patients with direct cardiac invasion by NSCLC have a poorer clinical outcome than those without direct cardiac invasion. A careful preoperative evaluation is mandatory and appropriate management of cardiac involvement should be considered in the treatment of NSCLC.

Relationship and interactions of curcumin with radiation therapy

Curcumin is widely reported to have remarkable medicinal - and antineoplastic - properties. This review details curcumin’s relationship with radiotherapy (RT), principally as a radiosensitizer for various malignancies and a radioprotector for normal tissues. First, examples of radiosensitization are provided for various cancers: Pediatric, lymphoma, sarcoma, prostate, gynecologic, pancreas, liver, colorectal, breast, lung, head/neck, and glioma. It is not the purpose of this article to comprehensively review all radiosensitization data; however, high-quality studies are discussed in relationship to currently-controversial RT questions for many cancers, and thus the importance of developing a natural radiosensitizer. Attention is then shifted to radioprotection, for which supporting research is discussed for the following RT toxicities: Dermatitis, pneumonitis, cataractogenesis, neurocognition, myelosuppression, secondary malignancies, and mucositis/enteritis. Though there is fewer data for radioprotection, the overall quality of clinical evidence is higher, and small clinical trials implicating the efficacy of curcumin for RT toxicities (vs placebo/current therapies) are also detailed. Though the overall level of evidence for curcumin as a radiosensitizer and radioprotector is low, it must be recognized that risks of adverse effects are exceedingly low, and clinicians may need to judge the yet-unproven rewards with low toxicity risks.