Malignant Cardiac Tamponade from Non-Small Cell Lung Cancer: Case Series from the Era of Molecular Targeted Therapy

• Main Authors: Bob T. Li, Antonia Pearson, Nick Pavlakis, David Bell, Adrian Lee, David Chan, Michael Harden, Manu Mathur, David Marshman, Peter Brady, Stephen Clarke
• Format: Article
• Language: English
• Published: MDPI AG 2014-12-01
• Series: Journal of Clinical Medicine
• Subjects: lung cancer; cardiac metastasis; pericardial effusion; pericardial window techniques; pericardiocentesis; chemotherapy; palliative therapy
• Online Access: http://www.mdpi.com/2077-0383/4/1/75

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.