Surgery of Primary Lung Cancer with Oligometastatic M1b Synchronous Single Brain Metastasis: Analysis of 37 Cases

Cheufou, Danjouma; Welter, Stefan; Chalvatzoulis, Eleftherios; Christof, Daniel; Theegarten, Dirk; Stamatis, Georgios

doi:10.1055/s-0034-1377060

Cited by 18 publications

(13 citation statements)

References 13 publications

(22 reference statements)

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“…Despite a series of reports with small sample showed survival benefits among NSCLC patients with metastasis, 4 – 7 improved survival with surgical intervention has not been clearly defined. Additionally, the lack of randomized controlled trials makes it difficult to develop treatment guidelines for NSCLC patients with metastasis.…”

Section: Introductionmentioning

confidence: 99%

Surgical Intervention Improves Survival for Metastatic Non-Small Cell Lung Cancer Patients

Shen

Cao

et al. 2016

Medicine

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Surgical intervention for stage IV non-small cell lung cancer (NSCLC) is still controversial. This study sought to evaluate the clinical effects of surgical intervention on survival in patients with stage IV NSCLCs and to identify the cohort benefitting the most from surgery.A retrospective study from the Surveillance, Epidemiology, and End Results database was performed to compare the survival of stage IV NSCLC patients who had undergone surgery with those who did not undergo surgery. Overall survival (OS) was evaluated using the Kaplan–Meier method and the log-rank test. The Cox proportional hazards model was used for multivariate analysis.The total number of eligible patients was 43,538, including 16.8% in the M1a stage and 83.2% in the M1b stage. The percentages of patients with no surgery (NONE), only metastatic tumor resection (MTR), only primary tumor resection (PTR), and both primary and metastatic tumor resection (PMTR) were 89.0%, 6.7%, 3.5%, and 0.8%, respectively; the corresponding 5-year survival rates were 2.0%, 4.0%, 13.0%, and 20.0%, respectively (P < 0.001); and the corresponding OS rates were 11.1 months, 14.7 months, 29.4 months, and 34.9 months, respectively (P < 0.001). Notably, the pairwise comparisons of 5-year survival rate and OS among the subgroups were all statistically significant. The multivariate analysis showed that surgical intervention was correlated with longer survival in patients with stage IV NSCLC. The stratified analysis showed significant differences in the OS on strata of the M1a stage and strata of the M1b stage. In the M1a stage, patients with PTR had significantly better OS than those with NONE (P < 0.001) or MTR (P < 0.001) but showed no significant differences compared with those with PMTR (P = 0.174); patients with MTR did not have prolonged survival compared with patients with NONE (P = 0.185), and they also did not have prolonged survival compared with patients with PMTR (P = 0.052). In the M1b stage, pairwise comparisons of OS were all statistically significant among the subgroups (P < 0.001).Surgical intervention can prolong survival to different degrees according to the modalities of surgery in stage IV NSCLC.

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Section: Introductionmentioning

confidence: 99%

Surgical Intervention Improves Survival for Metastatic Non-Small Cell Lung Cancer Patients

Shen

Cao

et al. 2016

Medicine

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“…Overall survival endpoints (level A) were reported in all but one study [ 90 ], however stronger study designs would have shown whether the survival endpoints were significant. OS was reported as MOS (11.7 [ 82 ], 17 [ 94 ], 20 [ 83 ], 26.4 [ 92 ], and 41months [ 91 ] and at four intervals in the remaining studies: 5-year (29.4% [ 84 ], 8.3–86% [ 76 ], 44.7% [ 98 ], 38% [ 96 ], 36% [ 86 ], and 24% [ 87 ]), 3-year (17.5% [ 81 ], 25% [ 85 ], and 15.8% [ 97 ]), 2-year (24% [ 93 ]and 38% [ 89 ]), 18-month (52.9%) [ 88 ] and 1-year (67% [ 80 ]and 75% [ 95 ]).…”

Section: Introductionmentioning

confidence: 99%

The biology and treatment of oligometastatic cancer

2015

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Clinical reports of limited and treatable cancer metastases, a disease state that exists in a transitional zone between localized and widespread systemic disease, were noted on occasion historically and are now termed oligometastasis. The ramification of a diagnosis of oligometastasis is a change in treatment paradigm, i.e. if the primary cancer site (if still present) is controlled, or resected, and the metastatic sites are ablated (surgically or with radiation), a prolonged disease-free interval, and perhaps even cure, may be achieved. Contemporary molecular diagnostics are edging closer to being able to determine where an individual metastatic deposit is within the continuum of malignancy. Preclinical models are on the outset of laying the groundwork for understanding the oligometastatic state. Meanwhile, in the clinic, patients are increasingly being designated as having oligometastatic disease and being treated owing to improved diagnostic imaging, novel treatment options with the potential to provide either direct or bridging therapy, and progressively broad definitions of oligometastasis.

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“…As a result, much of our knowledge on surgical interventions about outcomes for surgical management of metastatic disease is largely limited small single institution series, and this impacts the quality of the evidence evaluating its role. 14–20 The current literature lacks a review that includes the palliative, diagnostic, and therapeutic roles of surgery in metastatic NSCLC patients. To address this subject cohesively, we conducted a narrative review of the surgical literature on this topic.…”

Section: Introductionmentioning

confidence: 99%

The Role of Thoracic Surgery in the Therapeutic Management of Metastatic Non–Small Cell Lung Cancer

David

Clark

Cooke

et al. 2017

Journal of Thoracic Oncology

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Introduction The majority of non-small cell lung cancer (NSCLC) patients are diagnosed with advanced stage disease for whom the prognosis is poor and survival is typically measured in months. Standard therapeutic treatment regimens for patients with stage IV NSCLC typically include chemotherapy and palliative radiation. Despite newer regimens that may include molecularly targeted therapy and immunotherapy, the overall 5-year survival for stage IV disease remains low at 4–6%. Although therapeutic surgery is performed in a minority of cases, accumulating data suggest that thoracic surgery may play several beneficial roles for these patients. Methods In this narrative review, we summarize the literature on surgical intervention in the multimodality management of stage IV NSCLC; focusing on the potential evidence for and against therapeutic/curative intent procedures to impact outcomes for patients with oligometastatic disease and pleural metastasis. Results In selected patients, surgical resection can result in a 5-year survival of 30–50%, but this is heavily influenced by the presence of mediastinal nodal disease, which should be evaluated before therapeutic surgical procedures are undertaken. Additionally, diagnostic or palliative surgical procedures can play an important role in the personalized management of stage IV disease. These data suggest that for carefully selected patients with advanced stage NSCLC, surgical intervention can be an important component of combined modality treatment. Conclusions Given advances in molecular targeted therapy and immunotherapy, further studies should focus on the possible use of surgery as a strategy of therapeutic “consolidation” for appropriately selected patients with stage IV NSCLC receiving combined modality care.

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Surgery of Primary Lung Cancer with Oligometastatic M1b Synchronous Single Brain Metastasis: Analysis of 37 Cases

Abstract: The oncologic lung resection of NSCLC after the resection of a single brain metastasis can be implemented without an increased risk of complications or mortality. Despite the stage IV disease, the median survival appears encouraging.

Cited by 18 publications

References 13 publications

Surgical Intervention Improves Survival for Metastatic Non-Small Cell Lung Cancer Patients

Surgical Intervention Improves Survival for Metastatic Non-Small Cell Lung Cancer Patients

The biology and treatment of oligometastatic cancer

The Role of Thoracic Surgery in the Therapeutic Management of Metastatic Non–Small Cell Lung Cancer

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