The Case of the Award-Winning Actor With Multiple Diseases and Numerous Operations

Albert B. Lowenfels, MD

Disclosures

August 04, 2006

How Would This Patient Be Treated Today?

Surgery is still the standard treatment for most cases of early lung cancer -- Wayne's first major health problem. Of interest, Wayne was diagnosed with lung cancer the same year that Doll and Hill[1] published a landmark study conclusively linking smoking with lung cancer. In 2006, as a result of the smoking epidemic, an estimated 175,000 Americans will develop lung cancer with an expected 5-year survival of less than 15%.[2] Wayne was extremely fortunate to have been a long-term survivor. Today, in addition to surgery for a resectable tumor, it is likely that Wayne would be offered chemoradiotherapy as postoperative adjuvant treatment.[3] Wayne also developed a bronchopleural fistula; to prevent this complication now, which occurs in about 5% of patients, some surgeons recommend covering the bronchial stump with a patch.[4]

Wayne's second major health problem was a defective mitral valve for which he underwent open heart surgery in 1978, 14 years after the pneumonectomy. By the 1970s, advances in open heart surgery made this operation a sensible option for severely symptomatic patients. Open heart surgery is now safer than it was in 1978, and for some high-risk patients, like Wayne, it is possible to treat valvular heart disease using percutaneous approaches. Percutaneous balloon valvotomy is an accepted method for managing stenotic disease, and mitral regurgitation can be managed with a variety of percutanous techniques.[5,6,7,8] Today, because of his age and reduced lung capacity, instead of open heart valve replacement, Wayne's diseased mitral valve might be repaired using a percutaneous approach.

Gastric cancer was Wayne's final health problem. During the 20th century, the frequency of gastric cancer declined rapidly, and when John Wayne developed this tumor in 1979, it was already an uncommon cancer. Gastrectomy or total gastrectomy is still the treatment of choice, resulting in overall cure rates of about 20%. John Wayne's tumor had already spread to lymph nodes, so that today his treatment might include postoperative chemoradiotherapy, which has been associated with survival benefits.[9] There is no convincing evidence that interferon, which he received, is effective against gastric cancer.[10]

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