Secondary Lung Tumors Treatment & Management

  • Author: Daniel S Schwartz, MD, FACS; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Oct 14, 2011
 

Medical Therapy

Chemotherapy remains the treatment of choice for advanced cancer. Metastatic cancers known to favorably respond to chemotherapy include Hodgkin lymphoma, non-Hodgkin lymphoma, germ cell tumors, and thyroid cancer. A fair response to chemotherapy is expected for carcinomas of the breast, prostate, and ovary. Immunotherapy is an additional option for the treatment of metastatic malignant melanoma.

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Surgical Therapy

The presence of metastasis indicates an advanced stage of the malignant process. However, as mentioned above, in certain circumstances, surgical resection with curative intent can be performed with an expected 5-year survival rate of 30-40%, depending upon the underlying primary malignancy and the selection criteria for surgery.

Selection of patient for pulmonary metastasectomy

In general, good surgical candidates meet all of the following criteria:

  1. No other known extrapulmonary metastases (if additional metastases are present, they should be considered amenable to surgical or some other form of therapy)
  2. Good surgical candidates from the standpoint of cardiopulmonary and other comorbid conditions
  3. Location of metastatic lesion is such that it can be completely resected with reasonable (depending upon baseline pulmonary status) preservation of the remaining normal lung
  4. Primary tumor site has been controlled or resected

Sometimes the resection is done to confirm the diagnosis (eg, to rule out a new primary cancer that might require a different approach to therapy). A National Cancer Institute (NIH) retrospective series spanning 1979-2010 reports that because there is a dearth of effective systemic therapies, pulmonary metastasectomy may be the most beneficial treatment in patients who meet established selection criteria.[27]

Other therapies and experimental treatments

Several other therapies are currently being used as alternatives to surgical resection, including radiofrequency ablation, cryoablation, and conventional radiotherapy.

However, most have limited availability and most involve enrollment in a structured clinical trial. Most are performed at experienced centers for patients who have lung malignancies (primary lung cancer or pulmonary metastases) and who are not candidates for surgery with the intent to resect. These therapies may also be used in conjunction with other treatments (ie, chemotherapy, radiotherapy) for better disease control.

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Outcome and Prognosis

The following 5-year survival rates have been reported after resection of single pulmonary metastasis of the metastatic cancers known to respond favorably to surgical treatment:

  • Adenoid cystic carcinoma - 63%
  • Testicular cancer - 60%
  • Squamous cell carcinoma of the head and neck - 40-50%
  • Colon cancer - 40%
  • Breast cancer - 30-50%
  • Soft tissue sarcomas - 38%
  • Renal cell cancer - 30-35%
  • Osteogenic sarcoma - 20-57%

Solitary lung metastasis has a significantly better prognosis compared with any other visceral site in metastatic malignant melanoma, with a median survival of 8.3 months and a 5-year survival rate of 4%. The other important independent outcome predictor in metastatic malignant melanoma is the disease-free interval prior to the identification of metastatic disease (< 12 mo vs >12 mo).

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Contributor Information and Disclosures
Author

Daniel S Schwartz, MD, FACS  Assistant Clinical Professor of Cardiothoracic Surgery, Mount Sinai School of Medicine; Chief of Thoracic Surgery, Huntington Hospital

Daniel S Schwartz, MD, FACS is a member of the following medical societies: American College of Chest Physicians, American College of Surgeons, Society of Thoracic Surgeons, and Western Thoracic Surgical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Cynthia S Chin, MD  Assistant Professor, Department of Cardiothoracic Surgery, Mount Sinai School of Medicine; Attending Physician, Department of Cardiothoracic Surgery, Mount Sinai Hospital

Cynthia S Chin, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Benson B Roe, MD  Emeritus Chief, Division of Cardiothoracic Surgery, Emeritus Professor, Department of Surgery, University of California at San Francisco Medical Center

Benson B Roe, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Thoracic Surgery, American College of Cardiology, American College of Surgeons, American Heart Association, American Medical Association, American Society for Artificial Internal Organs, American Surgical Association, California Medical Association, Society for Vascular Surgery, Society of Thoracic Surgeons, and Society of University Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Shreekanth V Karwande, MBBS  Chair, Professor, Department of Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine and Medical Center

Shreekanth V Karwande, MBBS is a member of the following medical societies: American Association for Thoracic Surgery, American College of Chest Physicians, American College of Surgeons, American Heart Association, Society of Critical Care Medicine, Society of Thoracic Surgeons, and Western Thoracic Surgical Association

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; ARdelyx Ownership interest Board membership

Additional Contributors

We gratefully acknowledge the contributions of previous authors to the development and writing of this article.

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