Surgical Management of Non-small Cell Lung Cancer with Solitary Hematogenous Metastases

Abstract

Abstract. Background Stage IV disease at initial presentation accounts for approximately 41% of newly-diagnosed cases with non-small cell lung cancer (NSCLC) (1). Prognosis for metastatic lung cancer remains dismal, despite continuously emerging treatment options. Although the majority of patients have disseminated metastatic disease at diagnosis, a small percentage are found to have a solitary metastasis. In addition any patients with NSCLC who previously received definitive treatment may experience metachronous solitary distant recurrence during the course of their disease. This poorly understood state of limited metastatic load has been described as oligometastatic disease and it seems to run a more indolent course (2, 3). Retrospective clinical studies focused on the surgical management of solitary extrapulmonary metastases, have reported favorable results (4).The aim of this retrospective study was to review our experience with patients who underwent resection of primary NSCLC and solitary extrapulmonary metastasis, and to analyze prognostic factors affecting survival. Patients and MethodsWe reviewed the medical records of thoracic surgical Departments at Laikon General Hospital of Athens and Sotiria Hospital for Chest Diseases (former Second Department of Thoracic Surgery) from January 2004 to December 2012 for patients with NSCLC having undergone combined resections (including stereotactic radiosurgery) of primary lung tumor and solitary hematogenous metastasis.

Surgical Treatment for Pulmonary Metastasis of Pancreatic Ductal Adenocarcinoma: Study of 12 Cases

“…Metastasectomy is considered a beneficial treatment for patients with pulmonary metastases whose primary tumor has been well controlled, and pulmonary resection has been shown to be beneficial for patients with resectable and isolated pulmonary metastases (6). However, few studies have reported such results for pulmonary metastasectomy for PDAC, probably because of their extremely poor outcomes.…”

“…And recently, Karagkiouzis et al (6) reported that combined surgical resection of primary non-small cell lung cancer and solitary hematogenous metastasis might be associated with improved survival. Recurrent PDAC, in comparison, has been notoriously difficult to manage surgically as it is typically characterized by aggressive growth, a multifocal pattern of recurrence, and technically unresectable disease (7).…”

Role of FDG PET/CT in the Eighth Edition of TNM Staging of Non–Small Cell Lung Cancer

“…Extrathoracic metastases, which were an M1b descriptor in the seventh edition of the TNM staging system, are now divided into M1b and M1c descriptors in the eighth edition of the TNM staging system. Patients with a single extrathoracic metastatic lesion in a single organ (M1b) have better survival rates than those with multiple extrathoracic lesions (M1c) and may be candidates for surgical resection or local ablative therapy (18).…”

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

“…Finally, Karagkiouzis et al examined 12 extrapulmonary oligometastatic patients with NSCLC; adrenal metastasis was common (n = 6, 50%) followed by brain metastasis (n = 3, 25%), thoracic wall metastasis (n = 2, 16.7%), and diaphragm (n = 1, 8.3%) [26]. All patients underwent combined resections of the primary lung tumor and solitary hematogenous metastasis; subsequently all patients received adjuvant chemotherapy, and the median follow-up period was 13.5 months [26].…”

“…All patients underwent combined resections of the primary lung tumor and solitary hematogenous metastasis; subsequently all patients received adjuvant chemotherapy, and the median follow-up period was 13.5 months [26]. The median survival was 24.1 months, survival rates at 1-and 5-years were 73%, and 39%, respectively [26].…”