A 10-Year Single-Center Experience on 708 Lung Metastasectomies: The Evidence of the “International Registry of Lung Metastases”

Casiraghi, Monica; Pas, Tommaso De; Maisonneuve, Patrick; Brambilla, Daniela; Ciprandi, Barbara; Galetta, Domenico; Borri, Alessandro; Gasparri, Roberto; Petrella, Francesco; Tessitore, Adele; Guarize, Juliana; Donghi, Stefano; Veronesi, Giulia; Solli, Piergiorgio; Spaggiari, Lorenzo

doi:10.1097/jto.0b013e3182208e58

Cited by 151 publications

(133 citation statements)

References 18 publications

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“…In a study including 708 lung metastasectomies, the overall survival of patients after a complete resection was reported to be 74% at two years and 46% at five years whereas the overall survival for patients with incomplete resection was 47% at two years and 20% at five years (35). Similarly, our overall survival rate of patients with lung metastases as a whole group was 73% at two years and 38% at five years.…”

Section: Discussionsupporting

confidence: 56%

Radiofrequency ablation for lung tumors: outcomes, effects on survival, and prognostic factors

Akhan¹,

Güler²,

Akıncı³

et al. 2015

Diagn Interv Radiol

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P rimary lung cancer is the leading cause of cancer-related death worldwide (1). Treatment of primary lung cancers includes surgical resection, radiation therapy, chemotherapy, and thermal ablation. Surgical resection remains the treatment of choice for patients with early stage non-small cell lung cancer (NSCLC) (2). However, primary lung cancers are generally diagnosed in advanced stages. Moreover, due to the high incidence of associated comorbidities and limited pulmonary reserve, most patients are considered ineligible for surgery (3,4).In addition to primary cancers, lungs are the second most frequent site of metastatic disease. In selected patients with metastatic lung cancer, surgical resection is the preferred treatment. However, even patients who have undergone a complete resection have a high incidence of recurrence and may require multiple surgeries (5). Repeat thoracotomy leads to further removal of functional pulmonary tissue. Surgical resection might not be possible in patients with certain comorbidities and limited pulmonary reserve.Patients with pulmonary colorectal metastases constitute a significant portion of metastatic lung tumor group. Approximately 10% of patients with colorectal cancer develop pulmonary metastases during the course of disease (6). It has been reported that in patients with limited colorectal pulmonary metastases and no extrapulmonary disease, five-year survival following surgical resection is approximately 35%-45% (7). However, many patients are not suitable candidates for surgery. PURPOSEWe aimed to evaluate the survival benefit achieved with radiofrequency (RF) ablation of primary and metastatic lung tumors and determine significant prognostic factors for recurrence-free survival. METHODSForty-nine patients with lung cancer (10 primary and 39 metastatic) underwent computed tomography-guided percutaneous RF ablation between June 2005 and October 2013. A total of 112 tumors (101 metastatic and 11 primary non-small cell lung cancer) were treated with RF ablation. Tumor diameter ranged from 0.6 to 4 cm (median 1.5 cm). Effectiveness of treatment, complications, and survival were analyzed. RESULTSPrimary success rate was 79.5% and local tumor progression occurred in 23 tumors. Among tumors showing progression, 10 were re-treated with RF ablation and secondary success rate was 87.5%. One-, two-, and three-year overall survival rates of 10 patients with primary lung cancer were 100%, 86%, and 43%, respectively. One-, two-, three-, four-, and five-year overall survival rates for 39 patients with metastatic lung tumors were 90%, 73%, 59%, 55%, and 38%, respectively. One-, two-, three-, and four-year overall survival rates for 16 patients with colorectal pulmonary metastases were 94%, 80%, 68%, and 23%, respectively. Complications occurred in 30 sessions (24.6%). Pneumothorax occurred in 19 sessions with seven requiring image-guided percutaneous chest tube drainage. Tumor status (solitary or multiple) and presence of extrapulmonary metastasis at initial RF ablation were significa...

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Section: Discussionsupporting

confidence: 56%

Radiofrequency ablation for lung tumors: outcomes, effects on survival, and prognostic factors

Akhan¹,

Güler²,

Akıncı³

et al. 2015

Diagn Interv Radiol

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“…Several reports of resection of pulmonary, hepatic, or adrenal metastatectomies in select patients have demonstrated excellent long-term survival rates. 3,21,29 Stereotactic body radiation therapy is a less-invasive alternative to surgery and appears to offer acceptable local control and survival rates for patients with limited metastatic disease. 16,17,30 It is currently the subject of several ongoing clinical trials, examining the value of stereotactic body radiation therapy in oligometastatic disease for various primary sites.…”

Section: Discussionmentioning

confidence: 99%

“…2,24 There have been variable reports on the dose limitation to the spinal cord using SSRS, with 1 recent analysis reporting a ≤ 5% risk of myelopathy with a 12.4 Gy Dmax, 25 or even no reported myelopathy with a Dmax of 14 Gy. 33 In general, we limit the spinal cord receiving 10 Gy to 0.01 cm 3 or less for single-fraction SSRS.…”

Section: Discussionmentioning

confidence: 99%

The use of spine stereotactic radiosurgery for oligometastatic disease

Tang

Deegan

et al. 2016

SPI

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OBJECTIVE The authors investigated the outcomes following spine stereotactic radiosurgery (SSRS) for patients with oligometastatic disease of the spine. METHODS The study was a secondary analysis of 38 of 209 patients enrolled in 2 separate institutional Phase I/II prospective protocols and treated with SSRS between 2002 and 2011. Of these 38 patients, 33 (87%) were treated for a solitary spine metastasis, with no other history of metastatic disease. SSRS was prescribed to 24 Gy in 1 fraction (8%), 18 Gy in 1 fraction (18%), 16 Gy in 1 fraction (11%), 27 Gy in 3 fractions (53%), 30 Gy in 5 fractions (8%), or 20 Gy in 5 fractions (3%). Seventeen patients (45%) received prior conventional external beam radiation therapy. RESULTS The median overall survival (OS) was 75.7 months, and the 2- and 5-year OS rates were 84% and 60%, respectively. In multivariate analysis, patients who had prior spine surgery and a better Karnofsky Performance Scale score had an improved OS (HR 0.16, 95% CI 0.05–0.52, p < 0.01, and HR 0.33, 95% CI 0.13%–0.84%, p = 0.02, respectively), and those who had undergone prior radiation therapy had a worse OS (HR 3.6, 95% CI 1.2%–10%, p = 0.02). The 1-, 2-, and 5-year local progression-free survival rates were 85%, 82%, and 78%, respectively. The median time to systemic therapy modification was 41 months. Two patients (5%) experienced late Grade 3–4 toxicity. CONCLUSIONS Patients with oligometastatic disease of the spine treated with SSRS can experience long-term survival and a long time before needing a modification in systemic therapy. In addition, SSRS leads to excellent local control and minimal late toxicity.

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“…Lung metastases are a quite common event in solid tumors (1), frequently diagnosed in the course of regular follow-up in asymptomatic patients, without evidence of any other disease site or with a controlled primary tumor and/or other controlled metastatic lesions. Patients affected with 1-5 metastatic pulmonary nodules might be in a condition recently defined as oligo-metastatic disease (2,3), and are often treated with a combination of systemic and metastasis-directed therapies (2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Single Fraction Stereotactic Ablative Radiotherapy for Lung Metastases

Filippi

Badellino

Guarneri

et al. 2014

Technol Cancer Res Treat

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Stereotactic Ablative Radiotherapy (SABR) has been previously investigated as an alternative to thoracic surgery in patients with a limited number of pulmonary nodules from different primary tumors. We here report the clinical outcomes of a series of consecutive patients homogenously selected and treated with single dose SABR in our Institution. Eligibility criteria were: 1-5 lung metastases, maximum tumor diameter 50 mm, absent or controlled extra-thoracic disease, adequate pulmonary function, no prior radiotherapy, performance status ECOG 0-1. All patients were treated with a single dose of 26 Gy prescribed to the months. Treated metastasis progression at SABR site was observed in 10 lesions (11.1%), and actuarial LC rates at 1 and 2 years were respectively 93.4% and 88.1%. Systemic failure occurred in 37 patients (55.2%) at a median interval of 8 months after SABR. PFS rates were 72% and 55.4% at 1 and 2 year. Seven patients had grade 1 (10.4%) and 8 grade 2-3 late radiological toxicity (11.9%), while 6 experienced late chest wall toxicity (2 rib fractures, 4 chronic chest pain, 8.9%). CSS rates at 1 and 2 years were 90% and 76%, while OS rates were 85.1% and 70.5%, respectively. Median survival time was 40 months. On multivariate analysis, a disease-free interval longer than 24 months was close to significance for a benefit in CSS (p 5 0.07; HR 0.34 [95% CI 0.1-1.12]). The study includes a cohort of patients treated with single fraction 26 Gy SABR followed for a prolonged time interval. Single fraction SABR appears to be an effective treatment option, with little observed acute toxicity and limited late toxicity (15%); its advantages also include a high patients' compliance, a short overall treatment time and an easy combination with systemic therapies. These results might provide supportive evidence to the use of single fraction SABR as a valid and acceptable alternative to surgery for pulmonary metastases from different primary tumors.

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A 10-Year Single-Center Experience on 708 Lung Metastasectomies: The Evidence of the “International Registry of Lung Metastases”

Abstract: We confirmed completeness of surgery, histology, and DFI ≥36 months as independent prognostic factors. Number of metastases, presence of lymph node metastases, surgical approach, and number of metastasectomies did not statistically influence long-term survival.

Cited by 151 publications

References 18 publications

Radiofrequency ablation for lung tumors: outcomes, effects on survival, and prognostic factors

Radiofrequency ablation for lung tumors: outcomes, effects on survival, and prognostic factors

The use of spine stereotactic radiosurgery for oligometastatic disease

Outcomes of Single Fraction Stereotactic Ablative Radiotherapy for Lung Metastases

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