Clinicopathological Features and Outcomes of Gastric Cancer Patients with Pulmonary Lymphangitis Carcinomatosa

Funakoshi, Taro; Yasui, Hirofumi; Boku, Narikazu; Fukutomi, Akira; Yamazaki, Kentaro; Machida, Nozomu; Todaka, Akiko; Tsushima, Takahiro; Yokota, Tomoya; Onozawa, Yusuke; Kenmotsu, Hirotsugu; Endo, Masahiro

doi:10.1093/jjco/hyu091

Cited by 8 publications

(6 citation statements)

References 23 publications

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“…The role of lung metastasectomy in gastric cancer patients is still unclear (64). As many patients suffering from lung metastases form gastric cancers present synchronous carcinomatous lymphangitis or pleuritis, pulmonary metastasectomy has been rarely reported in this setting, thus only few data being available on short and long term outcomes (65,66).…”

Section: Gastric Cancersmentioning

confidence: 99%

Pulmonary metastasectomy: an overview

Petrella¹,

Diotti²,

Rimessi³

et al. 2017

J. Thorac. Dis.

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Metastasectomy is the most frequent surgical resection undertaken by thoracic surgeons, being the lung the second common site of metastases. The present oncological criteria for pulmonary metastasectomy are: (I) the primary cancer need to be controlled or controllable; (II) no extrathoracic metastasis-that is not controlled or controllable-exists; (III) all of the tumor must be resectable, with adequate pulmonary reserve; (IV) there are no alternative medical treatment options with lower morbidity. General favourable prognostic features in patients with pulmonary metastases are: (I) one or few metastases; (II) long disease free interval; (III) normal CEA levels in colorectal cancers. Negative predictive features in patients candidate to pulmonary metastasectomies are: (I) active primary cancer; (II) extrathoracic metastases; (III) inability to obtain surgical radicality; (IV) mediastinal lymphatic spread. The lack of controlled trials and studies limited by short follow-up and small cohorts did not allow to overcome some skepticism; moreover, the heterogeneity of these patients in terms of demographic, biologic and histologic characteristics represents a clear limit even in the largest series. On the basis of present knowledge, without results coming from on-going randomized trials, radical resection, histology, and disease free interval seem to be independent prognostic factors identifying a cohort of patients maximally benefitting from lung metastasectomy.

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Section: Gastric Cancersmentioning

confidence: 99%

Pulmonary metastasectomy: an overview

Petrella¹,

Diotti²,

Rimessi³

et al. 2017

J. Thorac. Dis.

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“…The reported median survival time of patients with pulmonary carcinomatous lymphangitis was 3 months, 23 and our study also confirmed similar prognostic outcomes. Effective chemotherapy was reported for carcinomatous lymphangitis, 24,25 but prompt chemotherapy was considered to be indemonstrable in patients with skeletal metastasis if the primary malignancy is not known. In this study, treatment for patients with respiratory failure was consequently only palliative treatment, which might not have improved their prognosis.…”

Section: Discussionmentioning

confidence: 99%

Oncologic emergency in patients with skeletal metastasis of unknown primary

Torigoe

Imanishi

Yazawa

et al. 2021

Acute Medicine & Surgery

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Aim: Patients with skeletal metastasis from prediagnosed primary malignancy sometimes have concurrent oncologic emergency (OE) during the first visit. This study aims to investigate the types of OEs and treatment outcome in such patients. Methods:We have experienced 359 patients with skeletal metastasis from unknown primary malignancy. Among them, 130 patients required immediate admission for OE treatment (OE group), 229 patients had no OE and did not required immediate admission (non-OE group). Results:The recognized types of OE were spinal cord compression in 60 patients, cancer pain in 30, hypercalcemia in 19, delirium in 16, deep vein thrombosis in 13, acute renal failure in 6, respiratory failure in 3, gastrointestinal hemorrhage in 3, and disseminated intravascular coagulation in 1. The overall 5-year survival rates were 28% and 37% in the OE and non-OE groups, respectively (P < 0.001). The multivariate analysis revealed that delirium (hazard ratio 4.2; 95% confidence interval, 1.6-12.5; P < 0.005) and respiratory failure (hazard ratio 22.6; 95% confidence interval, 4.5-92.8; P < 0.001) were significant prognostic factors in patients with OEs, whereas other OEs did not confer a significant risk for patient outcomes. Conclusion:In this study, OE was observed in as many as 36% of patients with skeletal metastasis from unknown primary malignancy. Delirium and respiratory failure were only two significant prognostic risk factors, which suggest that many of the OEs in untreated advanced cancer patients have probable chance to resolve. Early detection followed by appropriate treatment of such OEs is recommended.

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“…Clinical diagnosis is currently based on the chest X-ray and High-Resolution Computed Tomography often confirmed by histopathological examination of biopsy-derived tissue [10]. In addition to symptomatic management standard treatment relies on chemotherapy [11], which is usually the only causative treatment 3 . It should also be noted that this type of patient is often in poor performance status with poor prognosis and choice of chemotherapy regimen might be challenging.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic challenge: severe dyspnea in a patient with metastatic breast cancer and lymphangitis carcinomatosis syndrome

Gądek

Rutkowski

2019

Palliat Med Pract

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Introduction. Dyspnea, regardless of etiology (pulmonary, neuromuscular or caused by other factors), remains a significant challenge. There is still a lack of effective methods of the treatment of severe dyspnea associated with intensifying anxiety which is the most common indication for intensification of causative and symptomatic treatment or palliative sedation. Case report. A 48 year-old woman diagnosed with relapsed breast cancer with bone, pleural, hepatic and pulmonary metastases with lymphangitis carcinomatosis syndrome confirmed by lung biopsy. In 2011 the patient underwent breast conserving surgery followed by teletherapy, brachytherapy and tamoxifen hormone therapy for 5 years. Comorbidities included chronic obstructive pulmonary disease, diabetes mellitus type 2, depression and nicotine addiction. The patient was urgently admitted to the Department of Oncology and Radiotherapy from Clinical Emergency Department due to rapidly aggravating dyspnea and respiratory failure. Chest X-ray showed massive bilateral pleural effusion and threatening cardiac tamponade. Treatment involved thoracentesis and pericardiocentesis with concurrent symptomatic management. After temporary stabilization of the patient and due to rapid progression of the disease salvage, paclitaxel chemotherapy was started. Despite the features of potential chemosensitivity (chemotherapy-naïve, rapid progression, visceral metastases) the applied treatment was ineffective. After careful evaluation of clinical situation and possible treatment strategies, and after obtaining patient's consent, sedation with midazolam and morphine was applied. Conclusions. This case demonstrated ineffective salvage chemotherapy used in the patient with severe dyspnea induced by a rapid progression of metastatic breast cancer and difficulties in obtaining effective symptomatic treatment.

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Clinicopathological Features and Outcomes of Gastric Cancer Patients with Pulmonary Lymphangitis Carcinomatosa

Abstract: Pulmonary lymphangitis carcinomatosa caused by gastric cancer has some specific clinicopathological features. While the prognosis of gastric cancer patients with pulmonary lymphangitis carcinomatosa is extremely poor, some patients may have survival benefit from chemotherapy.

Cited by 8 publications

References 23 publications

Pulmonary metastasectomy: an overview

Pulmonary metastasectomy: an overview

Oncologic emergency in patients with skeletal metastasis of unknown primary

Therapeutic challenge: severe dyspnea in a patient with metastatic breast cancer and lymphangitis carcinomatosis syndrome

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