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Treasure T, Macbeth F, Fallowfield L. A prospective multicentre cohort study of colorectal lung metastasectomy with a nested randomized controlled trial: the key points from the pulmonary metastasectomy in colorectal cancer study. Eur J Cardiothorac Surg 2024; 65:ezae216. [PMID: 38873790 PMCID: PMC11176865 DOI: 10.1093/ejcts/ezae216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024] Open
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, Department of Mathematics, University College London, London WC1H 0BT, UK
| | - Fergus Macbeth
- Centre for Trails Research, Cardiff University, Cardiff CF14 4YS, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer, University of Sussex, Sussex BN1 9RX, UK
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Scanagatta P, Ancona G, Cagnetti S, Giorgetta CE, Inzirillo F, Ravalli E, Maiolani M, Naldi G. The Case for Pulmonary Metastasectomy-Clinical Practice Narrative Review and Commentary. Life (Basel) 2024; 14:702. [PMID: 38929685 PMCID: PMC11204682 DOI: 10.3390/life14060702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
Pulmonary metastasectomy has become a well-established procedure for patients with certain types of solid tumors. Patients are usually scheduled for staged lung metastasectomy in case of primary tumor control, the absence of distant non-lung metastases, and when complete resection is achievable. Nodules are removed with precision resection in order to ensure radical resection with minimal margins; this technique permits good oncological results, preserving the surrounding pulmonary parenchyma and causing minimal distortion compared to staplers. When possible, anatomical resections should be avoided since they are not justified by real oncological advantages and, in the majority of cases, sacrifice too much healthy tissue, possibly leading to inoperability in the case of metachronous relapses. Thus, preserving the maximum amount of pulmonary parenchyma is crucial because repeated metastasectomies are possible and frequent, with no theoretical limits to the number of reinterventions. In our multidisciplinary board team, we support the role of pulmonary metastasectomy as a useful curative therapy, with acceptable morbidity and mortality, with indications to be discussed case-by-case.
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Affiliation(s)
- Paolo Scanagatta
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Gianluca Ancona
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Sara Cagnetti
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Casimiro Eugenio Giorgetta
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Francesco Inzirillo
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Eugenio Ravalli
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
| | - Martina Maiolani
- Division of Oncology, ASST Valtellina e Alto Lario, “Ospedale Civile” Sondrio, 23100 Sondalo, Italy
| | - Giuseppe Naldi
- Division of Thoracic Surgery, ASST Valtellina e Alto Lario, “Eugenio Morelli” Hospital, 23035 Sondalo, Italy
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Hansdotter P, Scherman P, Nikberg M, Petersen SH, Holmberg E, Rizell M, Naredi P, Syk I. Treatment and survival of patients with metachronous colorectal lung metastases. J Surg Oncol 2023; 127:806-814. [PMID: 36607235 DOI: 10.1002/jso.27188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The lungs are the second most common site for metachronous metastases in colorectal cancer. No treatment algorithm is established, and the role of adjuvant chemotherapy is unclear. This study aimed to map pulmonary recurrences in a modern multimodal treated population, and to evaluate survival depending on management. METHODS Retrospective study based on the COLOFOL-trial population of 2442 patients, radically resected for colorectal cancer stage II-III. All recurrences within 5 years were identified and medical records were scrutinized. RESULTS Of 165 (6.8%) patients developing lung metastases as first recurrence, 89 (54%) were confined to the lungs. Potentially curative treatment was possible in 62 (37%) cases, of which 33 with surgery only and 29 with surgery and chemotherapy combined. The 5-year overall survival (5-year OS) for all lung recurrences was 28%. In patients treated with chemotherapy only the 5-year OS was 7.5%, compared with 55% in patients treated with surgery, and 72% when surgery was combined with chemotherapy. Hazard ratio for mortality was 2.9 (95% confidence interval 1.40-6.10) for chemotherapy only compared to surgery. CONCLUSION A high proportion of metachronous lung metastases after colorectal surgery were possible to resect, yielding good survival. The combination of surgery and chemotherapy might be advantageous for survival.
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Affiliation(s)
- Pernilla Hansdotter
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Institute of Clinical Sciences Malmö, Section of Surgery, Lund University, Lund, Sweden
| | - Peter Scherman
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - Maziar Nikberg
- Department of Surgery, Centre for Clinical Research of Uppsala University, Västmanland's Hospital, Västerås, Sweden
| | - Sune H Petersen
- Department of Paediatrics & Adolescent Medicine, Section of Paediatric Haematology & Oncology, Copenhagen, Denmark
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Rizell
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Naredi
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingvar Syk
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Institute of Clinical Sciences Malmö, Section of Surgery, Lund University, Lund, Sweden
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Treasure T, Macbeth F. Finding that outcomes after imaging-guided thermal ablation and surgery for colorectal lung metastases are similar does not prove a survival benefit from either. J Surg Oncol 2023; 127:510-512. [PMID: 36394433 DOI: 10.1002/jso.27145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Tom Treasure
- Department of Mathematics, Clinical Operational Research Unit, University College London, London, UK
| | - Fergus Macbeth
- Center for Trials Research, Cardiff University, Cardiff, UK
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Williams NR, Patrick H, Fiorentino F, Allen A, Sharma M, Milošević M, Macbeth F, Treasure T. Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) randomised controlled trial: a systematic review of published responses. Eur J Cardiothorac Surg 2022; 62:6567629. [PMID: 35415756 PMCID: PMC9257793 DOI: 10.1093/ejcts/ezac253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/15/2022] [Accepted: 04/09/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The objective of this review was to assess the nature and tone of the published responses to the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) randomized controlled trial. METHODS Published articles that cited the PulMiCC trial were identified from Clarivate Web of Science (©. Duplicates and self-citations were excluded and relevant text extracted. Four independent researchers rated the extracts independently using agreed scales for the representativeness of trial data and the textual tone. The ratings were aggregated and summarized. Two PulMiCC authors carried out a thematic analysis of the extracts. RESULTS Sixty-four citations were identified and relevant text was extracted and examined. The consensus rating for data inclusion was a median of 0.25 out of 6 (range 0 to 5.25, IQR 0-1.5) and for textual tone the median rating was 1.87 out of 6 (range 0 to 5.75, IQR 1-3.5). The majority of citations did not provide adequate representation of the PulMiCC data and the overall the textual tone was dismissive. Although some were supportive, many discounted the findings because the trial closed early and was underpowered to show non-inferiority. Two misinterpreted the authors' conclusions but there was acceptance that five-year survival was much higher than widely assumed. CONCLUSIONS Published comments reveal a widespread reluctance to consider seriously the results of a carefully conducted randomized trial. This may be because the results challenge accepted practice because of 'motivated reasoning'. But there is a widespread misunderstanding of the fact that though PulMiCC with 93 patients was underpowered to test non-inferiority, it still provides reliable evidence to undermine the widespread belief in a major survival benefit from metastasectomy.
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Affiliation(s)
- Norman R Williams
- Surgical and Interventional Trials Unit, University College London, UK
| | | | - Francesca Fiorentino
- Nightingale-Saunders Clinical Trials & Epidemiology Unit, King's Clinical Trials Unit, Kings College London, UK
| | | | - Manuj Sharma
- Research Department of Primary Care and Population Health, University College, London, UK
| | - Mišel Milošević
- Thoracic Surgery Clinic, Institute for Lung Diseases of Vojvodina, Sremska Kamenica, Serbia
| | | | - Tom Treasure
- Clinical Operational Research Unit, University College London, UK
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Gössling GCL, Chedid MF, Pereira FS, da Silva RK, Andrade LB, Peruzzo N, Saueressig MG, Schwartsmann G, Parikh AR. Outcomes and Prognostic Factors of Patients with Metastatic Colorectal Cancer Who Underwent Pulmonary Metastasectomy with Curative Intent: A Brazilian Experience. Oncologist 2021; 26:e1581-e1588. [PMID: 33896091 PMCID: PMC8417851 DOI: 10.1002/onco.13802] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We aimed to identify clinicopathological and molecular features associated with progression-free survival (PFS) and overall survival (OS) after pulmonary metastasectomy for metastatic colorectal cancer in a retrospective cohort in Brazil. MATERIALS AND METHODS We did a retrospective review of thoracic surgeries performed in a single large academic hospital in Brazil from January 1985 to September 2019. Demographics, previously described prognostic factors, and clinicopathological and molecular characteristics were abstracted. Univariate Cox regression was performed for each variable, and, when significant, data were dichotomized to provide clinically meaningful thresholds. RESULTS Records from 698 patients were reviewed. Fifty-eight patients underwent pulmonary metastasectomy with curative intent. Of those, 53.4% had a single metastatic lesion. The median size of the largest lesion was 1.5 cm. Results of RAS, RAF, and mismatch repair testing and of cytokeratin 20 (CK20) and CDX2 testing were available for 13.8% and 58.6% of the sample, respectively. Median PFS was 14 months, median OS was 58 months, and 5-year survival was 49.8%. Unfavorable prognostic factors for OS included disease-free interval (DFI) <24 months, synchronous presentation, size of the largest lesion ≥2 cm, and loss of CK20 expression. Presenting with more than one lesion was prognostic for PFS but not for OS. CONCLUSION In this Brazilian cohort, our findings corroborate existing data supporting DFI, synchronous presentation, and number and size of lesions as prognostic factors. Furthermore, we found that loss of CK20 expression may be associated with more aggressive disease and shorter OS. Additional molecular prognostic factors after pulmonary metastasectomy for colorectal cancer should be further explored. IMPLICATIONS FOR PRACTICE This study consolidates disease-free interval, synchronous presentation, and number and size of lesions as clinically relevant data that may help guide therapy for patients with colorectal cancer and lung metastases who are candidates for curative-intent metastasectomy. Additionally, in this sample, lack of cytokeratin 20 expression in metastases was associated with shorter progression-free survival and overall survival, suggesting that biomarkers also may have a role in guiding therapy in this setting and that additional biomarkers should be further explored.
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Affiliation(s)
- Gustavo C. L. Gössling
- Medical Oncology Department, Hospital de Clínicas de Porto AlegreBrazil
- Universidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
- Medical Oncology Department, Hospital Nossa Senhora da ConceiçãoPorto AlegreBrazil
| | - Márcio F. Chedid
- Liver and Pancreas Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto AlegreBrazil
- Universidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
| | - Fernando S. Pereira
- Medical Oncology Department, Hospital de Clínicas de Porto AlegreBrazil
- Universidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
| | | | | | - Nícolas Peruzzo
- Medical Oncology Department, Hospital de Clínicas de Porto AlegreBrazil
| | - Maurício G. Saueressig
- Thoracic Surgery Department, Hospital de Clínicas de Porto AlegreBrazil
- Universidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
| | - Gilberto Schwartsmann
- Medical Oncology Department, Hospital de Clínicas de Porto AlegreBrazil
- Universidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
| | - Aparna R. Parikh
- Department of Medical Oncology, Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Van Raemdonck D, Treasure T, Van Cutsem E, Macbeth F. Pulmonary Metastasectomy in Colorectal Cancer: has the randomized controlled trial brought enough reliable evidence to convince believers in metastasectomy to reconsider their oncological practice? Eur J Cardiothorac Surg 2021; 59:517-521. [PMID: 33332567 DOI: 10.1093/ejcts/ezaa450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Tom Treasure
- Clinical Operational Research Unit, Department of Mathematics and Physical Sciences, University College London, London, UK
| | - Eric Van Cutsem
- Department of Gastrointestinal and Liver Diseases, Digestive Oncology Unit, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
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8
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Abstract
The lung is one of the most common sites of metastatic disease. Assessing patients for pulmonary metastasectomy includes ensuring they are suitable surgical candidates for single-lung ventilation and pulmonary resection. Complete resection of metastases and control of primary tumor and oligometastatic disease are key tenets for metastasectomy. Negative prognostic factors include short disease-free interval, presence of lymphadenopathy, and multiple lesions. Primary tumors are associated with excellent outcomes. With modern high-resolution scans, minimally invasive approaches to metastasectomy are preferred. Consideration of extended resections should take place in a multidisciplinary manner. Nonoperative options include stereotactic body radiation therapy, radiofrequency ablation, and microwave ablation.
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Berkovic P, Gulyban A, Defraene G, Swenen L, Dechambre D, Nguyen PV, Jansen N, Mievis C, Lovinfosse P, Janvary L, Lambrecht M, De Meerleer G. Stereotactic robotic body radiotherapy for patients with oligorecurrent pulmonary metastases. BMC Cancer 2020; 20:402. [PMID: 32384918 PMCID: PMC7206759 DOI: 10.1186/s12885-020-06906-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 04/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Our aim is to report treatment efficacy and toxicity of patients treated by robotic (Cyberknife®) stereotactic body radiotherapy (SBRT) for oligorecurrent lung metastases (ORLM). Additionally we wanted to evaluate influence of tumor, patient and treatment related parameters on local control (LC), lung and distant progression free- (lung PFS/Di-PFS) and overall survival (OS). METHODS Consecutive patients with up to 5 ORLM (confirmed by FDG PET/CT) were included in this study. Intended dose was 60Gy in 3 fractions (prescribed to the 80% isodose volume). Patients were followed at regular intervals and tumor control and toxicity was prospectively scored. Tumor, patient and treatment data were analysed using competing risk- and Cox regression. RESULTS Between May 2010 and March 2016, 104 patients with 132 lesions were irradiated from primary lung carcinoma (47%), gastro-intestinal (34%) and mixed primary histologies (19%). The mean tumor volume was 7.9 cc. After a median follow up of 22 months, the 1, 2 and 3 year LC rate (per lesion) was 89.3, 80.0 and 77.8% respectively. The corresponding (per patient) 1, 2 and 3 years lung PFS were 66.3, 50.0, 42.6%, Di-PFS were 80.5, 64.4, 60.6% and OS rates were 92.2, 80.9 and 72.0% respectively. On univariable analysis, gastro-intestinal (GI) as primary tumor site showed a significant superior local control versus the other primary tumor sites. For OS, significant variables were primary histology and primary tumor site with a superior OS for patients with metastases of primary GI origin. LC was significantly affected by the tumor volume, physical and biologically effective dose coverage. Significant variables in multivariable analysis were BED prescription dose for LC and GI as primary site for OS. The vast majority of patients developed no toxicity or grade 1 acute and late toxicity. Acute and late grade 3 radiation pneumonitis (RP) was observed in 1 and 2 patients respectively. One patient with a centrally located lesion developed grade 4 RP and died due to possible RT-induced pulmonary hemorrhage. CONCLUSIONS SBRT is a highly effective local therapy for oligorecurrent lung metastases and could achieve long term survival in patients with favourable prognostic features.
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Affiliation(s)
- Patrick Berkovic
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Akos Gulyban
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
- Medical Physics Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 rue Héger-Bordet, 1000 Brussels, Belgium
| | - Gilles Defraene
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Laurie Swenen
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - David Dechambre
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Paul Viet Nguyen
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Nicolas Jansen
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Carole Mievis
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Pierre Lovinfosse
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Levente Janvary
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Maarten Lambrecht
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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Chudgar NP, Brennan MF, Munhoz RR, Bucciarelli PR, Tan KS, D'Angelo SP, Bains MS, Bott M, Huang J, Park BJ, Rusch VW, Adusumilli PS, Tap WD, Singer S, Jones DR. Pulmonary metastasectomy with therapeutic intent for soft-tissue sarcoma. J Thorac Cardiovasc Surg 2017; 154:319-330.e1. [PMID: 28395901 DOI: 10.1016/j.jtcvs.2017.02.061] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 02/07/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Soft-tissue sarcoma is a heterogeneous disease that frequently includes the development of pulmonary metastases. The purpose of this study is to determine factors associated with improved survival among patients with soft-tissue sarcoma to help guide selection for pulmonary metastasectomy. METHODS We reviewed a prospectively maintained database and identified 803 patients who underwent pulmonary metastasectomy for metastatic soft-tissue sarcoma between September 1991 and June 2014; of these, 539 patients undergoing 760 therapeutic-intent pulmonary metastasectomies were included. Clinicopathologic variables and characteristics of treatment were examined. The outcomes of interest were overall survival and disease-free survival. Survival was estimated with the Kaplan-Meier method and compared between variables with the log-rank test. Factors associated with hazard of death and recurrence were identified via the use of univariable and multivariable Cox proportional hazards models. RESULTS Median overall survival was 33.2 months (95% confidence interval, 29.9-37.1), and median disease-free survival was 6.8 months (95% confidence interval, 6.0-8.0). In multivariable analyses, leiomyosarcoma histologic subtype (P = .007), primary tumor size ≤10 cm (P = .006), increasing time from primary tumor resection to development of metastases (P < .001), solitary lung metastasis (P = .001), and minimally invasive resection (P = .023) were associated with lower hazard of death. Disease-free interval ≥1 year (P = .002), and 1 pulmonary metastasis (P < .001) were associated with lower hazard of disease recurrence. CONCLUSIONS In a large single-institution study, primary tumor histologic subtype and size, numbers of pulmonary metastases, disease-free interval, and selection for minimally invasive resection are associated with increased survival in patients undergoing pulmonary metastasectomy for soft-tissue sarcoma.
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Affiliation(s)
- Neel P Chudgar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Murray F Brennan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rodrigo R Munhoz
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sandra P D'Angelo
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Manjit S Bains
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew Bott
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Huang
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard J Park
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valerie W Rusch
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - William D Tap
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R Jones
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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11
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Pih GY, Kim DK, Park KM, Chang HM. Bilateral lung metastasectomy in carcinoma of the ampulla of Vater. Thorac Cancer 2017; 8:124-127. [PMID: 28168842 PMCID: PMC5334294 DOI: 10.1111/1759-7714.12418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/26/2016] [Accepted: 12/27/2016] [Indexed: 12/02/2022] Open
Abstract
The efficacy of lung metastasectomy is well established in several cancers, including colorectal cancer. However, little is known about the result of lung metastasectomy in carcinoma of the ampulla of Vater. Only two case reports have reported the efficacy of metastasectomy in ampullary cancer patients with pulmonary metastasis. We report the result of bilateral lung metastasectomy in a patient with ampullary cancer. A 63‐year‐old woman underwent pylorus‐preserving pancreaticoduodenectomy for carcinoma of the ampulla of Vater. About three years after the surgery, two non‐calcified lung nodules in the right lower and left upper lobes had developed. Wedge resections of both lung nodules were performed and the pathological examination showed that the lung nodules were pulmonary metastases from the ampullary cancer. Ten years after the lung surgery, the patient is well and there is no evidence of recurrence. Surgical resection could be considered in patients with pulmonary metastasis from ampulla of Vater cancer, even when the metastases are bilateral.
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Affiliation(s)
- Gyu Young Pih
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Korea
| | - Kwang-Min Park
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, Seoul, Korea
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12
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Depypere L, Lerut T, Moons J, Coosemans W, Decker G, Van Veer H, De Leyn P, Nafteux P. Isolated local recurrence or solitary solid organ metastasis after esophagectomy for cancer is not the end of the road. Dis Esophagus 2017; 30:1-8. [PMID: 27704661 DOI: 10.1111/dote.12508] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recurrent disease after esophagectomy bears an infaust prognosis, especially when multiple recurrences are present. But little is known about survival in patients with limited recurrence (solitary locoregional recurrence or solid organ metastasis). Herein, we report our experience with these subgroups. We analyzed 1754 consecutive patients surgically treated with curative resection for esophageal cancer and cancer of the gastroesophageal junction between 1990 and 2012. Seven subgroups were defined according to the recurrence type (locoregional vs. organ metastasis), the site of recurrence (abdominal, thoracic, cervical for lymph nodes and lung, liver, adrenals and others for organ metastasis) and also the number of lesions (one vs. multiple lymph node stations or organ metastasis) Of these groups; clinical isolated locoregional recurrence (ciLR) was defined as solitary lymph-node recurrence confined to one compartment (cervical, thoracic or abdominal, within or outside surgical dissection-field) at clinical staging. Clinical solitary solid organ metastasis (csSOM) was defined as metastasis in a resectable solid organ, i.e. liver, lung, brain or adrenal. Salvage therapies were grouped in five categories. Kaplan-Meier curves were used to calculate survival. Recurrent disease was observed in 766 patients (43.7%) with overall 5-year survival of 4.5% after diagnosis of recurrence. Fifty-seven patients (7.4%) showed ciLR and 110 (14.4%) csSOM. Median time-to-recurrence was 16.8 months in ciLR and 9.9 months in csSOM (P = 0.0074). Survival is significantly improved compared to supportive therapy when local therapy is possible (P < 0.0001). In 25 (15%) of ciLR or csSOM patients, surgical therapy with or without systemic therapy, yielded a 5-year survival of 49.9% (median 54.8 months) after diagnosis of recurrence. When surgery was impossible or contraindicated, the combination of chemoradiotherapy appeared to be superior to chemotherapy alone (respectively 27.0% vs. 4.6% 5-year survival) or radiotherapy alone (no 5-year survival). Recurrent disease after esophagectomy is a common problem with poor overall survival. However prolonged survival could be obtained in selected patients if the recurrent disease is limited to ciLR or csSOM, if surgery (+/- systemic therapy) can be performed. If not a combination of chemoradiotherapy seems to offer the second best option. Patients presenting with a ciLR or csSOM should be discussed in a dedicated multidisciplinary team meeting as to evaluate and define the place of salvage treatment which in well selected cases could offer a perspective of prolonged survival.
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Affiliation(s)
- L Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - T Lerut
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - J Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - W Coosemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - G Decker
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - H Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - P De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - P Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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13
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Jiménez Fuentes E, Arrieta Rodriguez OG, Herrera Gómez Á, Chinchilla Trigos LA. Metástasis a pulmón: manejo individualizado. GACETA MEXICANA DE ONCOLOGÍA 2016. [DOI: 10.1016/j.gamo.2016.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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14
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Åberg T, Treasure T. Analysis of pulmonary metastasis as an indication for operation: an evidence-based approach. Eur J Cardiothorac Surg 2016; 50:792-798. [PMID: 27369120 DOI: 10.1093/ejcts/ezw140] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Torkel Åberg
- Clinical Operational Research Unit, University College, London, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College, London, UK
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15
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Pagès PB, Serayssol C, Brioude G, Falcoz PE, Brouchet L, Le Pimpec-Barthes F, Thomas PA, Bernard A. Risk factors for survival and recurrence after lung metastasectomy. J Surg Res 2016; 203:293-300. [DOI: 10.1016/j.jss.2016.01.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/08/2016] [Accepted: 01/20/2016] [Indexed: 12/27/2022]
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16
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Pagès PB, Le Pimpec-Barthes F, Bernard A. [Surgery for pulmonary metastases from colorectal cancer: Predictive factors for survival]. Rev Mal Respir 2016; 33:838-852. [PMID: 27133381 DOI: 10.1016/j.rmr.2016.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 02/11/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Colorectal cancer is the 3rd commonest cause of death from cancer: 5% of patients will develop lung metastases. The management of oligometastatic disease is based on the objective of optimal local control. STATE OF THE ART To date, no results from randomized control trials support the resection of pulmonary metastases in oligometastastic colorectal cancer patients. However, numerous series, mainly retrospective, report long-term survival for highly selected patients, with 5-year survival ranging from 45 to 65% in the most recent series. The consensual predictive factors of a good prognosis are: a disease free-interval>36 months, a number of metastases≤3, a normal level of carcino-embryonic antigen and the absence of hilar or mediastinal lymph node involvement. PERSPECTIVES Around 20 to 40% of patients will develop recurrence, probably linked to the presence of undetectable micrometastases. Therefore, experimental work is being undertaken to develop new treatment techniques such as isolated lung perfusion, radiofrequency ablation and stereotactic radiation therapy. CONCLUSION Highly selected patients suffering from colorectal cancer lung metastases could benefit from resection with improved survival and disease-control.
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Affiliation(s)
- P-B Pagès
- Service de chirurgie cardiovasculaire et thoracique, CHU Bocage central, université de Bourgogne, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
| | - F Le Pimpec-Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - A Bernard
- Service de chirurgie cardiovasculaire et thoracique, CHU Bocage central, université de Bourgogne, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France
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17
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A Rare Thyroid Metastasis from Uveal Melanoma and Response to Immunotherapy Agents. Case Rep Oncol Med 2016; 2016:6564094. [PMID: 27110415 PMCID: PMC4823504 DOI: 10.1155/2016/6564094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/01/2016] [Indexed: 12/14/2022] Open
Abstract
Thyroid metastasis is a rare occurrence with cutaneous melanoma and even more uncommon with uveal melanoma. The management of such metastasis is uncertain due to its infrequency and, in the era of immunotherapy, the effect of these novel drugs on uncommon metastasis, such as to the thyroid, is unknown. We report the rare case of a thyroid metastasis in a patient diagnosed with ocular melanoma initially managed with enucleation. Metastatic disease developed in the lung and thyroid gland. The case patient received the immunotherapy ipilimumab with stable disease in the thyroid and progressive disease elsewhere. The patient was then further treated with a second immunotherapy agent, pembrolizumab, and remains with stable disease one year later. We discuss the current literature on thyroid metastases from all causes and the optimal known management strategies. Furthermore, we provide an original report on the response of this disease to the novel immunomodulators, ipilimumab, and pembrolizumab with stable disease four years after initial diagnosis of ocular melanoma.
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Kang X, Huang Z, Shi A, Wang J, Lin D, Sun Y, Zhu G, Niu X, Chen K. [Deficiencies in the Diagnosis and Treatment of Pulmonary Metastatic Osteosarcoma: A Chinese Multidisciplinary Survey]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:153-60. [PMID: 27009820 PMCID: PMC5999822 DOI: 10.3779/j.issn.1009-3419.2016.03.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
背景与目的 骨肉瘤是最常见的骨原发恶性肿瘤，好发于青少年。尽管多学科框架下骨肉瘤的治疗已经取得瞩目成就，然而影响骨肉瘤远期生存的重要因素是肺转移。约有1/2以上患者在其病程的不同时期会发生肺转移，其中10%~15%为同时性肺转移。毋庸置疑，治疗肺转移瘤的首选方法为外科切除，但因骨肉瘤肺转移的诊疗涉及多学科多专业，而由于各学科之间的理念存在差异，因此尚未形成标准化的诊疗模式。本研究通过问卷调查方式旨在了解当前我国骨肉瘤大型医疗中心在此领域中的诊疗模式现况。 方法 2015年9月-2015年11月期间，一项关于骨肉瘤肺转移的诊疗现况问卷在全国骨肉瘤大型诊疗中心范围内开展。根据调查对象所在单位、工作年限、年均收治病例数及医学专业不同，进一步行分层分析。 结果 调查共发放问卷150份，回收有效问卷105份，总应答率为70%。首先，关于骨肉瘤肺转移治疗的核心问题，41.0%的调查对象认同骨肿瘤外科专业在骨肉瘤肺转移多学科诊疗实践中的主导地位；首选肺转移瘤切除术作为转移灶局部控制措施的比例约64%；78.1%的调查对象会推荐患者行肺转移瘤切除术；骨科及胸外科医师较之其他专业更加积极（同骨科专业相比，OR其他专业=0.02；95%CI：0.00-0.22；P=0.001）；胸外科医师更倾向根据经验决定肺转移瘤切除术的指证，而非受限于病灶具体数目（OR胸外科专业=20.93；95%CI：2.05-213.64；P=0.001）。其次，关于骨肉瘤肺转移影像学诊断方法，约83%首选胸部计算机断层扫描（computed tomography, CT）；约70%的调查对象推荐原发灶切除术后3个月行胸部CT随诊；约68%认为CT诊断准确度90%水平；约92%同时推荐行肺外影像学评估。最后，关于术后生存获益的定义问题，约46%认为肺转移瘤术后生存期超过6个月即为生存获益。 结论 本次问卷调查提供了我国骨肉瘤肺转移诊疗模式的现况信息，其反映出缺少统一规范诊疗模式的不足。调查结果为今后研究方向及国际性临床指南提供了基线数据。
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Affiliation(s)
- Xiaozheng Kang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Zhen Huang
- Department of Orthopedic Oncology, Beijing Jishuitan Hospital, Peking University, Beijing 100035, China
| | - Anhui Shi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiation Oncology,Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Jie Wang
- The First Department of Thoracic Medical Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Dongmei Lin
- Department of Pathology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Yingshi Sun
- Department of Radiology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Guangying Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiation Oncology,Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Xiaohui Niu
- Department of Orthopedic Oncology, Beijing Jishuitan Hospital, Peking University, Beijing 100035, China
| | - Keneng Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), the First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
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Abstract
The development of metastases after curative treatment can be seen as a failure. A common justification for the removal of metastases is that the knowledge that they are there may cause psychological distress, a real symptom that may be relieved by their removal. Although it is a commonly used justification for metastasectomy, the authors are unaware of any studies confirming or quantifying the health gain. This article strongly challenges the belief in clinical effectiveness and demonstrates that it is supported neither by a sound biological rationale nor by any good evidence. Reasons are suggested why this unfounded belief has become so prevalent.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, 4 Taviton Street, University College London, London WC1H 0BT, United Kingdom.
| | - Fergus Macbeth
- Wales Cancer Trials Unit, 6th Floor, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff CF14 4YS, United Kingdom
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20
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Percutaneous management of pulmonary metastases arising from colorectal cancer; a systematic review. Eur J Surg Oncol 2015; 41:1447-55. [DOI: 10.1016/j.ejso.2015.07.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/03/2015] [Accepted: 07/23/2015] [Indexed: 01/25/2023] Open
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Van Raemdonck D. Pulmonary metastasectomy: common practice but is it also best practice? Future Oncol 2015; 11:11-4. [PMID: 25662321 DOI: 10.2217/fon.14.246] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Pulmonary metastasectomy is common practice among surgeons, comprising nearly 15% of all lung resections. Pulmonary metastasectomy from a primary tumor elsewhere is widely believed to improve survival in selected patients, although the evidence for the added value of surgery is still weak. Most resections are performed in patients with a long disease-free interval with few metastases limited to one or both lungs from all cancer types. Until results of a randomized trial comparing surgery versus no surgery, such as in patients with colorectal metastases (PulMiCC trial), are published, surgeons will be unable to give an evidence-based answer to patients asking for the benefit of this invasive treatment that jeopardizes their pulmonary function, exercise capacity and quality of life.
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22
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Treasure T. Lung metastasectomy paradoxes in practice: reflections on the Catania conference. Future Oncol 2015; 11:1-3. [PMID: 25662319 DOI: 10.2217/fon.14.297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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23
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Nichols FC. Pulmonary metastasectomy: role of pulmonary metastasectomy and type of surgery. Curr Treat Options Oncol 2015; 15:465-75. [PMID: 24986353 DOI: 10.1007/s11864-014-0300-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OPINION STATEMENT Patients with untreated metastatic disease have a less than 5 % to 10 % 5-year survival, and for the patient who has metastatic disease isolated to the lungs, pulmonary metastasectomy remains the best hope for cure. Pulmonary metastasectomy has been performed for decades. However, despite hundreds of studies spanning several decades, randomized control data in support of pulmonary metastasectomy is still lacking, and the evidence upon which we base this commonly accepted surgical practice is for the most part weak. While well-accepted surgical selection criteria exist, controversies related to pulmonary metastasectomy abound. Unanswered and clearly debatable are questions related to: optimal preoperative imaging, if mediastinal staging should be performed and if so when, is video-assisted thoracic surgery (VATS) equivalent to open thoracotomy, is finger palpation of the lung mandatory, is repeat pulmonary metastasectomy justified, and what is the interrelationship of pulmonary metastasectomy to other treatments. Current practice to the surgical approach to pulmonary metastasectomy remains quite variable.
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Treasure T, Mineo T, Ambrogi V, Fiorentino F. Survival is higher after repeat lung metastasectomy than after a first metastasectomy: Too good to be true? J Thorac Cardiovasc Surg 2015; 149:1249-52. [PMID: 25802136 DOI: 10.1016/j.jtcvs.2015.01.067] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/17/2015] [Accepted: 01/29/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, United Kingdom.
| | - Tommaso Mineo
- Thoracic Surgery, Policlinic Tor Vergata University, Rome, Italy
| | - Vincenzo Ambrogi
- Thoracic Surgery, Policlinic Tor Vergata University, Rome, Italy
| | - Francesca Fiorentino
- Francesca Fiorentino Cardiothoracic Surgery, National Heart and Lung Institute Imperial College London, London, United Kingdom
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Migliore M, Criscione A, Calvo D, Privitera G, Spatola C, Parra ES, Palmucci S, Ciancio N, Cajozzo M, Maria GD. Wider implications of video-assisted thoracic surgery versus open approach for lung metastasectomy. Future Oncol 2015; 11:25-9. [DOI: 10.2217/fon.14.257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Lung metastasectomy is considered a safe and potentially curative procedure despite there is not a strong evidence that metastasectomy prolongs long-term survival in patients with lung metastases. Moreover, the debate is open regarding the best approach for lung metastasectomy, video-assisted thoracic surgery versus open approach. A systematic review of literature to clarify what is the best approach to prolong survival in patients with lung metastases was performed. Our study confirms that overall survival is equivalent for video-assisted thoracic surgery and thoracotomy, therefore the ‘gold standard’ surgical treatment for lung metastases remains a point of debate. The choice of the surgical approach still depends more on the single center or surgeon practice than on strong scientific evidence. A prospective randomized trial could clarify the question.
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Affiliation(s)
- Marcello Migliore
- Academic Thoracic Surgery Unit, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
- Department of Surgery, University of Catania, Catania, Italy
| | - Alessandra Criscione
- Academic Thoracic Surgery Unit, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
- Department of Surgery, University of Catania, Catania, Italy
| | - Damiano Calvo
- Academic Thoracic Surgery Unit, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
- Department of Surgery, University of Catania, Catania, Italy
| | - Giuseppe Privitera
- Radiotherapy Unit, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Corrado Spatola
- Radiotherapy Unit, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Ector Soto Parra
- Oncology Unit, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Stefano Palmucci
- Radiology Unit, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Nicola Ciancio
- Pneumology Unit, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Massimo Cajozzo
- Thoracic Surgery Unit, University of Palermo, Palermo, Italy
| | - Giuseppe Di Maria
- Pneumology Unit, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
- Department of Clinical & Molecular Bio-Medicine, University of Catania, Catania, Italy
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Treasure T, Milošević M, Fiorentino F, Pfannschmidt J. History and present status of pulmonary metastasectomy in colorectal cancer. World J Gastroenterol 2014; 20:14517-26. [PMID: 25356017 PMCID: PMC4209520 DOI: 10.3748/wjg.v20.i40.14517] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 07/22/2014] [Accepted: 09/12/2014] [Indexed: 02/06/2023] Open
Abstract
Clinical practice with respect to metastatic colorectal cancer differs from the other two most common cancers, breast and lung, in that routine surveillance is recommended with the specific intent of detecting liver and lung metastases and undertaking liver and lung resections for their removal. We trace the history of this approach to colorectal cancer by reviewing evidence for effectiveness from the 1950s to the present day. Our sources included published citation network analyses, the documented proposal for randomised trials, large systematic reviews, and meta-analysis of observational studies. The present consensus position has been adopted on the basis of a large number of observational studies but the randomised trials proposed in the 1980s and 1990s were either not done, or having been done, were not reported. Clinical opinion is the mainstay of current practice but in the absence of randomised trials there remains a possibility of selection bias. Randomised controlled trials (RCTs) are now routine before adoption of a new practice but RCTs are harder to run in evaluation of already established practice. One such trial is recruiting and shows that controlled trial are possible.
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27
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Schur S, Hoetzenecker K, Lamm W, Koestler W, Lang G, Amann G, Funovics P, Nemecek E, Noebauer I, Windhager R, Klepetko W, Brodowicz T. Pulmonary metastasectomy for soft tissue sarcoma – Report from a dual institution experience at the Medical University of Vienna. Eur J Cancer 2014; 50:2289-97. [DOI: 10.1016/j.ejca.2014.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
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Optimal timing of pulmonary metastasectomy--is a delayed operation beneficial or counterproductive? Eur J Surg Oncol 2014; 40:1049-55. [PMID: 24746934 DOI: 10.1016/j.ejso.2014.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 02/24/2014] [Accepted: 03/19/2014] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Pulmonary metastasectomy represents an established approach in the treatment of lung metastases related to several solid malignant tumors, promising the chance of long term survival. Regarding the proper timing of metastasectomy both operation promptly after diagnosis and delayed operation after an interval of 3 months are common practice. MATERIALS AND METHODS A systematic Medline search addressing the optimal timing of metastasectomy was performed. Since the search query "timing of metastasectomy" yields only a limited number of articles, the Medline search was expanded to include the main arguments for prompt metastasectomy ("metastases of metastasis", "growth rate of pulmonary metastases") and for delayed metastasectomy. RESULTS Based on the data available to date, there is no necessity to expedite the timing of the operation. On the other hand, there is no evidence that a delayed operation, for example after re-staging following an interval of 3 months, provides a benefit. CONCLUSION Therefore the timing of metastasectomy should only depend on the patient's requirements, such as general state of health and oncologic considerations, such as promising multimodal therapy concepts, extrathoracal tumor manifestations or oncologic type of the primary tumor. A delayed operation seems justified if the indication for resection is questionable due to a high risk of early multilocal recurrence.
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Treasure T, Milošević M, Fiorentino F, Macbeth F. Pulmonary metastasectomy: what is the practice and where is the evidence for effectiveness? Thorax 2014; 69:946-9. [PMID: 24415715 PMCID: PMC4174129 DOI: 10.1136/thoraxjnl-2013-204528] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pulmonary metastasectomy is a commonly performed operation and is tending to increase as part of a concept of personalised treatment for advanced cancer. There have been no randomised trials; belief in effectiveness of metastasectomy is based on registry data and surgical follow-up studies. These retrospective series are comprised predominately of solitary or few metastases with primary resection to metastasectomy intervals longer than 2-3 years. Five-year survival rates of 30-50% are recorded, but as case selection is based on favourable prognostic features, an apparent association between metastasectomy and survival cannot be interpreted as causation. Cancers for which lung metastasectomy is used are considered in four pathological groups. In non-seminomatous germ cell tumour, for which chemotherapy is highly effective, excision of residual pulmonary disease guides future treatment and in particular allows an informed decisions as to further chemotherapy. Sarcoma metastasises predominately to lung and pulmonary metastasectomy for both bone and soft tissues sarcoma is routinely considered as a treatment option but without randomised data. The commonest circumstance for lung and liver metastasectomy is colorectal cancer. Repeated resections and ablations are commonplace but without evidence of effectiveness for either. For melanoma, results are particularly poor, but lung metastases are resected when no other treatment options are available. In this review, the available evidence is considered and the conclusion reached is that in the absence of randomised trials there is uncertainty about effectiveness. A randomised controlled trial, Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC), is in progress and randomised trials in sarcoma seem warranted.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Mišel Milošević
- Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Francesca Fiorentino
- Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, London, UK
| | - Fergus Macbeth
- Wales Cancer Trials Unit, Cardiff University, Cardiff, UK
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30
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Ripley RT, Downey RJ. Pulmonary metastasectomy. J Surg Oncol 2013; 109:42-6. [PMID: 24301202 DOI: 10.1002/jso.23450] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 09/10/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Robert T Ripley
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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Treasure T, Milošević M, Migliore M, Lees B. Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC International). COLORECTAL CANCER 2013. [DOI: 10.2217/crc.13.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
SUMMARY Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) is a randomized controlled trial. Patients with resected colorectal cancer found to have one or more pulmonary metastases are randomized to have a metastasectomy or not. Both arms include active monitoring. Patients considered possible candidates for pulmonary metastasectomy are asked to first give consent to be assessed according to protocol after which a decision to have or not have metastasectomy may be made. If there is uncertainty, patients are invited to consent to randomization, including minimization for known prognostic factors: the number of metastases, the interval since primary resection, carcinoembryonic antigen levels and the TNM stage of the primary cancer. The primary outcomes are survival and quality of life. The trial is open in England, and in Serbia and Italy as PulMiCC International.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Mišel Milošević
- Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, University of Novi Sad, Serbia
| | - Marcello Migliore
- Department of Thoracic Surgery, Policlinico Hospital Catania, University of Catania, Catania, Italy
| | - Belinda Lees
- Clinical Trials & Evaluation Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
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Treasure T, Milosevic M, Fiorentino F. Pulmonary metastasectomy and the use of molecular and radiological markers: is this a way to reduce unavailing surgery? Eur J Cardiothorac Surg 2013; 45:417-8. [PMID: 23803509 DOI: 10.1093/ejcts/ezt327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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Embún R, Fiorentino F, Treasure T, Rivas JJ, Molins L. Pulmonary metastasectomy in colorectal cancer: a prospective study of demography and clinical characteristics of 543 patients in the Spanish colorectal metastasectomy registry (GECMP-CCR). BMJ Open 2013; 3:e002787. [PMID: 23793698 PMCID: PMC3664355 DOI: 10.1136/bmjopen-2013-002787] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/09/2013] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To capture an accurate contemporary description of the practice of pulmonary metastasectomy for colorectal carcinoma in one national healthcare system. DESIGN A national registry set up in Spain by Grupo Español de Cirugía Metástasis Pulmonares de Carcinoma Colo-Rectal (GECMP-CCR). SETTING 32 Spanish thoracic units. PARTICIPANTS All patients with one or more histologically proven lung metastasis removed by surgery between March 2008 and February 2010. INTERVENTIONS Pulmonary metastasectomy for one or more pulmonary nodules proven to be metastatic colorectal carcinoma. PRIMARY AND SECONDARY OUTCOME MEASURES The age and sex of the patients having this surgery were recorded with the number of metastases removed, the interval between the primary colorectal cancer operation and the pulmonary metastasectomy, and the carcinoembryonic antigen level. Also recorded were the practices with respect to mediastinal lymphadenopathy and coexisting liver metastases. RESULTS Data were available on 543 patients from 32 units (6-43/unit). They were aged 32-88 (mean 65) years, and 65% were men. In 55% of patients, there was a solitary metastasis. The median interval between the primary cancer resection and metastasectomy was 28 months and the serum carcinoembryonic antigen was low/normal in the majority. Liver metastatic disease was present in 29% of patients at some point prior to pulmonary metastasectomy. Mediastinal lymphadenectomy varied from 9% to 100% of patients. CONCLUSIONS The data represent a prospective comprehensive national data collection on pulmonary metastasectomy. The practice is more conservative than the impression gained when members of the European Society of Thoracic Surgeons were surveyed in 2006/2007 but is more inclusive than would be recommended on the basis of recent outcome analyses. Further analyses on the morbidity associated with this surgery and the correlation between imaging studies and pathological findings are being published separately by GECMP-CCR.
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Affiliation(s)
- R Embún
- Department of General Thoracic Surgery, Miguel Servet University Hospital, Zaragoza, Spain
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Radical treatment of non-small-cell lung cancer patients with synchronous oligometastases: long-term results of a prospective phase II trial (Nct01282450). J Thorac Oncol 2013; 7:1547-55. [PMID: 22982655 DOI: 10.1097/jto.0b013e318262caf6] [Citation(s) in RCA: 215] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Stage IV non-small-cell lung cancer (NSCLC) patients with oligometastases (< 5 metastatic lesions) may experience long-term survival when all macroscopic tumor sites are treated radically, but no prospective data on NSCLCs with synchronous oligometastases are available. METHODS A prospective single-arm phase II trial was conducted. The main inclusion criteria were pathologically proven NSCLC stage IV with less than five metastases at primary diagnosis, amendable for radical local treatment (surgery or radiotherapy). The study is listed in clinicaltrials.gov, number NCT01282450. RESULTS Forty patients were enrolled, 39 of whom were evaluable (18 men, 21 women); mean age was 62.1 ± 9.2 years (range, 44-81). Twenty-nine (74%) had local stage III; 17 (44%) brain, seven (18%) bone, and four (10%) adrenal gland metastases. Thirty-five (87%) had a single metastatic lesion. Thirty-seven (95%) of the patients received chemotherapy as part of their primary treatment. Median overall survival (OS) was 13.5 months (95% confidence interval 7.6-19.4); 1-, 2-, and 3-year OS was 56.4%, 23.3%, and 17.5%, respectively. Median progression-free survival (PFS) was 12.1 months (95% confidence interval 9.6-14.3); 1-year PFS was 51.3%, and both 2- and 3-year PFS was 13.6%. Only two patients (5%) had a local recurrence. No patient or tumor parameter, including volume and F-deoxyglucose uptake was significantly correlated with OS or PFS. The treatment was well tolerated. CONCLUSION In this phase II study, long-term PFS was found in a subgroup of NSCLC patients with synchronous oligometastases when treated radically. Identification of this favorable subgroup before therapy is needed.
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Renaud S, Falcoz PE, Olland A, Massard G. Should mediastinal lymphadenectomy be performed during lung metastasectomy of renal cell carcinoma? Interact Cardiovasc Thorac Surg 2013; 16:525-8. [PMID: 23287593 DOI: 10.1093/icvts/ivs534] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A best evidence topic was constructed according to a structured protocol. The question addressed was whether radical mediastinal lymphadenectomy should be performed during lung metastasectomy of renal cell carcinoma (RCC). Of the 13 papers found through a report search, seven represent the best evidence to answer this clinical question. The authors, journal, date, country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that on the whole, the seven-retrieved studies support the realization of systematic radical mediastinal lymphadenectomy. The published literature showed a prevalence of lymph node involvement (LNI) that approaches 30%. The majority of the studies conclude that LNI is a significant, independent prognostic of survival. Indeed, some authors did not report any 5-year survival in the case of LNI. On the contrary, however, a 5-year survival of ~50% was reported when no LNI was present. To date, the published data do not allow conclusions to be drawn regarding the prognosis of hilar vs mediastinal LNI: only one paper focused on the difference between hilar and mediastinal location and showed no difference. In addition, only one study has compared the survival of patients with or without lymphadenectomy, showing greater survival when mediastinal lymphadenectomy was performed. Despite the poor prognosis of patients with LNI, surgery seems to be the best treatment for potentially curative RCC with metastases. It is known that RCC metastases do not respond well to chemotherapy and radiotherapy. Indeed, reported 5-year survival rate ranged between 3 and 11% for non-operated patients. Consequently, resection must be as complete as possible and include a systematic total mediastinal lymphadenectomy, which will probably yield better loco-regional control and evaluation of prognostic factor. However, the published evidence remains quite limited and mainly based on retrospective studies on highly selected patients, with a low level of evidence. Indeed, most patients referred to surgery are younger, fitter, and have fewer metastases. Consequently, the survival gain could be biased, related more to the resectability and the good performance status rather to the resection itself. Consequently, although these preliminary results are interesting, they must be interpreted with caution.
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Affiliation(s)
- Stéphane Renaud
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
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Treasure T. Doubt and its resolution in mesothelioma, pulmonary metastases and lung cancer. Lung Cancer Manag 2012. [DOI: 10.2217/lmt.12.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, Department of Mathematics, University College London, 4 Taviton Street, London, WC1H 0BT, UK
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Lung metastasectomy: Long-term outcomes in an 18-year cohort from a single center. Surg Oncol 2012; 21:237-44. [DOI: 10.1016/j.suronc.2012.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 05/12/2012] [Accepted: 05/23/2012] [Indexed: 01/15/2023]
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Treasure T, Fiorentino F, Scarci M, Møller H, Utley M. Pulmonary metastasectomy for sarcoma: a systematic review of reported outcomes in the context of Thames Cancer Registry data. BMJ Open 2012; 2:bmjopen-2012-001736. [PMID: 23048062 PMCID: PMC3488730 DOI: 10.1136/bmjopen-2012-001736] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Sarcoma has a predilection to metastasis to the lungs. Surgical excision of these metastases (pulmonary metastasectomy) when possible has become standard practice. We reviewed the published selection and outcome data. DESIGN Systematic review of published reports that include survival rates or any other outcome data. Survival data were put in the context of those in a cancer registry. SETTING Specialist thoracic surgical centres reporting the selection and outcome for pulmonary metastasectomy in 18 follow-up studies published 1991-2010. PARTICIPANTS Patients having one or more of 1357 pulmonary metastasectomy operations performed between 1980 and 2006. INTERVENTIONS All patients had surgical pulmonary metastasectomy. A first operation was reported in 1196 patients. Of 1357 patients, 43% had subsequent metastasectomy, some having 10 or more thoracotomies. Three studies were confined to patients having repeated pulmonary metastasectomy. PRIMARY AND SECONDARY OUTCOME MEASURES Survival data to various time points usually 5 years and sometimes 3 or 10 years. No symptomatic or quality of life data were reported. RESULTS About 34% and 25% of patients were alive 5 years after a first metastasectomy operation for bone or soft tissues sarcoma respectively. Better survival was reported with fewer metastases and longer intervals between diagnosis and the appearance of metastases. In the Thames Cancer Registry for 1985-1994 and 1995-2004 5 year survival rates for all patients with metastatic sarcoma were 20% and 25% for bone, and for soft tissue sarcoma 13% and 15%. CONCLUSIONS The 5 year survival rate among sarcoma patients who are selected to have pulmonary metastasectomy is higher than that observed among unselected registry data for patients with any metastatic disease at diagnosis. There is no evidence that survival difference is attributable to metastasectomy. No data were found on respiratory or any other symptomatic benefit. Given the certain harm associated with thoracotomy, often repeated, better evidence is required.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, Department of Mathematics, UCL , London, UK
| | - Francesca Fiorentino
- National Heart and Lung Institute, Cardiothoracic Surgery, Imperial College London, London, UK
| | - Marco Scarci
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Henrik Møller
- Thames Cancer Registry, King's College London, London, UK
| | - Martin Utley
- Clinical Operational Research Unit, Department of Mathematics, UCL , London, UK
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Response to the article "pulmonary resection for metastatic gastric cancer" by kemp et Al. J Thorac Oncol 2011; 6:836; author reply 836-7. [PMID: 21623262 DOI: 10.1097/jto.0b013e3182103f73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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