Cure of Oligometastatic Classic Biphasic Pulmonary Blastoma Using Aggressive Tri-modality Treatment: Case Series and Review of the Literature

Abstract

Pulmonary blastoma is a rare lung cancer classified into three subtypes: classic biphasic pulmonary blastoma (CBPB), well-differentiated fetal adenocarcinoma (WDFA), and pleuropulmonary blastoma (PPB) of childhood. Compared to the other subtypes, CPPB is an aggressive tumor with an overall five-year survival of 16% across all stages. We present two cases of biopsy-proven metastatic CBPB, who have been disease-free for over 10 years since treatment completion. Both patients were treated with surgery to the primary tumor followed by an adjuvant cisplatin-based chemotherapy for four cycles and thoracic radiation. One patient relapsed shortly after the completion of thoracic radiation with brain metastases and underwent craniotomy, gamma knife radiosurgery (GKRS), and whole brain radiation therapy. The other patient presented with synchronous pelvic metastases and underwent metastasectomy after the completion of chemotherapy but before the initiation of thoracic radiation. We review the literature regarding surgical, chemotherapeutic, and radiation treatment for patients with metastatic pulmonary blastoma. Based on our experience and review of the existing case reports, aggressive tri-modality treatment including surgery, chemotherapy with a cisplatin backbone, and a definitive treatment of oligometastatic lesions amenable to local therapy including resection or radiosurgery is reasonable to consider for medically fit patients with CBPB.

Clinical, pathological and treatment factors associated with the survival of patients with pulmonary sarcomatoid carcinoma

“…Meanwhile, of the 776 patients who underwent surgery, 255 (32.8%) had stage III/IV PSC. PSC has been reported to be associated with high rates of recurrence and low OS rates even after complete surgical resection (6,11,17). Aforementioned studies (13,27) also investigated the effects of neoadjuvant chemotherapy and radiotherapy on the OS rate of patients with PSC.…”

Pulmonary Blastoma: A Comprehensive Overview of A Rare Entity

“…The efficacy of adjuvant therapy has not been established with clinical trials; however, several published cases are reporting good outcomes with the use of adjuvant chemotherapy with or without radiotherapy [29,62,32]. Cisplatin combined with etoposide has been proposed as a regimen for adjuvant chemotherapy based on a review of the literature [63].…”

“…Cisplatin combined with etoposide has been proposed as a regimen for adjuvant chemotherapy based on a review of the literature [63]. In a more recent report by Lewis et al (2018), two patients underwent surgical treatment and they received adjuvant cisplatin-based chemotherapy for four cycles followed by thoracic radiation. Both patients achieved long-term survival [62].…”

“…In a more recent report by Lewis et al (2018), two patients underwent surgical treatment and they received adjuvant cisplatin-based chemotherapy for four cycles followed by thoracic radiation. Both patients achieved long-term survival [62].…”

“…Therefore, a preoperative course of radiation therapy and chemotherapy was decided and three weeks after completing therapy, he was reassessed with a chest CT showing impressive regression of disease, allowing for surgical treatment with right pmeumonectomy [67]. [62] have reviewed reports of patients who received chemotherapy. Historically, single-agent chemotherapy was initially tried with no clinical or objective response [62].…”