Adjuvant Radiation Therapy For Wedge-Resected Non-Small Cell Lung Cancer Adjacent To A Large Thoracic Aortic Aneurysm: A Case Report And Review Of The Literature

Lung cancer is the leading cause of cancer death in the United States, with an estimated 222,500 new cases diagnosed in 2010; non-small cell lung cancer (NSCLC) accounted for approximately 85% of these malignancies. Treatment for early stage NSCLC in an operable patient involves lobar resection. Thoracic aortic aneurysms form as a result of exposure to smoking, hypertension, atherosclerosis, and genetic connective tissue disorders. The literature is silent on the optimum course of action when the anatomic lobar resection for NSCLC is limited by a thoracic aortic aneurysm, particularly when a close surgical margin indicates consideration of adjuvant radiation therapy. Although there is some literature documenting the radiation injury pattern to intact great blood vessels, the literature is silent on the potential for further injury to the wall of the great vessels in the presence of an existing aneurysm. With the increase in the use of definitive stereotactic body radiotherapy for early stage NSCLC in medically inoperable patients, there is a potential for an increased risk of vascular injury secondary to radiation in patients whose vessels already have baseline atherosclerotic damage. Herein, we report a case of a patient diagnosed with wedge-resected early stage NSCLC with close margin in the immediate vicinity of a pre-existing large thoracic aortic aneurysm.