The Past, Present and Future of Pulmonary Metastasectomy: A Review Article

Abstract

Pulmonary metastases are a sign of advanced malignancy and an omen of poor prognosis. Once primary tumors metastasize, they become notoriously difficult to treat and interdisciplinary management often involves a combination of chemotherapy, radiotherapy, and surgery. Over the last 25 years, the emerging body of evidence has recognized the curative potential of pulmonary metastasectomy. Surgical resection of pulmonary metastases is now commonly considered for patients with controlled primary disease, absence of widely disseminated extrapulmonary disease, completely resectable lung metastases, sufficient cardiopulmonary reserve, and lack of a better alternative systemic therapy. Since the development of these selection criteria, other prognostic factors have been proposed to better predict survival and optimize the selection of surgical candidates. Disease-free interval (DFI), completeness of resection, surgical approach, number and laterality of lung metastases, and lymph node metastases all play a dynamic role in determining patient outcomes. There is a definite need to continue reviewing these prognosticators to identify patients who will benefit most from pulmonary metastasectomy and those who should avoid unnecessary loss of lung parenchyma. This literature review aims to explore and synthesize the last 25 years of evidence on the long-term survival, prognostic factors, and patient selection process for pulmonary metastasectomy.

Multi-Institutional Retrospective Analysis of the Outcomes of Proton Beam Therapy for Patients With 1 to 3 Pulmonary Oligometastases From Various Primary Cancers

“…The local aggressive treatment potentially extends survival in patients with pulmonary oligometastases of various primary cancers. 1,2 While pulmonary metastasectomy is the standard treatment for patients with a limited metastatic pattern, several retrospective studies have shown that x-ray stereotactic body radiation therapy (SBRT) yields short-term promising outcomes that are comparable to those of surgery. 3,4 Proton beam therapy (PBT) can reduce the volume of and radiation dose to the surrounding normal tissues using the sharp Bragg peak fall-off, as demonstrated in previous dosimetry studies.…”

Is repeated pulmonary metastasectomy justified?

“…Some other prognostic factors of survival have been described in the literature, but were not identified as statistically significant in our series: DFI1; completeness of resection; presence of lymph node metastases; number and size of pulmonary metastases; female sex [ 2 ]. The primary tumor histology has been identified as a prognostic factor in many studies [ 1 , 2 , 17 , 18 ]. The International Registry of Lung Metastases reported a better survival rate for patients with germ cell tumors (68% at 5 years), followed by epithelial tumors (37% at 5 years), sarcomas (31% at 5 years) and melanoma (21% at 5 years) [ 1 ].…”

Outcomes of surgical resection for pulmonary metastasis from ovarian cancer

“…DFI is reported to be an important prognostic factor after PM in various types of cancers [ 18 ]. Cormio et al [ 3 ] reported that patients with shorter DFI had a poor prognosis in patients with distant metastasis from ovarian cancer.…”