title: Malignant Cardiac Tamponade from Non-Small Cell Lung Cancer: Case Series from the Era of Molecular Targeted Therapy.
abstract: 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.
authors.affiliation: Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, NSW 2065, Sydney, Australia. bob.li@med.usyd.edu.au.|Sydney Medical School, University of Sydney, NSW 2006, Sydney, Australia. bob.li@med.usyd.edu.au.
authors.forename: Bob T
authors.initials: BT
authors.lastname: Li
authors.affiliation: Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, NSW 2065, Sydney, Australia. toni_35@hotmail.com.
authors.forename: Antonia
authors.initials: A
authors.lastname: Pearson
authors.affiliation: Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, NSW 2065, Sydney, Australia. nick.pavlakis@sydney.edu.au.|Sydney Medical School, University of Sydney, NSW 2006, Sydney, Australia. nick.pavlakis@sydney.edu.au.
authors.forename: Nick
authors.initials: N
authors.lastname: Pavlakis
authors.affiliation: Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, NSW 2065, Sydney, Australia. bellfam@bigpond.net.au.|Sydney Medical School, University of Sydney, NSW 2006, Sydney, Australia. bellfam@bigpond.net.au.
authors.forename: David
authors.initials: D
authors.lastname: Bell
authors.affiliation: Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, NSW 2065, Sydney, Australia. adrian.lee@sydney.edu.au.|Sydney Medical School, University of Sydney, NSW 2006, Sydney, Australia. adrian.lee@sydney.edu.au.
authors.forename: Adrian
authors.initials: A
authors.lastname: Lee
authors.affiliation: Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, NSW 2065, Sydney, Australia. dlhchan1@gmail.com.|Sydney Medical School, University of Sydney, NSW 2006, Sydney, Australia. dlhchan1@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Chan
authors.affiliation: Department of Cardiothoracic Surgery, Royal North Shore Hospital, St. Leonards, NSW 2065, Sydney, Australia. mickharden@bigpond.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Harden
authors.affiliation: Department of Cardiothoracic Surgery, Royal North Shore Hospital, St. Leonards, NSW 2065, Sydney, Australia. manu_mathur@hotmail.com.
authors.forename: Manu
authors.initials: M
authors.lastname: Mathur
authors.affiliation: Department of Cardiothoracic Surgery, Royal North Shore Hospital, St. Leonards, NSW 2065, Sydney, Australia. drdmar@bigpond.com.
authors.forename: David
authors.initials: D
authors.lastname: Marshman
authors.affiliation: Department of Cardiothoracic Surgery, Royal North Shore Hospital, St. Leonards, NSW 2065, Sydney, Australia. pwbrady@ozemail.com.au.
authors.forename: Peter
authors.initials: P
authors.lastname: Brady
authors.affiliation: Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, NSW 2065, Sydney, Australia. stephen.clarke@sydney.edu.au.|Sydney Medical School, University of Sydney, NSW 2006, Sydney, Australia. stephen.clarke@sydney.edu.au.
authors.forename: Stephen
authors.initials: S
authors.lastname: Clarke
keywords: cardiac metastasis; chemotherapy; lung cancer; palliative therapy; pericardial effusion; pericardial window techniques; pericardiocentesis