Late Adrenal Metastasis in Operable Non–Small-Cell Lung Carcinoma

Abstract

Treatment of early-stage (I, II, and some IIIA) non-small-cell lung cancer (NSCLC) is curative resection. Simultaneous isolated adrenal metastasis represents a dilemma. Although many studies addressing the management of adrenal metastasis diagnosed simultaneously with NSCLC have been published, only very few reports of late adrenal metastasis can be found in the literature. Our purpose is to discuss the management of solitary late (metachronous) adrenal metastasis from operable NSCLC based on published experience. We describe a patient with a solitary metachronous adrenal metastasis diagnosed 3 years after resection of NSCLC. Adrenalectomy was done, followed by combination chemotherapy with paclitaxel and carboplatin. MEDLINE literature on similar cases was reviewed and updated. Only 18 cases have been reported from 1965 to 2000. The median interval between the diagnosis of NSCLC and development of adrenal metastasis was 11.5 months. All patients were male. Unilateral adrenal metastases were reported in 15 patients, whereas 3 had bilateral metastases. Five patients were treated with adrenalectomy, and eight patients were treated with adrenalectomy and postoperative adjunctive chemotherapy. Chemotherapy alone was used in two patients and two patients underwent palliative radiation therapy. One patient was treated with intraarterial chemotherapy followed by radiation therapy. Solitary metachronous adrenal metastases are rare. There are no standard treatment guidelines for this group of patients. Review of the literature showed that median survival after treatment was 19 months for the group treated with adrenalectomy followed by chemotherapy; 15 months for the chemotherapy group; 14 months for the adrenalectomy group; and 8 months for the group treated with palliative radiation.

Combined Robotic Lobectomy and Adrenalectomy for Lung Cancer and Solitary Adrenal Metastasis

“…Retrospective and prospective research has failed to conclusively demonstrate a survival advantage. 14 Our patient received one course of induction chemotherapy and was noted to have a significant drop in the primary tumor standardized uptake value (SUV). Thus, given that in vivo litmus test, we would expect to achieve a survival improvement by administration of adjuvant chemotherapy.…”

Adiponectin inhibits migration and invasion by reversing epithelial‑mesenchymal transition in non‑small cell lung carcinoma

“…Data from the National Central Cancer Registry of China revealed that lung cancer accounts for the greatest number of cancer-related deaths and exhibits an increasing incidence and mortality trend in China ( 2 ). Non-small cell lung cancer (NSCLC) accounts for approximately 80–85% of lung cancer cases, and displays an aggressive phenotype with almost half of the patients presenting with metastases ( 3 ). Metastasis is the primary contributing factor to NSCLC-related mortality.…”

Incidental Adrenal Mass in a Patient With Surgically Treated Lung Adenocarcinoma

“…Common sites of metastases for lung cancer are the nervous system (39%), bone (34%), liver (20%), and adrenal gland (8%) [5]. Isolated metachronous or synchronous adrenal metastasis is rare, with an estimated incidence rate between 1%-6% [6][7][8]. In the case of isolated adrenal metastasis, metachronous metastasis, lack of lymph node involvement, and disease-free interval are among the factors associated with better survival rates [7,9].…”