Effect of synchronous solitary bone metastasectomy and lung cancer resection on non-small cell lung cancer patients

Abstract

Abstract. Lung cancer is the most frequent cause of cancer-associated mortality among men and women globally. The skeleton is one of the most common metastatic sites. The majority of patients exhibiting bone metastases are treated using systemic therapy or symptom-based palliative approaches without surgery. The present study attempted to improve the therapeutic effects of synchronous surgeries in resectable non-small cell lung cancer patients exhibiting solitary bone metastasis. A total of 5 patients underwent synchronous lung cancer resections and solitary bone metastasectomies between October 2009 and November 2011 in the Department of Cardiothoracic Surgery, Shanghai Sixth People's Hospital (Shanghai, China). All patients had received fluorodeoxyglucose positron emission tomography-computed tomography or bone scintigraphy to demonstrate the presence of solitary bone metastasis and to exclude the presence of metastases at alternative sites. The patients received standard lung cancer and mediastinal lymph node resections. In addition, bone lesions were assessed by orthopedists and operated on synchronously with standard procedures. Following surgery, all patients were administered standard chemotherapeutic regimens. Perioperative indicators, including time for thoracic drainage, length of hospital stay, incidence of post-operative complications and progression-free survival (PFS) time, were observed. The average time for post-operative drainage was 4.6±1.1 days, and the average length of post-operative hospitalization was 8.8±2.2 days. All procedures were performed safely with no serious complications. The PFS of the patients was 13.2±7.7 months. While 2 patients presenting with spinal metastases succumbed at ~1 year post-surgery, the remaining 3 patients presenting with limb bone metastases survived for >16 months post-surgery, and were alive at the last follow-up. In conclusion, the present study indicated that a synchronous metastasectomy and lung tumor resection is a safe method of treatment. The PFS time and survival results demonstrated that on the rare occasion that a patient exhibits solitary bone metastasis, aggressive surgical treatment may be a potential therapeutic option.

Prognostic Impact of Newly Proposed M Descriptors in TNM Classification of Non–Small Cell Lung Cancer

“…Aggressive treatment for patients with oligometastatic stage IV lung cancer has been shown to be associated with a favorable outcome. [22][23][24][25][26][27] However, our data cannot confirm the role of a radical treatment approach for the metastatic lesion in the M1b group. This could be due to the heterogeneity of metastatic organs in the M1b group and low statistical power owing to the small sample size.…”

“…This could be due to the heterogeneity of metastatic organs in the M1b group and low statistical power owing to the small sample size. As previous reports regarding this issue were also based on a small number of cases and retrospectively analyzed data, 22,24,26,27 a well-organized prospective trial is necessary to draw a reliable conclusion for this issue.…”

Expression of engrailed homeobox 2 regulates the proliferation, migration and invasion of non‑small cell lung cancer cells

“…The efficacy of surgical resection, adjuvant radiochemotherapy, immunotherapy and individualized targeted therapy have improved in recent years; however, the 5-year survival rate of NSCLC patients remains ~15% (3). The occurrence and development of lung cancer is closely associated with the biological behavior of lung cancer cells, although the molecular mechanism that drives the disease remains unclear (4)(5)(6). It is widely accepted that the proliferation, invasion and metastasis of tumor cells, and the alteration of intrinsic cellular processes such as apoptosis and the cell cycle, promotes the occurrence and development of NSCLC (7,8).…”

Current surgical management of extrapulmonary oligometastatic non-small cell lung carcinoma

“…In another case series by Zhao et al, five patients underwent synchronous lung cancer resections and solitary bone metastasectomies, the progression-free survive of the patients was 13.2 ± 7.7 months [57]. Zhao et al concluded lung tumor resection with bone metastasectomy is a safe method in selected cases [57].…”

“…In another report by Hirano et al, two NSCLC cases had bone oligometastasis in the fibula and femur, surgical excision was performed both for the primary tumor site and bone metastasis, and the patients were still alive for more than five years [55]. In another case series by Zhao et al, five patients underwent synchronous lung cancer resections and solitary bone metastasectomies, the progression-free survive of the patients was 13.2 ± 7.7 months [57]. Zhao et al concluded lung tumor resection with bone metastasectomy is a safe method in selected cases [57].…”