Outcomes of Adrenalectomy for Isolated Synchronous Versus Metachronous Adrenal Metastases in Non–Small-Cell Lung Cancer: A Systematic Review and Pooled Analysis

Tanvetyanon, Tawee; Robinson, Lary A.; Schell, Michael J.; Strong, Vivian E.; Kapoor, Rachna; Coit, Daniel G.; Bepler, Gerold

doi:10.1200/jco.2007.14.2091

Cited by 308 publications

(214 citation statements)

References 25 publications

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“…It was possible to extract some data from the included studies to compare these outcomes, but no statistically significant difference could be demonstrated between the two groups. In general, metastasectomies for synchronous metastases are associated with shorter median survival than resection of metachronous metastases; this has been shown in the case of hepatectomy for colorectal metastases [28,29], pulmonary resection for RCC metastases [30] and adrenalectomy for metastatic non-small-cell lung cancer [31]. The previously-mentioned review of case reports and series of pancreatectomy for metastatic RCC suggest that the same principle applies [27]; our data are not consistent with this, but a dedicated study looking specifically at this question remains to be performed.…”

Section: Discussionmentioning

confidence: 99%

Pancreatectomy for metastatic disease: A systematic review

Adler

Redmond

Heneghan

et al. 2014

European Journal of Surgical Oncology (EJSO)

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Aim: Tumours rarely metastasise to the pancreas. While surgical resection of such metastases is believed to confer a survival benefit, there is limited data to support such management. We present a systematic review of case series of pancreatic metastasectomy and analysis of survival outcomes.Methods: A literature search was performed using the PubMed and Cochrane databases and the reference lists of relevant articles, searching for sizeable case series of pancreatic metastasectomy with curative intent. Data extracted included basic demographics, histological primary tumour, presentation, operative management, complications and survival, while the MINORS index was used to assess study quality.Results: 18 studies were found which met our inclusion criteria, involving 399 patients. Renal cell carcinoma (RCC) was the commonest malignancy metastasising to the pancreas, responsible for 62.6% of cases, followed by sarcoma (7.2%) and colorectal carcinoma (6.2%). While survival data was not uniformly reported, the median survival post-metastasectomy was 50.2 months, with a oneyear survival of 86.81% and five-year survival of 50.02%. Median survival for RCC was 71.7 months with 70.4% five-year survival. Median survival was similar in patients with synchronous and metachronous pancreatic metastases, but patients with additional extrapancreatic metastases had a significantly shorter survival than patients with isolated pancreatic metastases (26 versus 45 months). Study quality was poor, with a median MINORS score of 10/16. Conclusions:Within the limitations of a review of non-randomised case series, it would appear that pancreatic metastasectomy confers a survival benefit in selected patients. Better evidence is required, but may prove difficult to acquire. Key words:pancreatic metastasis, metastasectomy, pancreatectomy, metastatic renal cell cancer, 3 Introduction:

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Section: Discussionmentioning

confidence: 99%

Pancreatectomy for metastatic disease: A systematic review

Adler

Redmond

Heneghan

et al. 2014

European Journal of Surgical Oncology (EJSO)

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“…In a recent retrospective study from centres in the USA, RAZ et al [161] reported a 5-year survival of 34% following excision of solitary adrenal metastasis. Patients with a synchronous metastasis usually have a shorter survival than those presenting with metachronous metastasis [166,167]. However, a durable long-term survival is achievable in both groups of patients (,25% at 5-years) [166].…”

Section: Surgery For Stage IV Lung Cancer (Solitary Metastasis)mentioning

confidence: 99%

“…Patients with a synchronous metastasis usually have a shorter survival than those presenting with metachronous metastasis [166,167]. However, a durable long-term survival is achievable in both groups of patients (,25% at 5-years) [166].…”

Section: Surgery For Stage IV Lung Cancer (Solitary Metastasis)mentioning

confidence: 99%

Surgery for nonsmall cell lung cancer

Lang-Lazdunski

2013

European Respiratory Review

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Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to perform lung resections on elderly patients, patients with poor pulmonary function or significant cardiopulmonary comorbidities. New techniques, such as stereotactic radiotherapy and ablative procedures, are being evaluated in early-stage lung cancer and may represent an alternative to surgery in patients unfit for lung resection. Perioperative mortality rates have dropped significantly at most institutions in the past two decades and complications are managed more efficiently. Progress in imaging and staging techniques have helped cut futile thoracotomy rates and offer patients the most adequate treatment options. Large randomised trials have helped clarify the role of neoadjuvant, induction and adjuvant chemotherapy, as well as radiotherapy. Surgery remains an essential step in the multimodality therapy of selected patients with advanced-stage lung cancer (stage III and IV). Interventional and endoscopic techniques have reduced the role of surgery in the diagnosis and staging of nonsmall cell lung cancer, but surgery remains an important tool in the palliation of advanced-stage lung cancer. Large national/international surgical databases have been developed and predictive risk-models for surgical mortality/morbidity published by learned surgical societies. Nonetheless, lung cancer overall survival rates remain deceptively low and it is hoped that early detection/screening, better understanding of tumour biology and development of biomarkers, and development of efficient targeted therapies will help improve the prognosis of lung cancer patients in the next decade. @ERSpublications Despite progress in surgical techniques, radiotherapy techniques and targeted therapy, lung cancer prognosis remains poor

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“…Tanvetyanon et al, demonstrated 5-year survival rates of 25% following resection of isolated synchronous adrenal metastases and reported 26% after resection of metachronous adrenal metastases in their study conducted on NSCLC patients developing solitary adrenal metastasis [4]. Conducted studies revealed that the rate of complication was 9-20% in patients having adrenalectomy for solitary adrenal metastasis [2][3][4]7].In recent years, the use of radiotherapy, which is a treatment modality as effective as surgical resection, has become prevalent for the management of oligometastases. Today, three different modalities have been tested in the radiotherapy treatment of adrenal gland metastases.…”

mentioning

confidence: 99%

“…They can be functional or non-functional. Major treatment methods used fort he treatment of adrenal gland primary tumors or metastases are surgery, arterial embolisation, chemical ablation, radiofrequency ablation and radiotherapy [1][2][3][4].…”

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confidence: 99%

Adrenal insufficiency in Bilateral Adrenal Metastasis implemented SBRT

Cihan¹

2018

J Radiol Oncol

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Today, there is a considerable increase in localizing adrenal bulks with the bringing radiologic diagnosis methods having high technology into use and improvement in diagnostic tests. Adrenal glands are vital tissues for the organism due to the hormones they secrete. Death is a natural result in the absence of adrenal cortex. Adrenal bulks can be seen with different clinical, laboratory and radiological data. These bulks are often benign and rarely malign. They can be functional or non-functional. Major treatment methods used fort he treatment of adrenal gland primary tumors or metastases are surgery, arterial embolisation, chemical ablation, radiofrequency ablation and radiotherapy [1][2][3][4].Adrenal glands are one of the metastatic ields. In wide autopsy series, adrenal metastasis has been determined between the rates of 13-17% [5]. While unilateral metastasis is common, bilateral metastasis' rate of incidence is between 4-20%. It has been stated that lung (35%), gastric (14%), esophageal (12%) and hepatobiliary (10%) primary carcinomas adrenal metastasis are prevalent most frequently [2]. Curative treatments are tested on patients having cancer with oligo metastasis limited with adrenal gland and primary source is under control because of the expectation of longterm survival, and the surgery is the irst choice. These bulks can be treated with open and laparoscopic surrenalectomy in a curative way. It was reported in studies that overall survival was longer in resection of clinically isolated adrenal metastases when compared with nonsurgical therapy (including RFA, external beam radiotherapy, arterial embolization, radioembolization, chemical ablation, and cryoablation) [1,2,5,7]. Lo et al., found one-year survival as 73% and two-year survival as 40% in their study conducted on 52 patients having curative resection for solitary adrenal metastasis [3]. Tanvetyanon et al., demonstrated 5-year survival rates of 25% following resection of isolated synchronous adrenal metastases and reported 26% after resection of metachronous adrenal metastases in their study conducted on NSCLC patients developing solitary adrenal metastasis [4]. Conducted studies revealed that the rate of complication was 9-20% in patients having adrenalectomy for solitary adrenal metastasis [2][3][4]7].In recent years, the use of radiotherapy, which is a treatment modality as effective as surgical resection, has become prevalent for the management of oligometastases. Today, three different modalities have been tested in the radiotherapy treatment of adrenal gland metastases. In the irst one, total 50 Gy treatment dose with 3D-CRT as daily 2 Gy fraction dose is given [8]. The second one is IMRT implementations for adrenal gland metastases but it isn't thought as suitable according to Practice Guidelines for Neuroendocrine Tumors published by NCCN in 2010. The third radiotherapy modality is stereotactic body radiotherapy (SBRT). SBRT implementations have started to be preferred today since they are completed in a few fractions in addition to tha...

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Outcomes of Adrenalectomy for Isolated Synchronous Versus Metachronous Adrenal Metastases in Non–Small-Cell Lung Cancer: A Systematic Review and Pooled Analysis

Abstract: For an isolated adrenal metastasis from NSCLC, patients with a synchronous metastasis who underwent adrenalectomy had a shorter median overall survival than those with a metachronous metastasis. However, a durable long-term survival is achieved in approximately 25% in both groups.

Cited by 308 publications

References 25 publications

Pancreatectomy for metastatic disease: A systematic review

Pancreatectomy for metastatic disease: A systematic review

Surgery for nonsmall cell lung cancer

Adrenal insufficiency in Bilateral Adrenal Metastasis implemented SBRT

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