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Lung metastases

Table of Contents



Metastatic disease to the lung is common. Since the entire cardiac output flows through the lungs, the risk of hematogenous metastases is very high. Excluding primary lung cancers, which do metastasize to either lung, the most common tumors involving the lung parenchyma are breast cancer, gastrointestinal tumors, kidney cancer, melanoma, sarcomas, lymphomas and leukemias, germ cell tumors, and rarely ovarian cancer.[1,2]

In most cases, management of metastatic cancer to the lung relies on systemic treatment for the primary malignancy. A few tumors, like sarcomas, metastasize almost exclusively to the lung and can on rare occasion be cured by treatment of the primary site and resection of lung metastases. Others, like testicular cancer, present with disseminated disease that can be eradicated with systemic chemotherapy (except for residual teratoma in the lungs and retroperitoneum which require surgical excision for cure). Finally, some tumors like kidney cancer can have a few slow-growing pulmonary metastases that can be resected to increase the disease-free survival.

There is an extensive surgical experience with resection of pulmonary metastases. Goals for resection of metastases are: (1) cure of the disease or

(2) increase in disease-free interval.
Major prognostic factors for resection of pulmonary metastases are tumor type, time from treatment of the primary tumor to lung metastases, number of metastases in the lung, tumor doubling time, existence of extrapulmonary metastases, and finally, the general medical condition of the patient.[3-5] The most favorable group of patients are young patients in good general condition with sarcomas who present with a small number of metastatic nodules a year or more after successful treatment of the primary. In addition, the tumor doubling time should be over 45 days. In osteosarcoma, male sex and less than 5 nodules detected radiographically or at surgery were statistically correlated with improved survival by Cox regression analysis.[6]

Thoracotomy has been the standard surgical approach for unilateral pulmonary metastases. Since up to 40% of patients thought to have unilateral metastases have bilateral metastases at surgical exploration, the use of median sternotomy to enable bilateral exploration has been advocated.[3,6,7] Bilateral thoracotomy [8] or median sternotomy are accepted surgical approaches for bilateral pulmonary metastases.

The designations in PDQ that treatments are "standard" or "under clinical evaluation" are not to be used as a basis for reimbursement determinations.

Under clinical evaluation:

Isolated lung perfusion. See the PDQ Protocol File for a listing of current
clinical trials.

  1. Rusch VW: Pulmonary metastasectomy: current indications. Chest 107(6, Suppl): 322S-331S, 1995.

  2. van Geel AN, Pastorino U, Jauch KW, et al.: Surgical treatment of lung metastases: the European Organization for Research and Treatment of Cancer - Soft Tissue and Bone Sarcoma Group study of 255 patients. Cancer 77(4): 675-682, 1996.

  3. Regal AM, Reese P, Antkowiak J, et al.: Median sternotomy for metastatic lung lesions in 131 patients. Cancer 55(6): 1334-1339, 1985.

  4. Mountain CF, McMurtrey MJ, Hermes KE: Surgery for pulmonary metastasis: a 20-year experience. Annals of Thoracic Surgery 38(4): 323-330, 1984.

  5. Pass HI: Treatment of metastatic cancer to the lung. In: DeVita VT, Hellman S, Rosenberg SA, Eds.: Cancer: Principles and Practice of Oncology. Philadelphia: JB Lippincott Company, 4th Edition, 1993, pp 2186-2200.

  6. Meyer WH, Schell MJ, Kumar AP, et al.: Thoracotomy for pulmonary metastatic osteosarcoma: an analysis of prognostic indicators of survival. Cancer 59(2): 374-379, 1987.

  7. Casson AG, Putman JB, Natarajan G, et al.: Five-year survival after pulmonary metastasectomy for adult soft tissue sarcoma. Cancer 69(3): 662-668, 1992.

  8. Bains MS, Ginsberg RJ, Jones WG, et al.: The clamshell incision: an improved approach to bilateral pulmonary and mediastinal tumor. Annals of Thoracic Surgery 58(1): 30-33, 1994.

Date Last Modified: 08/96

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