Lung metastases
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Lung metastases
Table of Contents
- DISEASE DESCRIPTION
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.
References:
- Rusch VW: Pulmonary metastasectomy: current indications. Chest 107(6,
Suppl): 322S-331S, 1995.
- 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.
- Regal AM, Reese P, Antkowiak J, et al.: Median sternotomy for metastatic
lung lesions in 131 patients. Cancer 55(6): 1334-1339, 1985.
- Mountain CF, McMurtrey MJ, Hermes KE: Surgery for pulmonary metastasis: a
20-year experience. Annals of Thoracic Surgery 38(4): 323-330, 1984.
- 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.
- 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.
- 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.
- 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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