Surgical Outcome and Prognostic Stratification for Pulmonary Metastasis From Colorectal Cancer

Okumura, Takehiro; Boku, Narikazu; Hishida, Tomoyuki; Ohde, Yasuhisa; Sakao, Yukinori; Yoshiya, Katsuo; Higashiyama, Masahiko; Hyodo, Ichinosuke; Mori, Keita; Kondo, Haruhiko

doi:10.1016/j.athoracsur.2017.03.021

Cited by 78 publications

(66 citation statements)

References 17 publications

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“…While surgery remains the gold standard for resectable oligometastasis from CRC, local control outcomes in vivo 34: 2991-2996 (2020) in recent reports of SBRT have closely approached those of surgery. Several investigators have reported 2-year LC and OS rates of 53% to 100% and 68% to 92%, respectively, in their SBRT series (14-19), which were almost comparable to those of surgery (20,21). In the present study, we treated patients with SBRT using the Cyberknife ® system, and report 2-year rates of 65.8% and 88.6% for LC and OS, respectively.…”

Section: Discussionsupporting

confidence: 73%

Stereotactic Body Radiotherapy for Pulmonary Oligometastasis from Colorectal Cancer

Kobayashi

Abe

Noda

et al. 2020

In Vivo

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Background/Aim: A retrospective study was conducted to evaluate the safety and efficacy of stereotactic body radiotherapy (SBRT) for pulmonary oligometastasis from colorectal cancer (CRC). Patients and Methods: Patients with pulmonary oligometastasis from CRC who were treated with SBRT between April 2010 and October 2018 were enrolled in this study. All patients underwent SBRT using Cyberknife ® with a dose of 54-60 Gy in 3 fractions to 99% of the clinical target volume. The treatment efficacy was evaluated by the local control (LC) and overall survival (OS) rates. The toxicity was evaluated using the National Cancer Institute's Common Terminology Criteria for Adverse Events version 4.0. Results: Twenty-six lesions in 20 patients were treated with SBRT. The median followup duration was 19 months (range=6-98 months). Local recurrence occurred in 6 of 26 lesions with a median followup of 12 months. The 2-year LC and OS rates were 65.8% and 88.6%, respectively. No patient developed ≥ grade 2 toxicity in the lung and other sites. Conclusion: Although very high doses were delivered to the tumors with SBRT, the LC of pulmonary metastasis from CRC was not satisfactory when compared to that for stage I primary non-small cell lung cancer reported in the literature.

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Section: Discussionsupporting

confidence: 73%

Stereotactic Body Radiotherapy for Pulmonary Oligometastasis from Colorectal Cancer

Kobayashi

Abe

Noda

et al. 2020

In Vivo

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“…Less commonly reported criteria include LN involvement, DFI and number of metastases. When these criteria are achieved, the tail or flattening of OS curves in contemporary reports include colorectal (OS 20-52% at 7-9 yrs) [13,14], renal cell carcinoma (OS 33% 7 yrs) [15], melanoma (OS 14% 10 yr) [16], soft tissue sarcoma (OS 11-23% 7-11 yrs) [17,18], head and neck squamous cell cancer (OS 18% 13 yrs) [19], breast cancer (OS 40% at 18 yrs) [20] and hepatocellular carcinoma (OS 38% over 10 yrs) [21]. Is PM associated with prolonged survival (without cure)?…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Expert Consensus Document on Pulmonary Metastasectomy

Handy

Bremner

Crocenzi

et al. 2019

The Annals of Thoracic Surgery

160

172

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When managing nonseminomatous germ cell tumors, contralateral lung abnormalities ≤ 10 mm can be observed if histology of unilateral PM demonstrates complete tumor necrosis. 17. When managing nonseminomatous germ cell tumors, PM is indicated for select patients with limited number of lung abnormalities after first or second-line platin-based chemotherapy suspected of containing viable nonseminomatous cancer and/or malignant transformation of teratoma into non-germ cell cancer. 18. In breast cancer patients, PM can be considered within a MDT construct. Pulmonary metastasectomy literature characteristics Since 1980, greater than 1000 publications addressed pulmonary metastasectomy, without a single randomized controlled trial (RCT). The overwhelming majority is surgical series, usually single institution, and includes single or multiple pathologies. The pool of patients from which metastasectomy patients derive is not reported, allowing no comparative survival analysis. Historical controls are used or metastatic disease survival is assumed to be zero, a contention not supported by the literature. Yet metastasectomy is infrequently performed (1-6.5%) when sizable populations of cancer patients are reported. [1-3] Thus surgical case series manifest inherent selection bias and do not clarify the role of metastasectomy in prolongation of survival or cure. The literature is further hampered by inconsistent or absent description of other local or systemic therapies and variable length of follow up. Finally, the literature fails to distinguish between prognostic (indolent disease which will do well with any or no treatment) or predictive

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“…Pulmonary metastasectomy has evolved for other cancers with synchronous or metachronous metastatic disease, such as colorectal adenocarcinoma, with a demonstrated survival benefit [ 12 – 15 ]. In PDAC, Arnaoutakis et al reported that, in patients with isolated PM from PDAC, median cumulative survival was significantly improved in the pulmonary metastasectomy group compared with the chemotherapy group (51 vs 23 months); they considered that a relatively long interval between the initial PDAC resection and tumor relapse, with isolated and stable disease over time, and a favorable response to systemic chemotherapy indicated “good biology” [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term survival with repeat resection for lung oligometastasis from pancreatic ductal adenocarcinoma: a case report

et al. 2018

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BackgroundLong-term survival after resection of metastases from pancreatic ductal adenocarcinoma is rare.Case presentationA 54-year-old man underwent pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) with UICC staging pT3N1M0 followed by adjuvant chemotherapy with gemcitabine (GEM). Three years after radical resection of the primary tumor, a tiny nodule was found in the lower lobe of the left lung. Despite treatment with GEM, it increased gradually, but no other metastases were found. Eighteen months after the first indication of the nodule, wedge resection was performed. Pathological examination of the nodule indicated a metastatic tumor from PDAC. Pulmonary metastasectomy was again performed for lung oligometastases at 77 and 101 months after PD. The patient has been asymptomatic without tumor recurrence for 4 years since the last pulmonary resection.ConclusionsIn PDAC, the treatment strategy for oligometastasis is controversial. However, a few cases of long-term survival after pulmonary metastasectomy for oligometastasis of PDAC have been reported. More such cases need to be studied to address this issue effectively.

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Surgical Outcome and Prognostic Stratification for Pulmonary Metastasis From Colorectal Cancer

Abstract: Metastasectomy of PM from colorectal cancer was associated with a favorable prognosis. Patients could be classified into three risk groups using five prognostic factors. This grouping may be useful for identifying an optimal treatment strategy according to risk in future studies.

Cited by 78 publications

References 17 publications

Stereotactic Body Radiotherapy for Pulmonary Oligometastasis from Colorectal Cancer

Stereotactic Body Radiotherapy for Pulmonary Oligometastasis from Colorectal Cancer

Expert Consensus Document on Pulmonary Metastasectomy

Long-term survival with repeat resection for lung oligometastasis from pancreatic ductal adenocarcinoma: a case report

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