Surgical approach in oligometastatic non-small cell lung cancer

Radiation Therapy in Non-Small-Cell Lung Cancer

The management of non-small-cell lung cancer (NSCLC) varies according to stage. Surgical resection is reserved for operable patients with early-stage NSCLC, while high-dose target radiation-stereotactic body radiation therapy (SBRT)-is reserved for patients whose comorbidities prohibit them from a major surgical procedure. The treatment of locally advanced NSCLC (LA-NSCLC) is stratified according to resectability. Those with resectable disease may require additional treatments such as chemotherapy and radiation, while patients with unresectable disease will require definitive chemoradiation therapy with adjuvant durvalumab. Patients with limited metastatic disease benefit from the combination of SBRT and systemic therapy.

A risk stratification scheme for synchronous oligometastatic non-small cell lung cancer developed by a multicentre analysis

BACKGROUNDS

Oligometastatic Non-Small Cell Lung Cancer (NSCLC) patients represent a category without a standard therapeutic approach. However, in selected oligometastatic NSCLC, radical surgery seems to offer a good prognosis. This retrospective study aimed to analyse the long-term outcomes of synchronous oligometastatic patients treated with curative intent and identify the factors associated with better results and the proposal of a risk stratification system for classifying the synchronous oligometastatic NSCLC.

METHODS

The medical records of patients from 18 centres with pathologically diagnosed synchronous oligometastatic NSCLC were retrospectively reviewed. The inclusion criteria were synchronous oligometastatic NSCLC, radical surgical treatment of the primary tumour with or without neoadjuvant/adjuvant therapy and radical treatment of all metastatic sites. The Kaplan - Meier method estimated survivals. A stratified backward stepwise Cox regression model was assessed for multivariable survival analyses.

RESULTS

281 patients were included. The most common site of metastasis was the brain, in 50.89 % patients. Median overall survival was 40 months (95 % CI: 29-53). Age ≤65 years (HR = 1.02, 95 % CI: 1.00-1.05; p = 0.019), single metastasis (HR = 0.71, 95 % CI: 0.45-1.13; p = 0.15) and presence of contralateral lung metastases (HR = 0.30, 95 % CI: 0.15 - 0.62; p = 0.001) were associated with a good prognosis. The presence of pathological N2 metastases negatively affected survival (HR = 2.00, 95 % CI: 1.21-3.32; p = 0.0065). These prognostic factors were used to build a simple risk classification scheme.

CONCLUSIONS

Treatment of selected synchronous oligometastatic NSCLC with curative purpose could be conducted safely and at acceptable 5-year survival levels, especially in younger patients with pN0 disease.

Presentation of cervical metastases and pathological mandibular fracture due to pulmonal adenocarcinoma: A case report

•

Oral metastatic tumors due to malignancies at distant locations are very rare.

•

Cervical metastases of level I and II due to adenocarcinoma of the lung have hardly been described before.

•

Diagnosis of unclear oral lesions requires extensive staging.

•

In cases of oligometastases in the oral region tumor resection may be a curative treatment.

Introduction

Oral metastatic tumors due to malignancies at distant locations are very rare. There are only few cases in the literature reporting about mandible/cervical metastases. Sometimes the oral finding is the manifestation of the disease.

Presentation of case

We report on a 50-year-old patient who was diagnosed with a pathological mandibular fracture and cervical lymph node metastases due to an adenocarcinoma of the lung without other peripheral metastases. Following the interdisciplinary tumor board decision, resection and ipsilateral neck dissection including a mandible reconstruction using a microvascular fibula transplant was performed. The patient received an adjuvant chemotherapy with carboplatin/pemetrexed.

Discussion

The combination of cervical metastases and a pathological mandibular fracture has not been reported before. Distinction between oligometastatic and polymetastatic disease may be difficult. Bone lesions and a high number of metastases are associated with a negative outcome. In cases of limited oligometastatic diseases, metastasectomy might sometimes be indicated. Due to the absence of other peripheral metastases decision of metastasectomy was made.

Conclusion

Due to rare occurrence of cervical metastases special attention should be paid to the incidence of possible metastases of distant malignancies at uncommon regions.

Patient outcomes post-pulmonary resection for synchronous bone-metastatic non-small cell lung cancer

Background

The efficacy of curative-intent pulmonary resection for non-small cell lung cancer (NSCLC) patients with certain types of oligometastases, particularly brain and adrenal metastases, has previously been described. We investigated the outcomes of curative-intent pulmonary resection for NSCLC patients with synchronous isolated bone metastases, which have been less clear to date.

Methods

We retrospectively reviewed the clinical and pathological records of 41 patients with NSCLC and synchronous isolated bone metastases who underwent radical treatments (surgery and/or chemotherapy and/or radiotherapy) for both their primary tumors and bone metastases at the National Hospital Organization, Hokkaido Cancer Center, between 2008 and 2013.

Results

Nine of the 41 patients underwent pulmonary primary tumor resection; the rate of clinical N0-1 disease among these 9 patients (100%) was significantly higher than that among the 32 patients who did not undergo resection (34.4%). The five-year overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) rates of the nine patients who underwent pulmonary resection were 66.7%, 55.6%, and 44.4%, respectively. On multivariate analysis, the predictors of longer OS among all 41 patients were primary site resection [hazard ratio (HR) =4.18, 95% CI, 1.20-14.6, P=0.025] and epidermal growth factor receptor (EGFR) mutation (HR =3.30, 95% CI, 1.08-10.1, P=0.036). The former was also a predictor of longer PFS (HR =3.75, 95% CI, 1.27-11.0, P=0.016).

Conclusions

Patients with clinical N0-1 NSCLC and synchronous isolated bone metastases may achieve longer survival rates following primary lung tumor resection.

Knockdown of SNHG12 suppresses tumor metastasis and epithelial-mesenchymal transition via the Slug/ZEB2 signaling pathway by targeting miR-218 in NSCLC

Non-small cell lung cancer (NSCLC) is a type of lung cancer which has a high mortality and low survival rate. Previous studies have revealed that long non-coding RNAs participate in tumorigenesis and metastasis in NSCLC. In the present study, the function of small nucleolar RNA host gene 12 (SNHG12) was investigated in NSCLC. Using reverse transcription-quantitative polymerase chain reaction analysis, it was identified that SNHG12 was significantly overexpressed in NSCLC specimens. Furthermore, overexpression of SNHG12 was identified to be associated with tumor progression and poor overall survival rates. Knockdown of SNHG12 in NSCLC cells could effectively induce cell apoptosis and suppress cell viability, proliferation, migration and invasion via inhibition of the epithelial-mesenchymal transition process. Furthermore, a direct interaction between microRNA (miR)-218 and the binding site of SNHG12 was identified. SNHG12 acted as an endogenous sponge for miR-218. Knockdown of SNHG12 upregulated the expression level of miR-218 as well as downregulating the Slug/zinc finger E-box-binding homeobox 2 EMT signaling pathway, and thus inhibited cell migration and invasion. Therefore, SNHG12 may serve as a key biomarker and a potential therapeutic target for the treatment of NSCLC.