Management of small pulmonary nodules in patients with sarcoma

Nakamura, Tomoki; Matsumine, Akihiko; Niimi, Rui; Matsubara, Takehiro; Kusuzaki, Katsuyuki; Maeda, Masayuki; Tagami, Tomoyasu; Uchida, Atsushi

doi:10.1007/s10585-009-9270-y

Cited by 21 publications

(24 citation statements)

References 18 publications

(16 reference statements)

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“…However, chest radiography usually do not allow detection of small lung nodules (\10 mm) [19]. Improvements in CT scanning have enabled clinicians to detect small lung nodules less than 5 mm in size [20]. A lung nodule of 5 mm in patients with a short VDT (within 30 days) tumor, like OS, LMS, MPNST, would grow to about 10 mm within 3 months based on the Schwaltz equation [9].…”

Section: Discussionmentioning

confidence: 99%

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Clinical impact of the tumor volume doubling time on sarcoma patients with lung metastases

Nakamura

Matsumine

Matsubara

et al. 2011

Clin Exp Metastasis

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The volume doubling time (VDT) is an accurate and reproducible method for the quantitation of the rate and pattern of tumor growth in individual patients. The purpose of this study is to investigate the tumor VDT using chest CT in individual sarcoma patients with lung metastasis and to determine whether VDT is associated with survival after lung metastasis in bone and soft tissue sarcomas. Forty patients had measurable lung metastases in at least two sequential chest CT images taken at least 14 days apart. The VDT was calculated using the method originally described by Schwartz. The median and mean VDT in all 40 patients was 21.5 and 53 days, respectively. Similarly, the median and average VDT in 29 soft tissue sarcoma patients was 26 and 57 days, respectively. The median and mean VDT in 11 bone sarcoma patients was 13 and 42 days, respectively. The current univariate analysis revealed significantly poorer predictive values for VDT in all 40 sarcoma patients and 29 soft tissue sarcoma patients. A multivariate analysis showed the VDT to be an independent predictor of survival in 29 soft tissue sarcoma patients. These results suggest that patients with a shorter VDT and consequently a more rapid rate of tumor growth have a significantly lower chance for long term survival especially in soft tissue sarcoma. The patients with lung metastasis that have a longer VDT should therefore be considered for aggressive treatment even if the lesions are multiple and/or bilateral.

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Section: Discussionmentioning

confidence: 99%

“…Treatment such as RFA or surgical excision of the nodules is recommended if the nodule becomes larger. The nodules normally continue to be benign if they remain 5 mm or smaller than 5 mm in size for more than 6 months [20].…”

Section: Discussionmentioning

confidence: 99%

Clinical impact of the tumor volume doubling time on sarcoma patients with lung metastases

Nakamura

Matsumine

Matsubara

et al. 2011

Clin Exp Metastasis

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“…For lesions smaller than 5 mm a follow-up CT scan is indicated after 2 months to evaluate tumour growth. When the lesion starts growing, it is more likely that this represents malignant disease (8). If the nodule in sarcoma patients remains 5 mm or smaller, further follow-up is needed.…”

Section: Radiographic Diagnosis and Preoperative Imagingmentioning

confidence: 99%

“…If the nodule in sarcoma patients remains 5 mm or smaller, further follow-up is needed. If the nodule remains under the 5 mm after 6 months of follow-up, the chance is very high that this is a benign lesion (8).…”

Section: Radiographic Diagnosis and Preoperative Imagingmentioning

confidence: 99%

Lung Metastatic Disease: Surgical Resection and Locoregional Chemotherapy

Hengst¹,

Hendriks²,

Schil³

2012

Toraks Cer Bult

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Currently, surgical resection remains the gold standard for resectable lung metastases. Prognostic factors are histology, complete resection, number of metastases and disease-free interval. However, there is a high rate of recurrent disease in the thorax, even if systemic chemotherapy is applied. Because the latter is limited in dose due to systemic toxicity, new treatment options are being developed to selectively deliver high-dose chemotherapy into the lung, reducing systemic toxicity. Isolated lung perfusion (ILuP), similar to isolated limb perfusion, is an experimental surgical technique to deliver highdose chemotherapy into the lung without systemic exposure. Biological response modifiers like tumour necrosis factor can also be administered. ILuP results in significantly higher concentration of chemotherapy in the target organ compared to systemic chemotherapy, together with a survival benefit in experimental models of pulmonary metastases. Several phase I studies have shown that ILuP is technically feasible with low morbidity and low impact on the patient's pulmonary function. However, the utility of this technique is limited because it is an invasive technique. Other techniques to selectively deliver high-dose locoregional chemotherapy are embolic trapping (chemo-embolization), selective pulmonary artery perfusion (SPAP) without control of the venous effluent and the minimally invasive lung suffusion technique. This review will discuss surgical resection of lung metastases and address several techniques developed to deliver high doses of chemotherapy into the lung, as well as the current progress in experimental and clinical studies.

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“…Of all patients with sarcomas, 10-38 % of patients present with clinically detectable metastases [1][2][3]. Even after an apparent complete resection of metastasis, the 3-year survival rates after metastasectomy and/or radiofrequency ablation (RFA) have been reported to be 30-59.2 % [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

The role of C-reactive protein in predicting post-metastatic survival of patients with metastatic bone and soft tissue sarcoma

et al. 2015

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Although elevated preoperative serum C-reactive protein (CRP) level is an indicator of a poorer prognosis in many cancers including non-metastatic bone and soft tissue sarcoma, there have been no reports focused on sarcoma patients with advanced stage who had distant metastases. The aim of this study is to determine whether the serum CRP level after metastasis is associated with post-metastatic survival in patients with bone and soft tissue sarcoma. A total of 71 patients were studied including 38 male and 33 female. Of all patients, 22 patients had metastases at presentation. The remaining 49 patients developed initial metastasis after the treatment of primary tumor. The average age at the diagnosis of metastasis was 55 years. Blood was obtained after initial detection of metastasis. CRP levels ranged from 0.1 to 165 mg/L with an average of 16.4 mg/L in all patients. Elevated CRP levels (>3 mg/L) were seen in 31 patients (range 3.1-165). The disease-specific survival after metastasis estimates at 3 and 5 years was 17.1 and 17.1 % for those with an elevated CRP vs. 59.5 and 45.3 % for those with a normal CRP (p < 0.0001). In 49 patients who developed lung metastasis after initial primary treatment, patients with elevated CRP levels also had a poorer post-metastatic survival than patients with normal CRP levels (p < 0.0001). In conclusion, we recommend routine measurement of CRP level to identify the patients who have high risk of death after metastasis.

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Management of small pulmonary nodules in patients with sarcoma

Cited by 21 publications

References 18 publications

Clinical impact of the tumor volume doubling time on sarcoma patients with lung metastases

Clinical impact of the tumor volume doubling time on sarcoma patients with lung metastases

Lung Metastatic Disease: Surgical Resection and Locoregional Chemotherapy

The role of C-reactive protein in predicting post-metastatic survival of patients with metastatic bone and soft tissue sarcoma

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