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Tsujimoto Y, Matsumoto Y, Tanaka M, Imabayashi T, Uchimura K, Tsuchida T. Diagnostic Value of Bronchoscopy for Peripheral Metastatic Lung Tumors. Cancers (Basel) 2022; 14:cancers14020375. [PMID: 35053537 PMCID: PMC8773960 DOI: 10.3390/cancers14020375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Metastatic lung tumors are relatively common, and their pathological diagnosis is crucial for determining the appropriate treatment strategy. Although bronchoscopy is one biopsy method, its role has not been established for peripheral metastatic lung tumors. The present study aimed to investigate the value of bronchoscopy, using radial endobronchial ultrasound for diagnosis. We analyzed 235 lesions consecutively, and the overall diagnostic yield was 76.6%, which was slightly higher than the reported cumulative sensitivity for general peripheral pulmonary lesions. There were no serious complications. The results demonstrated that bronchoscopy is a valuable technique for peripheral metastatic lung tumors that combines diagnostic accuracy and safety. Moreover, the higher diagnostic yield was associated with the large lesion size, inner location, and visibility on radiography. These findings should contribute to the selection of biopsy methods for metastatic lung tumors and improve the diagnostic yield. Abstract Although lungs are one of the most frequent sites of metastasis for malignant tumors, little has been reported about the value of bronchoscopy for lung metastases presenting with peripheral pulmonary lesions (PPLs). This retrospective cohort study investigated the diagnostic value of bronchoscopy for peripheral metastatic lung tumors. Consecutive patients who underwent diagnostic bronchoscopy with radial endobronchial ultrasound for PPLs and were finally diagnosed with metastatic lung tumors from April 2012 to March 2019 were included. We analyzed 235 PPLs, with a median size of 18.8 mm. The overall diagnostic yield was 76.6%. In a multivariable analysis, large lesion size (>20.0 mm vs. <20.0 mm: 87.6% vs. 67.7%, p = 0.043, OR = 2.26), inner location (inner 2/3 vs. outer 1/3: 84.8% vs. 69.1%, p = 0.004, OR = 2.79), and visibility on radiography (visible vs. invisible: 83.2% vs. 56.1%, p = 0.015, OR = 3.29) significantly affected the diagnostic yield. Although a positive bronchus sign tended to have a higher yield, no significant difference was observed (81.8% vs. 70.6%, p = 0.063). Only one case of lung abscess was observed, with no serious complications. In conclusion, bronchoscopy is a valuable technique for peripheral metastatic lung tumors, with good diagnostic accuracy and safety.
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Affiliation(s)
- Yoshie Tsujimoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 1040045, Japan; (Y.T.); (M.T.); (T.I.); (K.U.); (T.T.)
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo 1628655, Japan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 1040045, Japan; (Y.T.); (M.T.); (T.I.); (K.U.); (T.T.)
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 1040045, Japan
- Correspondence: ; Tel.: +813-3542-2511
| | - Midori Tanaka
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 1040045, Japan; (Y.T.); (M.T.); (T.I.); (K.U.); (T.T.)
| | - Tatsuya Imabayashi
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 1040045, Japan; (Y.T.); (M.T.); (T.I.); (K.U.); (T.T.)
| | - Keigo Uchimura
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 1040045, Japan; (Y.T.); (M.T.); (T.I.); (K.U.); (T.T.)
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo 1040045, Japan; (Y.T.); (M.T.); (T.I.); (K.U.); (T.T.)
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Lacaze JL, Aziza R, Chira C, De Maio E, Izar F, Jouve E, Massabeau C, Pradines A, Selmes G, Ung M, Zerdoud S, Dalenc F. Diagnosis, biology and epidemiology of oligometastatic breast cancer. Breast 2021; 59:144-156. [PMID: 34252822 PMCID: PMC8441842 DOI: 10.1016/j.breast.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/31/2021] [Accepted: 06/23/2021] [Indexed: 11/01/2022] Open
Abstract
Does oligometastatic breast cancer (OMBC) deserve a dedicated treatment? Although some authors recommend multidisciplinary management of OMBC with a curative intent, there is no evidence proving this strategy beneficial in the absence of a randomized trial. The existing literature sheds little light on OMBC. Incidence is unknown; data available are either obsolete or biased; there is no consensus on the definition of OMBC and metastatic sites, nor on necessary imaging techniques. However, certain proposals merit consideration. Knowledge of eventual specific OMBC biological characteristics is limited to circulating tumor cell (CTC) counts. Given the data available for other cancers, studies on microRNAs (miRNAs), circulating tumor DNA (ctDNA) and genomic alterations should be developed Finally, safe and effective therapies do exist, but results of randomized trials will not be available for many years. Prospective observational cohort studies need to be implemented.
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Affiliation(s)
- Jean-Louis Lacaze
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France.
| | - Richard Aziza
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Imagerie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Ciprian Chira
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Radiothérapie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Eleonora De Maio
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Françoise Izar
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Radiothérapie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Eva Jouve
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Chirurgie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Carole Massabeau
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Radiothérapie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Anne Pradines
- Institut Claudius Regaud (ICR), Département Biologie Médicale Oncologique, Centre de Recherche en Cancérologie de Toulouse, (CRCT), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), INSERM UMR-1037, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Gabrielle Selmes
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Chirurgie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Mony Ung
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Slimane Zerdoud
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Médecine Nucléaire, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Florence Dalenc
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, Université de Toulouse, UPS, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
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Cao C, Yang X. The Prevalence, Associated Factors for Lung Metastases Development and Prognosis in Ovarian Serous Cancer Based on SEER Database. Technol Cancer Res Treat 2020; 19:1533033820983801. [PMID: 33356997 PMCID: PMC7768314 DOI: 10.1177/1533033820983801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ovarian carcinoma (OC) is one of the 3 most common gynecological malignancies,
and the prognosis of patients with lung metastasis was the worst. SEER
documented OC patients, diagnosed between 2010 and 2016, were included in the
study. Univariable and multivariable logistic regression analyses were performed
to identify associated factors for lung metastases (LM) development.
Kaplan–Meier analysis was used to estimate the overall survival for OC patients
with LM. A total of 10146 eligible serous ovarian cancer (SOC) patients were
included, the prevalence of LM was 3.77% (N = 378). Patients with T4 stage
(χ2 = 128.515; P = 0.000), N1 stage
(χ2 = 49.536; P = 0.000), right laterality
(χ2 = 18.756; P = 0.000) (compared with left
side), undifferentiated grade (χ2 = 36.174; P =
0.000), bone metastasis (χ2 = 183.529); P = 0.000),
brain metastasis (χ2 = 117.539; P = 0.000), liver
metastasis (χ2 = 442.472; P = 0.000) had a larger
probability of LM than other groups. Results showed that T3/N1 stage, bone
metastases, liver metastases, chemotherapy, surgery were positively correlated
with LM. Multivariable cox analysis showed that age, bone metastasis, no
chemotherapy, no surgery were independent risk factors in SOC-LM patients. This
study provided new research insights on the prevalent LM in patients with SOC.
The factors associated with LM development and prognosis can be potentially used
for LM early screening and professional care.
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Affiliation(s)
- Chengcheng Cao
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xianghong Yang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Surgery versus stereotactic radiotherapy for treatment of pulmonary metastases. A systematic review of literature. Future Sci OA 2020; 6:FSO471. [PMID: 32518686 PMCID: PMC7273364 DOI: 10.2144/fsoa-2019-0120] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
It is not clear as to which is the best treatment among surgery and stereotactic radiotherapy (SBRT) for lung oligometastases. A systematic review of literature with a priori selection criteria was conducted on articles on the treatment of pulmonary metastases with surgery or SBRT. Only original articles with a population of patients of more than 50 were selected. After final selection, 61 articles on surgical treatment and 18 on SBRT were included. No difference was encountered in short-term survival between pulmonary metastasectomy and SBRT. In the long-term surgery seems to guarantee better survival rates. Mortality and morbidity after treatment are 0–4.7% and 0–23% for surgery, and 0–2% and 4–31% for SBRT. Surgical metastasectomy remains the treatment of choice for pulmonary oligometastases. Patients with metastatic cancer with a limited number of deposits may benefit from surgical removal or irradiation of tumor nodules in addiction to chemotherapy. Surgical resection has been demonstrated to improve survival and, in some cases, can be curative. Stereotactic radiotherapy is emerging as a less invasive alternative to surgery, but settings and implications of the two treatments are profoundly different. The two techniques show similar results in the short-term, with lower complications rates for radiotherapy, while in the long-term surgery seems to guarantee higher survival rates.
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Cheung FPY, Alam NZ, Wright GM. The Past, Present and Future of Pulmonary Metastasectomy: A Review Article. Ann Thorac Cardiovasc Surg 2019; 25:129-141. [PMID: 30971647 PMCID: PMC6587129 DOI: 10.5761/atcs.ra.18-00229] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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.
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Affiliation(s)
| | - Naveed Zeb Alam
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Gavin Michael Wright
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
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Is open surgery necessary for metastatic pulmonary tumors evaluated with thorax tomography? TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:254-259. [PMID: 32082742 DOI: 10.5606/tgkdc.dergisi.2018.15117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/23/2017] [Indexed: 11/21/2022]
Abstract
Background This study aims to compare the tomographic evaluations and intraoperative findings of patients treated surgically for primary tumors and who had pulmonary metastasis. Methods The study included 160 patients (102 males, 58 females; mean age 34.6±14.3 years; range, 11 to 64 years) who underwent pulmonary metastasectomy. The primary focus was surgically excised and no metastases other than pulmonary were detected on scans. Preoperative tomographic images together with the findings of the open surgical intervention were evaluated and compared. Results A total of 296 surgical resection were performed and 345 metastatic lesions were excised in 166 open surgical procedures. In 35 patients (21.9%), 71 (20.6%) metastatic lesions were detected in tomographic evaluations although no lesions had been detected on direct radiographs. In 29 patients (18.1%), 33 (9.6%) metastatic lesions, which had not been detected radiologically, were found intraoperatively. Conclusion Tomographic evaluation is used in the follow-up of patients with malignancy but as for pulmonary metastasis it is not efficient and adequate. Therefore, open surgery should be the preferred approach for intraoperative detection of metastases that cannot be detected radiologically. Open surgical resection for pulmonary metastasis can be performed safely with low rates of perioperative morbidity and mortality.
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Zhao X, Wen X, Wei W, Chen Y, Zhu J, Wang C. Clinical characteristics and prognoses of patients treated surgically for metastatic lung tumors. Oncotarget 2018; 8:46491-46497. [PMID: 28148889 PMCID: PMC5542284 DOI: 10.18632/oncotarget.14822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/17/2017] [Indexed: 11/25/2022] Open
Abstract
The clinical characteristics of metastatic lung tumors are not well understood. To explore the surgical indications, surgical modes, and factors that influence postoperative outcomes, we analyzed clinical data from 42 patients with metastatic lung tumors who received surgical treatment at Tianjin Medical University Cancer Institute and Hospital between January 2000 and January 2014. Gender, age, nature of resections, surgical mode, smoking index, disease-free intervals (DFIs), number of metastatic lesions, and lymph node metastases were analyzed. Patients were followed for 6 to 98 months. We found that surgical treatment is feasible for resectable metastatic lung tumors, though postoperative radiochemotherapy had no significant effect on postoperative survival rates among patients with metastatic lung tumors. No patients died perioperatively. The 1-year, 3-year, and 5-year survival rates after surgical resection of metastatic lung tumors were 88.1%, 45.7%, and 34.6%, respectively. Univariate analysis indicated that DFIs and lymph node metastasis correlated with patient prognoses, while multivariate analysis indicated these two variables were independent prognostic factors. Thus surgical treatment may be indicated, depending on patients' specific condition, to lengthen DFIs in patients with metastatic lung tumors with or without evident lymph node metastasis.
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Affiliation(s)
- Xiaoliang Zhao
- Department of Lung Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin Lung Cancer Center, Tianjin Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer Tianjin, Tianjin, P.R. China
| | - Xiaohua Wen
- Tianjin University of Traditional Chinese Medicine, Tianjin, P.R. China
| | - Wei Wei
- Department of Lung Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin Lung Cancer Center, Tianjin Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer Tianjin, Tianjin, P.R. China
| | - Yulong Chen
- Department of Lung Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin Lung Cancer Center, Tianjin Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer Tianjin, Tianjin, P.R. China
| | - Jianquan Zhu
- Department of Lung Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin Lung Cancer Center, Tianjin Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer Tianjin, Tianjin, P.R. China
| | - Changli Wang
- Department of Lung Cancer Tianjin Medical University Cancer Institute and Hospital, Tianjin Lung Cancer Center, Tianjin Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer Tianjin, Tianjin, P.R. China
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Matsutani N, Okumura S, Yoshino I, Ikeda N, Ozeki Y, Kawamura M. Pneumonectomy in pulmonary metastasis. J Thorac Dis 2017; 9:4523-4530. [PMID: 29268522 DOI: 10.21037/jtd.2017.10.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The risk of complication following pneumonectomy is high; therefore, the decision to perform pneumonectomy should be carefully evaluated. A retrospective multicenter study of patients with metastatic lung tumors who underwent pneumonectomy was conducted. Methods The database from the Metastatic Lung Tumor Study Group of Japan was retrospectively reviewed. Between 1984 and 2013, 4,742 patients underwent pulmonary metastasectomy. Of the 4,742 patients, 55 patients (1.16%) who underwent pneumonectomy were analyzed, and their survival parameters and prognostic factors were evaluated. Results Of the 55 patients who underwent pneumonectomy, 34 patients were male and 21 patients were female. The primary tumor sites were colorectal in 28 patients, head and neck in 12 patients, bone in three patients, bladder in three patients, and other regions in nine patients (breast, uterus, liver, soft tissues in two patients, respectively, and pancreas in one patient). The overall 5-year survival rate of patients following pneumonectomy was 28.9%. The rate was significantly lower than that of patients who underwent other metastasectomy which had an overall 5-year survival rate of 53.4% (P<0.001). There were 3 hospital mortalities (3/55, 5.45%). Univariate analysis revealed that patients 55 years old or older (P=0.016) and patients who had lymph node metastasis (P=0.032) were significant predictors of poor prognosis. Multivariate analysis indicated that the age group 55 years old or older was an independent prognostic factor (P=0.040). Conclusions The indication of pneumonectomy should be carefully reviewed, especially for patients 55 years old or older, however characteristics of each primary organ should also be considered.
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Affiliation(s)
- Noriyuki Matsutani
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ichiro Yoshino
- Department of general thoracic surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Norihiko Ikeda
- Department Of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yuichi Ozeki
- Department of Thoracic Surgery, National Defense Medical College, Saitama, Japan
| | - Masafumi Kawamura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Patrini D, Panagiotopoulos N, Lawrence D, Scarci M. Surgical management of lung metastases. Br J Hosp Med (Lond) 2017; 78:192-198. [PMID: 28398890 DOI: 10.12968/hmed.2017.78.4.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Management of pulmonary metastases has evolved considerably over the last few decades but is still controversial. The surgical management of lung metastases is outlined, discussing the preoperative management, indications for surgery, the surgical approach and outcomes according to the primary histology.
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Affiliation(s)
- Davide Patrini
- Senior Registrar in Thoracic Surgery, Thoracic Surgery Department, University College London Hospitals, London W1G 8PH
| | - Nikolaos Panagiotopoulos
- Consultant Thoracic Surgeon, Thoracic Surgery Department, University College London Hospitals, London
| | - David Lawrence
- Consultant Cardiothoracic Surgeon, Thoracic Surgery Department, University College London Hospitals, London
| | - Marco Scarci
- Consultant Thoracic Surgeon, Thoracic Surgery Department, University College London Hospitals, London
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Surgical management of lung, liver and brain metastases from gynecological cancers: a literature review. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2016; 3:7. [PMID: 27330821 PMCID: PMC4912748 DOI: 10.1186/s40661-016-0028-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/03/2016] [Indexed: 12/28/2022]
Abstract
Background The management of patients with recurrent gynecological malignancy is complex, and often contentious. While historically, patients with metastases in the lungs, liver or brain have been treated with palliative intent, surgery is proving to have an increasing role in the management of such patients. Methods In this review article, the surgical management of lung, liver and brain metastases from gynecological cancers is examined. A search of the English language literature over the last 25 years was conducted using the Medline and PubMed databases. Results The results for management of metastases from the endometrium, ovary and cervix to the lung, brain and liver show that surprisingly good long-term survival results can be achieved for resection of metastases from all three organs. Patient selection is critical, and surgery is often used in conjunction with other treatment modalities. Conclusions From this review, it is apparent that surgery should play an increasing role in the management of patients with parenchymal metastases from gynecological cancers. The surgery should ideally be performed in high volume, tertiary centers where there is a committed multi-disciplinary team with the necessary infrastructure to achieve the best possible outcomes in terms of both survival and morbidity.
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Abstract
In appropriately selected patients, resection of pulmonary metastases from various primary tumors can lead to improved survival. Metastasectomy has traditionally been performed by open thoracotomy; however, thoracoscopic resection offers the important benefits of a less invasive approach with more expeditious recovery. Concerns regarding missed lesions during thoracoscopy have not been realized in analyses of survival and may be offset by a policy of repeat metastasectomy for pulmonary recurrences. Despite the relative paucity of prospective trials, the preponderance of data supports the use of video-assisted thoracic surgery for pulmonary metastasectomy, which represents our preferred strategy for these patients.
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Fan J, Chen D, Du H, Shen C, Che G. Prognostic factors for resection of isolated pulmonary metastases in breast cancer patients: a systematic review and meta-analysis. J Thorac Dis 2015; 7:1441-51. [PMID: 26380770 DOI: 10.3978/j.issn.2072-1439.2015.08.10] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/15/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lung is a common organ of metastases in patients with primary breast cancer. Pulmonary metastasis of primary breast cancer is usually considered as a systemic disease, however, the systemic approaches have achieved little progress in terms of prolonging survival time. In contrast, some studies revealed a probable survival benefit of pulmonary metastasectomy for such patients. However, the prognostic factor for pulmonary metastasectomy in breast cancer patients is still a controversial issue. The aim of this study was to conduct a systematic review and meta-analysis of cohort studies to assess the pooled 5-year overall survival (OS) rate and the prognostic factors for pulmonary metastasectomy from breast cancer. METHODS An electronic search in MEDLINE (via PubMed), EMBASE (via OVID), CENTRAL (via Cochrane Library), and Chinese BioMedical Literature Database (CBM) complemented by manual searches in article references were conducted to identify eligible studies. All cohort studies in which survival and/or prognostic factors for pulmonary metastasectomy from breast cancer were reported were included in the analysis. We calculated the pooled 5-year survival rates, identified the prognostic factors for OS and combined the hazard ratios (HRs) of the identified prognostic factors. RESULTS Sixteen studies with a total of 1937 patients were included in this meta-analysis. The pooled 5-year survival rates after pulmonary metastasectomy was 46% [95% confidence interval (95% CI): 43-49%]. The poor prognostic factors were disease-free interval (DFI) (<3 years) with HR =1.70 (95% CI: 1.37-2.10), resection of metastases (incomplete) with HR =2.06 (95% CI: 1.63-2.62), No. of pulmonary metastases (>1) with HR =1.31 (95% CI: 1.13-1.50) and the hormone receptor status of metastases (negative) with HR =2.30 (95% CI: 1.43-3.70). CONCLUSIONS Surgery with a relatively high 5-year OS rate after pulmonary metastasectomy (46%), may be a promising treatment for pulmonary metastases in the breast cancer patients with a good performance status and limited disease. The main poor prognostic factors were DFI (<3 years), resection of metastases (incomplete), No. of pulmonary metastasis (>1) and hormone receptor status of metastases (negative). And prospective randomized trials will be needed to address these issues in the future.
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Affiliation(s)
- Jun Fan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Dali Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Heng Du
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Okamoto T, Kitahara H, Shimamatsu S, Morodomi Y, Tagawa T, Maehara Y. Applicability of Pulmonary Lobectomy in Treating Metastatic Lung Tumors. Ann Thorac Cardiovasc Surg 2015; 21:189-93. [PMID: 25641034 DOI: 10.5761/atcs.oa.14-00183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Although metastases to the lung from other organs are usually removed with limited lung resections (e.g., wedge resections or segmentectomies), pulmonary lobectomies are often required to remove whole pulmonary tumors. This study investigated the clinical applicability of pulmonary lobectomies to treat metastatic lung tumors. METHODS We retrospectively reviewed clinical records of 143 consecutive patients with metastatic tumors in the lung who underwent surgery in our department, including data sets for 100 patients treated for their first metastatic lung tumors. RESULTS Of the 100 patients, 23 received pulmonary lobectomies, 69 received wedge resections and eight received segmentectomies. Patients in the lobectomy group were more likely to be younger, have larger and/or multiple tumors, and to have tumors of musculoskeletal origin (sarcomas) than those who underwent segmentectomies or wedge resections (the limited resection group). The two groups did not significantly differ in survival (3-year survival rate; lobectomy vs limited resection: 75.2% vs 80.4%, P = 0.15), or post-operative morbidity, although the only post-operative morbidity was associated with post-operative prognosis in the lobectomy group. CONCLUSIONS Pulmonary lobectomy is a safe and applicable surgical procedure for metastatic lung tumors when long survival is expected after the tumor resection.
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Affiliation(s)
- Tatsuro Okamoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
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Schweiger T, Lang G, Klepetko W, Hoetzenecker K. Prognostic factors in pulmonary metastasectomy: spotlight on molecular and radiological markers. Eur J Cardiothorac Surg 2014; 45:408-416. [DOI: 10.1093/ejcts/ezt288] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Poletti GB, Toro IFC, Alves TF, Miranda ECM, Seabra JCT, Mussi RK. Descriptive analysis of and overall survival after surgical treatment of lung metastases. J Bras Pneumol 2014; 39:650-8. [PMID: 24473758 PMCID: PMC4075905 DOI: 10.1590/s1806-37132013000600003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 10/14/2013] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE: To describe demographic characteristics, surgical results, postoperative
complications, and overall survival rates in surgically treated patients
with lung metastases. METHODS: This was a retrospective analysis of 119 patients who underwent a total of
154 lung metastasis resections between 1997 and 2011. RESULTS: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The
median age was 52 years (range, 15-75 years). In this sample, 63 patients
(52.9%) presented with comorbidities, the most common being systemic
arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal
tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of
origin of the metastases. Approximately 24% of the patients underwent more
than one resection of the lesions, and 71% had adjuvant treatment prior to
metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the
median disease-free interval was 23 months. The main surgical access used
was thoracotomy (78%), and the most common approach was wedge resection with
segmentectomy (51%). The rate of postoperative complications was 22%, and
perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60,
and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis
confirmed that complications within the first 30 postoperative days were
associated with poor prognosis (hazard ratio = 1.81; 95% CI: 1.09-3.06; p =
0.02). CONCLUSIONS: Surgical treatment of lung metastases is safe and effective, with good
overall survival, especially in patients with fewer metastases.
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Su X, Ma G, Zhang X, Long H, Rong TH. Surgical approach and outcomes for treatment of pulmonary metastases. Ann Thorac Med 2013; 8:160-4. [PMID: 23922611 PMCID: PMC3731858 DOI: 10.4103/1817-1737.114300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 03/24/2013] [Indexed: 02/06/2023] Open
Abstract
AIMS: To investigate the surgical approach and outcomes, as well as prognostic factors for pulmonary metastasectomy. METHODS: Clinical data of 201 patients treated by pulmonary metastasectomy between January 1990 and December 2009 were retrospectively reviewed. One hundred thirty three patients were received an approach of thoracotomy while 68 with video-assisted thoracoscopic surgery (VATS). There were 54 lobectomies, 139 wedge resections and 8 pneumonectomies. Hilar or mediastinal lymph nodes dissection or sampling was carried out in 38 patients with lobectomy. The Kaplan-Meier method was used for the survival analysis. Cox proportional hazards model was used for multivariate analysis. RESULTS: The 5 years survival rate of patients after metastasectomy was 50.5%, and the median survival time was 65.9 months. The median survival time of patients with hilar or mediastinal lymph nodes metastasis was 23 months. By univariate analysis, significant prognostic factors included disease-free interval (DFI), number of metastases, number of affected lobe, surgical approach (open vs. VATS) and pathology types. DFI, number of metastases, and pathology types were revealed by Cox multivariate analysis as independent prognostic factors. CONCLUSION: Surgical resection of pulmonary metastases is safe and effective. Palpation of the lung is still seen as necessary to detect the occult nodule. More accurate and sensitive pre-operative mediastinal staging are required.
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Affiliation(s)
- Xiaodong Su
- Department of Thoracic Surgery, Cancer Center, Sun Yet-Sen University, State Key Laboratory of Oncology, Southern China, China
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Thoracoscopic resection of solitary lung metastases evaluated by using thin-section chest computed tomography: is thoracoscopic surgery still a valid option? Gen Thorac Cardiovasc Surg 2013; 61:565-70. [PMID: 23832549 DOI: 10.1007/s11748-013-0284-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study evaluated long-term outcomes of pulmonary metastasectomy for solitary lung metastases to clarify the role of video-assisted thoracoscopic surgery in the selected population. METHODS We retrospectively investigated oncologic results after the resection of solitary lung metastases guided by thin-section chest computed tomography scans in 105 patients. Pulmonary metastasectomy for solitary lung metastases was approached by thoracotomy (n = 43) and by thoracoscopy (n = 62). RESULTS Compared to the thoracotomy group, the thoracoscopy group had a shorter hospital stay (p < 0.001) postoperatively. Intrathoracic recurrence developed in 11 (25.6 %) patients in the thoracotomy group and 15 (24.2 %) in the thoracoscopy group. 19 patients (18.1 %) underwent re-metastasectomy during the median 36-month (5-113) follow-up (p = 0.693). Re-metastasectomy was performed in 8 patients (18.6 %) in the thoracotomy group and in 11 patients (17.7 %) in the thoracoscopy group (p = 0.910). Overall survival was not significantly different between the two groups (p = 0.210). Intrathoracic recurrence was the only significant risk factor for overall survival (p = 0.036) in multivariate analysis. CONCLUSIONS In a highly selected group with solitary lung metastases, pulmonary metastasectomy by thoracotomy or thoracoscopy did not affect survival. There were comparable oncologic results from both surgeries when applied in solitary lung metastases from an extra-thoracic malignancy. Thoracoscopic metastasectomy is a promising option in small, solitary pulmonary metastases.
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Meimarakis G, Rüttinger D, Stemmler J, Crispin A, Weidenhagen R, Angele M, Fertmann J, Hatz RA, Winter H. Prolonged overall survival after pulmonary metastasectomy in patients with breast cancer. Ann Thorac Surg 2013; 95:1170-80. [PMID: 23391172 DOI: 10.1016/j.athoracsur.2012.11.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 11/13/2012] [Accepted: 11/16/2012] [Indexed: 01/03/2023]
Abstract
BACKGROUND We investigated whether overall survival (OS) in patients with primary breast cancer (BC) is prolonged by pulmonary metastasectomy and which prognostic criteria may facilitate the decision in favor of thoracic surgical intervention. METHODS We assessed the median OS of 81 women after resection of pulmonary primary BC metastases by means of Kaplan-Meier estimators. Statistical interferences regarding prognostic factors were based on univariate log-rank tests and multivariate Cox proportional hazards regression. Matched patients who had not undergone resection from the Munich Tumor Registry served as controls. RESULTS Between 1982 and 2007, 81 patients were recruited prospectively. In 81.5% of the patients R0 resection was achieved, which was associated with significantly longer median OS than occurred after R1 or R2 resection (103.4 months versus 23.6 months versus 20.2 months, respectively; p<0.001). Multivariate analysis revealed R0 resection, number (n≥2), size (≥3 cm), and estrogen receptor (ER) and/or progesterone receptor (PR) positivity of metastases as independent prognostic factors for long-term survival. Presence of metastases in mediastinal and hilar lymph nodes correlated with decreased survival only in the univariate analysis (32.1 versus 103.4 months; p=0.095). Matched pair analysis confirmed that pulmonary metastasectomy significantly improved survival. CONCLUSIONS OS in patients with isolated pulmonary primary BC metastasis is prolonged by metastasectomy. Patients with multiple pulmonary lesions or metastases with negative hormone receptor (HR) status are at greater risk of disease relapse and should be followed closely. Moreover, additive treatment tailored to the biological subtype defined by HR expression should be considered for this group.
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Affiliation(s)
- Georgios Meimarakis
- Department of Surgery, Grosshadern-Medical-Center, Ludwig-Maximilians-University, Munich, Germany.
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Pattern of Postoperative Recurrence and Hepatic and/or Pulmonary Resection for Liver and/or Lung Metastases From Esophageal Carcinoma. World J Surg 2012; 37:398-407. [DOI: 10.1007/s00268-012-1830-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Kozu Y, Sato H, Tsubosa Y, Ogawa H, Yasui H, Kondo H. Surgical treatment for pulmonary metastases from esophageal carcinoma after definitive chemoradiotherapy: experience from a single institution. J Cardiothorac Surg 2011; 6:135. [PMID: 21992542 PMCID: PMC3204234 DOI: 10.1186/1749-8090-6-135] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 10/12/2011] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Surgical treatment for pulmonary metastases is known to be a safe and potentially curative procedure for various primary malignancies. However, there are few reports regarding the prognostic role of surgical treatment for pulmonary metastases from esophageal carcinoma, especially after definitive chemoradiotherapy (CRT). METHODS We retrospectively reviewed 5 patients who underwent surgical treatment for pulmonary metastases from esophageal carcinoma at our institution. The primary treatment for esophageal carcinoma was definitive CRT, and a complete response (CR) was achieved in all patients. RESULTS The surgical procedure for pulmonary metastases was wedge resection, and pathological complete resection was achieved in all 5 patients. The disease free interval after definitive CRT varied from 7 to 36 months, with a median of 19 months. There were no perioperative complications, but postoperative respiratory failure occurred in 1 patient. The postoperative hospital stay varied from 4 to 7 days, with a median of 6 days. Three patients are now alive with a good performance status (PS) and are disease free. The other 2 patients died of primary disease. The overall survival after surgical treatment varied from 20 to 90 months, with a median of 29 months. CONCLUSIONS Surgical treatment should be considered for patients with pulmonary metastases from esophageal carcinoma who previously received CRT and achieved a CR, because it provides not only a longer survival, but also a good postoperative PS for some patients.
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Affiliation(s)
- Yoshiki Kozu
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroshi Sato
- Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yasuhiro Tsubosa
- Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hirofumi Ogawa
- Division of Therapeutic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hirofumi Yasui
- Division of Gastrointestinal Medicine, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruhiko Kondo
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
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Abstract
The primary imaging modality for the detection of pulmonary metastases is computed tomography (CT). Ideally, a helical CT scan with 3- to 5-mm reconstruction thickness or a volumetric thin section scanning should be performed within 4 weeks of pulmonary metastasectomy. A period of observation to see whether further metastases develop does not seem to allow better patient selection. If positron emission tomography is available, it may identify the extrathoracic metastatic sites in 10 to 15% of patients. Despite helical CT scan, palpation identifies the metastases not detected by imaging in 20 to 25% of patients and remains the standard. No data define the optimal interval for follow-up surveillance imaging.
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Yano T, Shoji F, Maehara Y. Current status of pulmonary metastasectomy from primary epithelial tumors. Surg Today 2009; 39:91-7. [PMID: 19198984 DOI: 10.1007/s00595-008-3820-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Accepted: 05/21/2008] [Indexed: 12/23/2022]
Abstract
The resection of pulmonary metastases can prolong the survival of selected patients and its therapeutic value is now accepted. The criteria for eligibility have also evolved. We reviewed the recent literature on pulmonary metastasectomy for various epithelial primary tumors and tried to establish better prognostic indicators for its surgical application. In addition to the welldefined requisites for pulmonary metastasectomy, other requirements include the absence of mediastinal lymph node involvement, a limited number of pulmonary metastatic lesions, a long disease-free interval, small metastasis, and no elevation of tumor markers, although the clinical importance of each factor varies among the primary tumors. On the other hand, with the development of video-assisted thoracoscopic surgery (VATS) and advances in thoracic imaging technology, VATS metastasectomy might become an accepted treatment for metastatic nodules located in the periphery of the lung, which can be easily removed by a wedge resection. Repeat surgery is also possible during follow-up after VATS.
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Affiliation(s)
- Tokujiro Yano
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Norihisa Y, Nagata Y, Takayama K, Matsuo Y, Sakamoto T, Sakamoto M, Mizowaki T, Yano S, Hiraoka M. Stereotactic Body Radiotherapy for Oligometastatic Lung Tumors. Int J Radiat Oncol Biol Phys 2008; 72:398-403. [DOI: 10.1016/j.ijrobp.2008.01.002] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Revised: 12/27/2007] [Accepted: 01/03/2008] [Indexed: 12/13/2022]
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Nakajima T, Yasufuku K, Iyoda A, Yoshida S, Suzuki M, Sekine Y, Shibuya K, Hiroshima K, Nakatani Y, Fujisawa T. The evaluation of lymph node metastasis by endobronchial ultrasound-guided transbronchial needle aspiration: crucial for selection of surgical candidates with metastatic lung tumors. J Thorac Cardiovasc Surg 2007; 134:1485-90. [PMID: 18023670 DOI: 10.1016/j.jtcvs.2007.07.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 07/19/2007] [Accepted: 07/26/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Pulmonary metastasectomy is accepted as an effective treatment for properly selected patients with metastatic lung tumors. In such patients, the presence of mediastinal and/or hilar lymph node metastasis is a significant negative prognostic factor. The purpose of this study was to evaluate the usefulness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the detection of mediastinal and hilar lymph node metastasis in patients with potentially resectable metastatic lung tumors. METHODS Patients with metastatic lung tumors with radiologically defined mediastinal and/or hilar lymph nodes on chest computed tomographic scans referred to our department for pulmonary resection were retrospectively analyzed. Successful lymph node aspiration was evidenced by the presence of malignant cells or normal lymphocytes. Cytologic and histologic analysis was used to confirm metastasis in surgically resected specimens unless metastasis was proven by EBUS-TBNA. RESULTS A total of 106 patients were referred for metastasectomy during the study period. EBUS-TBNA was performed in 60 lymph nodes (37 mediastinal and 23 hilar nodes) from 43 patients. Cytologic and/or histologic samples were diagnostic in 41 (95.3%) patients. EBUS-TBNA detected lymph node metastasis in 23 patients. The sensitivity, specificity, and diagnostic accuracy rate of EBUS-TBNA for diagnosis of mediastinal and hilar lymph node metastasis were 92.0%, 100%, and 95.3%, respectively. CONCLUSIONS EBUS-TBNA is a highly sensitive modality for the evaluation of mediastinal and hilar lymph node metastasis in patients with metastatic lung tumors. EBUS-TBNA allows preoperative histologic as well as cytologic evaluation of mediastinal and hilar lymph nodes.
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Affiliation(s)
- Takahiro Nakajima
- Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Demmy TL, Dunn KB. Surgical and Nonsurgical Therapy for Lung Metastasis: Indications and Outcomes. Surg Oncol Clin N Am 2007; 16:579-605, ix. [PMID: 17606195 DOI: 10.1016/j.soc.2007.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The management of pulmonary metastasis is a broad and multifaceted topic. Because of the filtration function and the favorable microenvironment of the lung, most malignancies cause pulmonary metastases. This article focuses on recent experience with secondary lung malignancies and their newer treatment options, indications, and technical aspects.
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Affiliation(s)
- Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14231, USA.
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Veronesi G, Petrella F, Leo F, Solli P, Maissoneuve P, Galetta D, Gasparri R, Pelosi G, De Pas T, Spaggiari L. Prognostic role of lymph node involvement in lung metastasectomy. J Thorac Cardiovasc Surg 2007; 133:967-72. [PMID: 17382635 DOI: 10.1016/j.jtcvs.2006.09.104] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 08/22/2006] [Accepted: 09/05/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The impact of lymph node involvement in lung metastasectomy from extrapulmonary malignancies is uncertain. We assessed the prognostic value of lymph node status in lung metastasectomy and the prevalence of unexpected mediastinal lymph node involvement after lymph node sampling or dissection. METHODS From May 1998 to October 2005, 388 patients underwent 430 pulmonary metastasectomies with curative intent. The clinical records of all patients who underwent radical lymph node dissection or sampling were reviewed retrospectively. Survival was evaluated using the Kaplan-Meier method and comparison of survival curves by log-rank test. RESULTS A total of 124 patients (61 men, mean age 59 years) underwent 139 pulmonary metastasectomies (56 wedge resections, 30 segmentectomies, 49 lobectomies, and 4 pneumonectomies with radical lymph node dissection [88] or sampling [51]). Means of 9.4 lymph nodes and 2 lung metastases per intervention were removed. The median disease-free interval from primary treatment to lung metastasectomy was 49 months. Lymph node involvement was present in 25 patients (20%), in 10 (8%) at N1 stations (hilar or peribronchial) and in 15 (12%) at N2 stations (mediastinal), and in 7 (12.5%) after atypical resection and in 19 (23%) after typical resection. In 15 patients (12%) (60% of N+ patients), lymph node involvement was unexpected. Estimated overall 5-year survival was 46%: It was 60% for subjects with no lymph node metastasis and 17% and 0% for those with N1 and N2 disease, respectively (P = .01). CONCLUSIONS Lymph node involvement heavily affects prognosis after pulmonary metastasectomies. In most patients, lymph node involvement was not revealed by preoperative workup.
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Affiliation(s)
- Giulia Veronesi
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
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Clavero JM, Deschamps C, Cassivi SD, Allen MS, Nichols FC, Barrette BA, Larson DR, Pairolero PC. Gynecologic Cancers: Factors Affecting Survival After Pulmonary Metastasectomy. Ann Thorac Surg 2006; 81:2004-7. [PMID: 16731120 DOI: 10.1016/j.athoracsur.2006.01.068] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Revised: 12/30/2005] [Accepted: 01/04/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little information is available regarding long-term survival after pulmonary metastasectomy for gynecologic malignancies. METHODS All patients who underwent pulmonary resection for gynecologic malignancies at our institution between January 1985 and June 2001 were reviewed. Factors affecting long-term survival were analyzed. RESULTS There were 103 patients, 70 of whom had metastatic disease limited to the lungs. Median age of these 70 patients was 59.4 years (range, 31 to 80 years). The primary tumor originated in the uterine corpus in 37 patients, endometrium in 23, cervix in 7, ovaries in 2, and vagina in 1. Histopathology was leiomyosarcoma in 29 patients, adenocarcinoma in 23, other sarcoma in 11, squamous cell carcinoma in 5, and choriocarcinoma and endolymphatic stromal myosis in 1 each. The median time interval between the first gynecologic procedure and pulmonary resection was 24 months (range, 0 to 237 months). A wedge excision was performed in 44 patients, lobectomy in 14, bilobectomy in 2, pneumonectomy in 1, and a combination in 9. Five patients (7%) had an incomplete resection. Eighteen patients (25.7%) developed at least one complication and 1 died (operative mortality, 1.4%). At last follow-up, 35 had died, and the median follow-up among those who were still alive was 36 months (range, 6 months to 13 years). Five-year and 10-year survival was 46.8% (95% confidence interval, 34.2% to 63.0%) and 34.3% (95% confidence interval, 19.7% to 52.5%), respectively. Factors that adversely affected survival include a disease-free interval between the first gynecologic procedure and pulmonary resection of less than 24 months (p = 0.004) and a primary site located in the cervix (p < 0.001). CONCLUSIONS Pulmonary resection for metastatic gynecologic cancer in selected patients is safe and effective. Both a short disease-free interval between the primary gynecologic procedure and pulmonary metastasectomy, and a primary cervical tumor had an adverse effect on survival.
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Affiliation(s)
- Jose M Clavero
- Division of General Thoracic Surgery, Rochester, Minnesota, USA
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