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A case of heart failure after radiation therapy for mediastinum
Annals of Oncology 30 (Supplement 6): vi9, 2019 doi:10.1093/annonc/mdz306
JOINT SYMPOSIUM 3 (JCS/JSMO) : CARDIO-ONCOLOGY LEARNED FROM CASE DISCUSSION JS3
1
A case of heart failure after radiation therapy for mediastinum
A case of a 65-year-old female with Stage IIIA non-small cell lung cancer (NSCLC) who developed congestive heart failure after radiation therapy for mediastinum is described. The patient was diagnosed with unresectable Stage IIIA NSCLC (squamous cell carcinoma). She received chemotherapy and curative sequential radiotherapy with a dose of 60 Gy on the primary site and mediastinum. She developed dyspnea and chest-X ray demonstrated pleural effusion in the right thorax as of 75 months after radiation therapy. Cardiac ultrasonography revealed a left ventricular ejection fraction of 28% and wall motion diffuse hypokinesis. Coronary angiography showed no signs of coronary stenosis. According to the clinical course and test results, the patient was diagnosed with congestive heart failure due to radiation therapy.
JS3
6
Therapeutic strategies for ischemic heart disease
Daisuke Sueta, Kenichi Tsujita Department of Cardiovascular Medicine, Kumamoto University Hospital JS3
3
An endometrial cancer patient with sudden loss of consciousness
Yoshinori Imamura Medical Oncology/Hematology, Kobe University Hospital A 67-year-old female patient with metastatic endometrial cancer received carboplatin and paclitaxel combination therapy as the first-line treatment due to chronic kidney disease (Cr 1.18 mg/dL, eGFR 35.8 mL/min/1.73m2). Her electrocardiogram and ejection fraction (63.8%) before the start of chemotherapy were normal. On cycle 2 day 11, she had an emergency visit due to persistent severe nausea. Laboratory studies revealed that she had acute kidney injury (Cr 2.45 mg/dL, eGFR 16.1 mL/min/1.73m2), severe electrolyte imbalance (Na 130 mmol/L, K 3.0 mmol/L, Cl 83 mmol/L, corrected Ca 8.6 mg/dL, and Mg 1.4 mg/dL), and no CK elevation (85 IU/L). She was admitted as an emergency case and received intravenous fluids and antiemetic drugs, but response was poor. On cycle 2 day 13, she experienced sudden loss of consciousness. An electrocardiogram showed intermitted torsade de pointe (TdP) and long QT interval (QTc 536 ms), and she was transferred to the coronary care unit. Additional laboratory studies found persistent severe electrolyte imbalance (Na 130 mmol/L, K 2.8 mmol/L, Cl
The original concept of "onco-cardiology" was developed as cardiotoxicity associated with anticancer treatment; however, recently, the number of cases in which atherosclerotic cardiovascular diseases coexist with malignant diseases has increased, and increasing attention is being paid to the relationship between malignant diseases and cardiovascular diseases, based on the long-term surveillance of cancer survivors. Several studies have described a high risk of cardiovascular disease events in cancer survivors. Similarly, a history of cardiovascular disease also confers higher risk incident cancer. Thus, this relationship has been drawing attention as a new aspect of oncocardiology. The most troublesome issue in cancer patients is antithrombotic therapy. The clinical benefits of using dual anti-platelet therapy (DAPT) with aspirin and P2Y12 inhibitors in patients with ischemic heart diseases (acute coronary syndrome (ACS) or after percutaneous coronary intervention [PCI]) has been well established; premature discontinuation of DAPT increases the risk of adverse coronary events in those patients. In this joint symposium by JSMO and the Japanese Circulation Society(JCS), we present therapeutic strategies for ischemic heart disease.
C The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. V
All rights reserved. For permissions, please email: [email protected].
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_6/mdz306/5582909 by guest on 28 October 2019
Jun Sato Department of Experimental Therapeutics, National Cancer Center Hospital
90 mmol/L, corrected Ca 8.1 mg/dL, and Mg 1.2 mg/dL), no hypothyroidism and reduced left ventricle contraction (ejection fraction 36.2%). Carboplatin can trigger renal tubular dysfunction and electrolyte imbalance. In addition, QTc alterations have been reported with the use of both carboplatin and paclitaxel regardless of electrolyte imbalance. On this basis, a diagnosis of chemotherapy-induced long QT syndrome which led to TdP was made, although the baseline chronic kidney disease might also have been involved. Because of the lack of tumor response and deterioration of general condition, chemotherapy was terminated, and she was transferred to a hospice. The occurrence of TdP is a rare but potentially life-threatening cardiotoxicity. Because many anticancer treatments are known to prolong the QT interval through a variety of mechanisms, clinicians should keep this potential in mind.
JOINT SYMPOSIUM 3 (JCS/JSMO) : CARDIO-ONCOLOGY LEARNED FROM CASE DISCUSSION JS3
1
A case of heart failure after radiation therapy for mediastinum
A case of a 65-year-old female with Stage IIIA non-small cell lung cancer (NSCLC) who developed congestive heart failure after radiation therapy for mediastinum is described. The patient was diagnosed with unresectable Stage IIIA NSCLC (squamous cell carcinoma). She received chemotherapy and curative sequential radiotherapy with a dose of 60 Gy on the primary site and mediastinum. She developed dyspnea and chest-X ray demonstrated pleural effusion in the right thorax as of 75 months after radiation therapy. Cardiac ultrasonography revealed a left ventricular ejection fraction of 28% and wall motion diffuse hypokinesis. Coronary angiography showed no signs of coronary stenosis. According to the clinical course and test results, the patient was diagnosed with congestive heart failure due to radiation therapy.
JS3
6
Therapeutic strategies for ischemic heart disease
Daisuke Sueta, Kenichi Tsujita Department of Cardiovascular Medicine, Kumamoto University Hospital JS3
3
An endometrial cancer patient with sudden loss of consciousness
Yoshinori Imamura Medical Oncology/Hematology, Kobe University Hospital A 67-year-old female patient with metastatic endometrial cancer received carboplatin and paclitaxel combination therapy as the first-line treatment due to chronic kidney disease (Cr 1.18 mg/dL, eGFR 35.8 mL/min/1.73m2). Her electrocardiogram and ejection fraction (63.8%) before the start of chemotherapy were normal. On cycle 2 day 11, she had an emergency visit due to persistent severe nausea. Laboratory studies revealed that she had acute kidney injury (Cr 2.45 mg/dL, eGFR 16.1 mL/min/1.73m2), severe electrolyte imbalance (Na 130 mmol/L, K 3.0 mmol/L, Cl 83 mmol/L, corrected Ca 8.6 mg/dL, and Mg 1.4 mg/dL), and no CK elevation (85 IU/L). She was admitted as an emergency case and received intravenous fluids and antiemetic drugs, but response was poor. On cycle 2 day 13, she experienced sudden loss of consciousness. An electrocardiogram showed intermitted torsade de pointe (TdP) and long QT interval (QTc 536 ms), and she was transferred to the coronary care unit. Additional laboratory studies found persistent severe electrolyte imbalance (Na 130 mmol/L, K 2.8 mmol/L, Cl
The original concept of "onco-cardiology" was developed as cardiotoxicity associated with anticancer treatment; however, recently, the number of cases in which atherosclerotic cardiovascular diseases coexist with malignant diseases has increased, and increasing attention is being paid to the relationship between malignant diseases and cardiovascular diseases, based on the long-term surveillance of cancer survivors. Several studies have described a high risk of cardiovascular disease events in cancer survivors. Similarly, a history of cardiovascular disease also confers higher risk incident cancer. Thus, this relationship has been drawing attention as a new aspect of oncocardiology. The most troublesome issue in cancer patients is antithrombotic therapy. The clinical benefits of using dual anti-platelet therapy (DAPT) with aspirin and P2Y12 inhibitors in patients with ischemic heart diseases (acute coronary syndrome (ACS) or after percutaneous coronary intervention [PCI]) has been well established; premature discontinuation of DAPT increases the risk of adverse coronary events in those patients. In this joint symposium by JSMO and the Japanese Circulation Society(JCS), we present therapeutic strategies for ischemic heart disease.
C The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. V
All rights reserved. For permissions, please email: [email protected].
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_6/mdz306/5582909 by guest on 28 October 2019
Jun Sato Department of Experimental Therapeutics, National Cancer Center Hospital
90 mmol/L, corrected Ca 8.1 mg/dL, and Mg 1.2 mg/dL), no hypothyroidism and reduced left ventricle contraction (ejection fraction 36.2%). Carboplatin can trigger renal tubular dysfunction and electrolyte imbalance. In addition, QTc alterations have been reported with the use of both carboplatin and paclitaxel regardless of electrolyte imbalance. On this basis, a diagnosis of chemotherapy-induced long QT syndrome which led to TdP was made, although the baseline chronic kidney disease might also have been involved. Because of the lack of tumor response and deterioration of general condition, chemotherapy was terminated, and she was transferred to a hospice. The occurrence of TdP is a rare but potentially life-threatening cardiotoxicity. Because many anticancer treatments are known to prolong the QT interval through a variety of mechanisms, clinicians should keep this potential in mind.