title: The effect of chemotherapy for malignancy on the natural history of aortic aneurysm.
abstract: OBJECTIVE
  Surgical dogma holds that chemotherapy increases the risk of aneurysm growth and rupture. We sought to determine the effect of cytotoxic chemotherapy on the growth of aortic aneurysms.
  
  
  METHODS
  All patients undergoing chemotherapy for malignancy with coexisting aortic aneurysms at our institution between 2000 and 2011 were identified. Review of electronic medical records and rereview of serial cross-sectional imaging was performed. An additional cohort of patients undergoing aneurysm surveillance during the same period was identified, and demographic and anatomic variables were collected. Planned analysis included descriptive analysis, change in aneurysm diameter over time, and association of growth or need for intervention with type of chemotherapy and type of malignancy.
  
  
  RESULTS
  Between 2000 and 2011, 125 patients at our institution had a concurrent diagnosis of aortic aneurysm and malignancy requiring cytotoxic chemotherapy. Cross-sectional imaging was available for 91 patients. The predominant malignancy type was lung cancer (34 of 91 [38%]), followed by lymphoma (21 of 91 [23%]) and colorectal cancer (10 of 91 [11%]). Most aneurysms were infrarenal (53 of 91 [58%]). Most patients were treated with more than one class of chemotherapeutic agent over 267 days (interquartile range [IQR], 144-469 days), and most had at least one cycle of alkylating agents (73 of 91), in addition to antimetabolites (42 of 91) and plant alkaloids/terpenoids (40 of 92). Chemotherapy regimens included steroids in 84 patients (92%). The baseline aneurysm diameter was 41.4 mm (IQR, 34.9-51.3 mm) for patients who received chemotherapeutic agents and 46.0 mm (IQR, 40-52 mm) for those who did not. Eight of the 91 patients (9%) underwent aneurysm repair during chemotherapy, but only two required urgent repair due to aneurysm rupture. The rate of aneurysm growth per year for patients who did and did not receive chemotherapy was similar at 2.3 mm vs 2.4 mm (P = .69).
  
  
  CONCLUSIONS
  In 91 patients over 10 years at our institution, chemotherapy did not increase aneurysm growth compared with patients not undergoing treatment for malignancy.
authors.affiliation: Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Zenia L
authors.initials: ZL
authors.lastname: Martin
authors.affiliation: Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: mastrat@ccf.org.
authors.forename: Tara M
authors.initials: TM
authors.lastname: Mastracci
authors.affiliation: Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Roy K
authors.initials: RK
authors.lastname: Greenberg
authors.affiliation: Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Jose P
authors.initials: JP
authors.lastname: Morales
authors.affiliation: Department of Quantitative Health Sciences, The Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: James
authors.initials: J
authors.lastname: Bena
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001014:Aortic Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D001019:Aortic Rupture / Q000209:etiology / Q000601:surgery; D001027:Aortography / Q000379:methods; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D009820:Ohio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome