
        Pulmonary Metastases   written and compiled by doctordee May 2001


Top of Form

Bottom of Form




Metastatic Disease -- Local Control -- Treatment Options by Site - Lung

Pulmonary Metastases

* Surgical Resection 
* VATS: Video Assisted Thoracoscopic Surgery 
* Radio Frequency Ablation [RFA]  
* Surgical RE-resection
* Chemotherapy 
* Isolated Lung Perfusion


How to Use This Page
The index gives some methods of treatment. Under each method, often with a short explanation at the beginning, there is a collection of medical journal references relating to that technique, its success with LMS or sarcomas if such is available, and further information about its use and complications. Generally, the best way to deal with LMS metastases is by surgical resection, if it is at all possible. 
Should you be interested in a specific technique, abstracts can be highlighted and copied, and then printed out and taken with you to your doctor for further discussion. The institution where the research was done is often listed in the citation, should you or your doctor wish to contact the researchers.


[ ] will indicate editorial comment by the compiler. Some sentences are highlighted in bold, again done by the compiler.


Pulmonary Metastases: Surgical Resection 


Pulmonary metastases may appear simultaneously with the diagnosis, or up to 10 or more years later. Surgical Resection of Pulmonary Metastases is the treatment of choice. Resection of pulmonary metastases of leiomyosarcoma offers a possibility of cure, and a larger possibility of long term survival, if all tumorous tissue is removed. 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10235518&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10589033&dopt=Abstract

Re-resection of recurrent pulmonary metastases is also possible. "Re-exploration for recurrent sarcomatous pulmonary metastases appears beneficial for patients who can be completely re-resected. Outcomes are described by factors that may be determined preoperatively, including metastasis size, metastasis number, and primary tumor histologic grade. Patients who cannot be completely re-resected or those with numerous, large metastasis and high-grade primary tumor pathology have poor outcomes and should be considered for investigational therapy." 
Surgery can be done by thoracotomy, wide opening up of the chest, or by VATS [Video Assisted Thoracoscopic Surgery] which is like laparoscopic surgery, but in the chest.  VATS surgery cannot deal with large tumors; the tumors must be small enough to be retrieved through the operative incision.  
Where appropriate, ablative methods are now coming into use:  Radio Frequency Ablation [RFA] is a low morbidity, seemingly effective method of dealing with lung metastases if they are not near large blood vessels or vital structures.  See the web page on RFA on this site.  Lasers have also been used.
For patients for whom the metastases are unresectable, or for whom there is additional and unresectable tumor mass elsewhere, chemotherapy is an option. 
Cryosurgical techniques can be used if the tumor is tracheobronchial and can be reached. This technique is indicated in patients who cannot be given surgical or radiation treatment and in cases of asphyxial syndrome requiring faster relief of obstruction than is obtainable with radiation treatment. 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3025779&dopt=Abstract
For more information and the current Pubmed Searches:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=PubMed&term=lung%20sarcoma%20surgical%20treatment
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=PubMed&term=lung%20metastases%20surgical%20treatment
Go To Top




Pulmonary Metastases, and
Surgical Resection of Pulmonary Metastases 
Selected Medical Journal Annotated References



Ann Surg 1999 May;229(5):602-10; discussion 610-2 
Pulmonary metastases from soft tissue sarcoma: analysis of patterns of diseases and postmetastasis survival. 
Billingsley KG, Burt ME, Jara E, Ginsberg RJ, Woodruff JM, Leung DH, Brennan MF. 
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. 

... To report the patterns of disease and postmetastasis survival for patients with pulmonary metastases from soft tissue sarcoma in a large group of patients treated at a single institution. Clinical factors that influence postmetastasis survival are analyzed. ...For patients with soft tissue sarcoma, the lungs are the most common site of metastatic disease. Although pulmonary metastases most commonly arise from primary tumors in the extremities, they may arise from almost any primary site or histology. To date, resection of disease has been the only effective therapy for metastatic sarcoma. ..., 719 patients either developed or presented with lung metastases. Patients were treated with resection of metastatic disease whenever possible. Disease-specific survival was the endpoint of the study. .. ... The overall median survival from diagnosis of pulmonary metastasis for all patients was 15 months. The 3-year actuarial survival rate was 25%. The ability to resect all metastatic disease completely was the most important prognostic factor for survival. 

Patients treated with complete resection had a median survival of 33 months and a 3-year actuarial survival rate of 46%. For patients treated with nonoperative therapy, the median survival was 11 months. A disease-free interval of more than 12 months before the development of metastases was also a favorable prognostic factor. Unfavorable factors included ... patient age older than 50 years at the time of treatment of metastasis. ... Resection of metastatic disease is the single most important factor that determines outcome in these patients. Long-term survival is possible in selected patients, particularly when recurrent pulmonary disease is resected. Surgical excision should remain the treatment of choice for metastases of soft tissue sarcoma to the lung. PMID: 10235518 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10235518&dopt=Abstract




J Surg Oncol 2001 Jan;76(1):47-52 
Pulmonary metastasectomy: might the type of resection affect survival? 
Mineo TC, Ambrogi V, Tonini G, Nofroni I. Thoracic Surgery Tor Vergata University, Rome, Italy. mineo@med.uniroma2.it 

 Metastasectomy proved to be the choice treatment in the case of pulmonary metastasis. In this study we assessed the impact on survival of three types of resection: minimal by laser or conventional device and lobectomy. ...We considered 85 patients who underwent lung metastasectomy for tumors that originated from various sites. Fifty-two minimal resections were accomplished in 34 patients by conventional (diathermy dissection or stapler suture line) device, 59 resections in 29 by Nd:YAG laser. Lobectomies were 22. Minimum follow up required was 2 years. ... The 3-year Kaplan-Meier survival rate was 63%, 44%, 53% for laser, conventional resections and lobectomy. The 5-year survival was 40%, 28%, 26% respectively. Among the groups there was no significant difference (P = 0.15). Laser patients showed shorter periods of air leakage and hospital stay. ... The type of resection did not disclose statistically significant differences on survival. Minimal surgery, especially by laser device, is recommended for less morbidity. PMID: 11223824 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11223824&dopt=Abstract



Virchows Arch 2000 Sep;437(3):284-92 
Benign metastasizing leiomyoma of the uterus: documentation of clinical, immunohistochemical and lectin-histochemical data of ten cases. 
Kayser K, Zink S, Schneider T, Dienemann H, Andre S, Kaltner H, Schuring MP, Zick Y, Gabius HJ. Department of Pathology, Thoraxklinik, Heidelberg, Germany. klkayser@lung.de 

The clinical histories of 10 women suffering from benign metastasizing leiomyoma (BML) after hysterectomy and information on lung lesions detected in these women are presented, together with corresponding data for 2 women with metastasizing leiomyosarcoma of the uterus for comparison: gross appearance, survival, and light microscopical, immunohistochemical and lectin-histochemical findings are reported. All patients with BML had undergone hysterectomy for uterus leiomyomatosus without any detection of sarcomatous lesions in the uterus wall. After a median period of 14.9 years intrapulmonary masses were detected by imaging techniques. On average, six nodules with a mean diameter of 1.8 cm were seen. Resection of the lesions was performed in all cases. ... The lesions were characterized by low proliferation activity of 2.9% (measured with Ki-67), frequent hormone receptor expression (8 of the 10 cases presented hormone-specific receptors), low to moderate vascularization compared with metastases from the two uterine sarcomas, remarkable p53 overexpression ... The median survival of the BML patients was 94 months after excision of the intrapulmonary lesions, and the maximum survival of the two sarcoma patients was 22 months. The results recorded in this patient sample with the methodology applied suggest that benign metastasizing leiomyomas are a slow-growing variant of leiomyosarcoma of the uterus, which becomes clinically apparent at a young age and progresses with low velocity.  PMID: 11037349 

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11037349&dopt=Abstract




Am J Surg 2000 Feb;179(2):122-5 
Importance of the control of lung recurrence soon after surgery of pulmonary metastases. 
Maniwa Y, Kanki M, Okita Y. Department of Surgery, Division II, Kobe University School of Medicine, Kobe, Japan. 

...In this study, we investigated factors that determined prognosis in patients who underwent surgery for metastatic lung tumors, focusing on early relapse of metastatic lung lesions after surgery, and considered countermeasures for improving long-term results based on this study. ...This study was performed in patients with metastatic lung tumors who underwent surgery during the 22 years after November 1975 in this department. ... The 1-year, 3-year, and 5-year survival rates in all patients were 70%, 42%, and 37%, respectively. On comparison among the groups, there were no significant differences by gender, age, organ with the primary lesion, disease-free interval, number of metastases, or surgical procedure. However, prognosis was significantly poorer in patients with recurrent metastatic lung lesions. Prognosis was especially poor in patients with recurrence within 6 months after pneumonectomy, and this was an important factor that worsened the surgical results. ... As the mechanism of early recurrence of lung metastasis after surgery for metastatic lung tumor, multiple micrometastases (dormancy) that cannot be detected during surgery for metastatic lung tumor may be present in the lung. Establishment of a method of controlling an increase in dormant metastasis may lead to improvement of surgical results of metastatic lung tumors. PMID: 10773147 



J Surg Oncol 1999 Dec;72(4):193-8 
Surgical treatment of lung metastases: prognostic factors for long-term survival. 
Abecasis N, Cortez F, Bettencourt A, Costa CS, Orvalho F, de Almeida JM. Department of Surgery, Instituto Portugues de Oncologia Francisco Gentil-Centro de Lisboa, Lisboa, Portugal. nop479762@mail.telepac.pt 

"...Surgical resection of lung metastases is an established therapy for a large number of primary tumors, but there is some controversy about prognostic factors for long-term survival. ... From 1968 to 1996, we performed a retrospective review of a series of 85 patients (100 operations) that have been operated for resection of lung metastases. ... The operative mortality was 4% and the morbidity 18%. The mean follow-up after lung resection was 22.13 months (1-146). The actuarial 5-year survival rate was 29.2%. By univariate analysis, the following factors were associated with survival after resection: location and histology of the primary tumor, greatest dimension of the largest metastasis, radicality of the resection, involvement of the resection margins, and use of adjuvant therapy (P < 0.05).  After multivariate analysis, only the dimension of the metastases and involvement of surgical margins have been found to be independently associated with survival. ... Surgical excision is a safe and effective therapy for lung metastases from a large number of primary tumors, provided a complete resection is feasible." Copyright 1999 Wiley-Liss, Inc. PMID: 10589033
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10589033&dopt=Abstract
 


Ann Thorac Surg 1999 Jul;68(1):227-31 
Prognostic factors and results after surgical treatment of primary sarcomas of the lung. 
Regnard JF, Icard P, Guibert L, de Montpreville VT, Magdeleinat P, Levasseur P. Department of Thoracic Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France. 

...Primary sarcoma of the lung is a rare tumor. Our purpose was to study survival after resection and prognostic factors, which have been rarely reported. ...In a 24-year period, we performed 20 complete resections and three exploratory thoracotomies only for primary lung sarcomas. One patient declined operation. Mean diameter of resected tumors was 9 cm (range, 4 to 18 cm). There were eight stage IB, eight stage IIB, one stage IIIA, and three stage IIIB. Sixty percent of patients with resected tumors received adjuvant therapy. Age, sex, resectability, tumor size, histologic cell type, stage, and adjuvant therapy were analyzed as predictors of survival. ... No postoperative deaths occurred. All 4 patients who had no resection died within 15 months. The 5- and 10-year actuarial survival after complete resection was 48%. The 5- and 10-year actuarial survival in stage IB was 83%, whereas the 4-year actuarial survival in stage IIB was 30% (p < 0.05). Complete resection and stage of disease were the sole significant prognostic factors. ... Complete resection of primary sarcoma of the lung, when feasible, can achieve prolonged survival, although almost half of the patients died of metastasis within 2 years of operation. Adjuvant therapy needs to be investigated. PMID: 10421146 


Kobe J Med Sci 1998 Dec;44(5-6):247-64 
The prognostic factor of the surgically treated metastatic lung cancer. 
Kanki M, Okada M, Maniwa Y, Kiyooka K. Department of Surgery, Kobe University School of Medicine. 

Surgical treatment for metastatic lung tumor has also been aggressively performed to treat multiple or bilateral lesions recently. However, in some patients, metastatic pulmonary foci have recurred after surgery for metastatic lung tumor. These foci could not be controlled even after performing thoracotomy several times in some patients. In this study, we examined prognostic factors in patients undergoing surgery for metastatic lung tumor with respect to early relapse of metastatic pulmonary foci after surgery, and discussed strategies for improving long-term results. 

This study included 120 patients who underwent surgery for metastatic lung tumor in our department between November 1975 and November 1997. Overall, the 5-year survival rate was 37.1%. .... However, the prognosis was significantly poorer in patients with recurrent metastatic pulmonary foci after surgery. Especially in patients with early relapse within 6 months after resection of the lung, the prognosis was markedly poor. Early relapse was an important factor involved in unfavorable surgical outcomes. The mechanism involved in the early relapse of metastatic pulmonary foci after surgery for metastatic lung tumor may be associated with the presence of several micrometastases that could not be recognized during surgery for metastatic lung tumor, that is, dormancy, in the lung. Surgical outcomes in patients with metastatic lung tumor will be improved if a method of controlling this increase in dormant metastases is established. PMID: 10401227 



Eur J Cardiothorac Surg 1999 Apr;15(4):456-60 
Surgical treatment of primary pulmonary sarcomas. 
Bacha EA, Wright CD, Grillo HC, Wain JC, Moncure A, Keel SB, Donahue DM, Mathisen DJ. 
Thoracic Surgical Unit, Massachusetts General Hospital, Boston 02114, USA. 

...We sought to identify the long-term prognosis after surgical treatment for primary pulmonary sarcoma. METHODS: Twenty-three patients were retrospectively identified as having been treated surgically for primary pulmonary sarcoma between 1981 and 1996. The records of all patients were reviewed, and the histopathology reexamined by a pathologist. ...: Fifteen patients were male and eight female; their ages ranged from 20 to 78 (mean 51) years. Tumors measured between 0.9 and 12.0 (mean 5.2) cm across the greatest diameter. The histologic diagnoses were ... leiomyosarcoma (3), ... Three patients were found to be unresectable. All three underwent radiation and chemotherapy. Lobectomies or bilobectomies were performed in 13 patients including two sleeve resections, one carinal resection, and one chest wall resection. Four patients underwent radical pneumonectomies. Three patients with invasion of the pulmonary artery, pulmonary veins or atrial wall underwent extended resections with the use of cardiopulmonary bypass. In two, a homograft was used to reconstruct the right ventricular outflow tract. Of the resected patients, six had a positive resection margin, and four had at least one positive lymph node in the specimen. Three patients underwent repeat pulmonary resections for recurrences. Eleven patients received postoperative chemotherapy and eight had radiation therapy. Follow-up was available on 22 patients, and ranged from 2 to 183 (mean 48) months; 14 patients are disease free, six died of disease, one died of surgical complications (operative mortality 5%), and two are alive with disease. Actuarial 3- and 5-year survival of the resected patients was 69%. Size and grade were not found to be correlated with significantly increased survival, but completeness of resection was (P<0.05). ... Resection of primary pulmonary sarcomas can produce an acceptable survival rate if the resection is complete. Cardiopulmonary bypass can be a useful adjunct when tumors involve a resectable area of the heart or great vessels. PMID: 10371121 




Eur J Surg 1998 Jul;164(7):507-12 
Median sternotomy: the preferred incision for resection of lung metastases. 
van der Veen AH, van Geel AN, Hop WC, Wiggers T. Department of Surgical Oncology, University Hospital Rotterdam/Dr. Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands. 

...To describe our experience with median sternotomy for resection of lung metastases and to assess whether computer tomography (CT) accurately predicts the number and extent of lung metastases. ...Retrospective case record study. ... 78 patients with pulmonary metastases from various histological types of tumours who were operated on through a median sternotomy during the 10-year period January 1985-January 1995...Median sternotomy for resection of lung metastases with the intention to cure. Extension of the incision in case of extended disease. .... [whether there was] Presence of unilateral or bilateral metastases in relation to preoperative CT. 
...78 patients underwent a total of 82 sternotomies. CT did not accurately diagnose the extent of disease in 38 patients (49%). In 72 cases metastases were excised. In 58 patients (81%) histological examination showed tumour-free margins microscopically. 36 patients had bilateral metastases. CT showed unilateral disease in 49 patients. 14 (29%) had bilateral involvement. 4 patients required lobectomy and in two patients anterolateral extension of the sternotomy was necessary. Eleven patients (15%) developed minor complications. There was no operative mortality. ... Bilateral staging and finding of occult metastases, complete surgical clearance in a one stage procedure, and lower morbidity are the reasons that we suggest that median sternotomy is the procedure of choice of resection of pulmonary metastases. For eligible patients the choice of surgical approach should not be made conditional on the results of CT alone. PMID: 9696972 



Nippon Geka Gakkai Zasshi 1998 Dec;99(12):855-60 
[Surgical management of pulmonary metastases].[Article in Japanese] 
Hara S, Otsuka H, Hirohata T, Nishi K, Yasutomi M. First Department of Surgery, Kinki University School of Medicine, Osakasayama, Japan. 

The results of surgical resection for pulmonary metastases from ..., soft tissue sarcoma, and osteosarcoma are reviewed. The number of pulmonary metastases, the presence of hilar or mediastinal involvement, and extrapulmonary foci are discussed in terms of surgical treatment. The size of pulmonary tumors or tumor doubling time has no significant effect on survival, while the number of metastatic foci does.... Higher relapse rates have been reported in patients with soft tissue sarcoma and osteosarcoma, although patients with these metastases can achieve long-term survival after a second metastasectomy. VATS is not be recommended for metastatic cancer surgery, because intraoperative identification of metastatic foci is often difficult. Publication Types: Review PMID: 10063499 




Ann Thorac Surg 1998 Jul;66(1):231-3 
Resection of pulmonary metastases in six patients with disease-free interval greater than 10 years. 
Kamiyoshihara M, Hirai T, Kawashima O, Morishita Y. 
Department of Surgery, National Sanatorium Nishi-Gunma Hospital, Shibukawa, Gunma, Japan. kamiyosi@sa2.so-net.ne.jp 

... The relationship between disease-free interval (DFI) and prognosis has been discussed; however, there is little information on long-term DFI. In this study, we surveyed the cases of pulmonary metastases with DFI greater than 10 years. ... Between January 1980 and December 1995, we saw 6 patients with DFI greater than 10 years. All the patients had a histopathologic diagnosis of pulmonary metastases based on surgical resection, and the patients' characteristics and clinical course were reviewed. RESULTS: The median age was 63 years. Primary sites were breast in 2 patients, and one case each of skin, colon, thyroid, and bladder. The numbers of metastases were one in 4 patients and two in 2 patients. The median DFI was 134 months (range, 127 to 235 months). The median tumor-doubling time was 227 days (range, 80 to 815 days). All the patients underwent a lobectomy. Three patients with metastases from the bladder, colon, and breast died of recurrence. One patient with metastasis from the thyroid died of heart failure. Two patients with metastases from breast and skin cancer survived for more than 3 years. CONCLUSIONS: Early death occurred regardless of the long DFI, suggesting that intensive follow-up is mandatory for patients with DFI greater than 10 years. PMID: 9692470 




Ann Thorac Surg 1998 Dec;66(6):1930-3 
Pneumonectomy for lung metastases: indications, risks, and outcome. 
Spaggiari L, Grunenwald DH, Girard P, Solli P, Le Chevalier T. Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France. 

...Resection of pulmonary metastases (PM) by pneumonectomy [removal of a lung. Ed.] is infrequently performed and benefits are uncertain. ... From 1985 to 1995, 42 patients underwent pneumonectomy for PM. Twenty-nine patients had PM from sarcomas, .... The indications for pneumonectomy were pulmonary recurrences in 12 patients, PM centrally located in 26 patients, and high number of PM in 4 patients. There were 11 intrapericardial and 6 extended pneumonectomies. The average number of PM resected was 3. Twenty-two patients (52%) had lymph nodes involvement. ...: There were 2 postoperative deaths (4.8%) related to pneumonectomy and one death within 30 days for rapidly evolving disease; 4 patients (9.5%) had major postoperative complications that were medically treated. Five patients (12%) were operated on for recurrences on the residual lung. At the completion of the study, 12 patients were still alive, 8 without recurrences. The median survival was 6.5 months (range, 1 to 144 months); the 5-year survival was 16.8%. ... Pneumonectomy should not be considered an absolute contraindication in patients with PM, but the poor outcome of our series suggests strict criteria of selection. PMID: 9930471 
 


Eur J Surg Oncol 1998 Oct;24(5):403-6 
Thoracic cancer surgery in the elderly. 
Hasse J, Wertzel H, Kassa M, Burgard G. Department of Thoracic Surgery, University Hospital of Freiburg, Germany.
 
The risk of thoracic cancer surgery in patients of advanced age, i.e. 75 years or older, was analysed by reviewing 119 consecutive patients from August 1986 to May 1998 .... Repeated surgery ...gave a total of 124 operations. Of the patients, 22 were 80 years or older (21%) and 32% were female. The median age was 77 years (range 75-87 years). Six fatalities occurred within 30 days or during hospitalization. This corresponds to a 4.8% mortality for the whole series and 6.8% for the subgroup of bronchial carcinoma. The causes of death were surgical complications in two patients, one died from heart failure after simultaneous combined coronary artery bypass grafting and left lower lobectomy 2 hours after the operation from heart failure refractory to resuscitation. With this exception all these patients had stage II (n = 2) or stage III A (n = 3) bronchial carcinoma. It is concluded that cancer surgery in the elderly is safe provided appropriate selection is observed. Indications should be very restrictive for advanced cancer and for pneumonectomy. PMID: 9800968 



Eur Respir J 1996 Sep;9(9):1826-30 
Prognostic significance of thrombocytosis in patients with primary lung cancer. 
Pedersen LM, Milman N. Dept of Pulmonary Medicine, Gentofte Hospital, University of Copenhagen, Denmark. 

In patients with malignancies, thrombocytosis has previously been related to disease stage, histological type, and survival. In the present study, the prevalence of thrombocytosis and the prognostic information provided by platelet counts were analysed in a large cohort of patients with primary lung cancer. At the time of diagnosis, pretreatment platelet counts were retrospectively recorded in 1,115 consecutive patients with histologically proven primary lung cancer. All patients were reviewed regarding histological type, tumour, node, metastasis (TNM) classification stage and survival. The prevalence of thrombocytosis in patients with lung cancer was compared with that in a series of 550 consecutive outpatients with benign lung disorders. In 269 surgically resected patients, postoperative platelet counts were recorded 1-3 months after resection of the tumour. In the follow-up period, thromboembolic episodes diagnosed either clinically or at autopsy were recorded. The overall prevalence of thrombocytosis (> 400 x 10(9) platelets.L-1) in the patients with lung cancer was 32%. The frequency of thrombocytosis was significantly higher compared with the control subjects (32 vs 6%; p < 0.0001). Platelet counts differed significantly among subgroups defined by the TNM classification, with the proportion of patients with > 400 x 10(9) platelets. L-1 greatest in the more advanced TNM stages (stage I and II 23% vs stage III and IV 37%; p < 0.0001). Patients with thrombocytosis had a significantly poorer survival than patients with normal platelet counts (p < 0.0001). In a multivariate survival analysis (Cox model), thrombocytosis continued to correlate strongly with poor survival even when adjusted for histological type, sex, age, and TNM stage (p < 0.001). In surgically resected patients, the frequency of preoperative and postoperative thrombocytosis differed significantly (23.0 vs 8.9%; p < 0.0001). Survival rate was significantly reduced in patients with preoperative thrombocytosis (p = 0.005). Thrombocytosis was not associated with an increased incidence of thromboembolism. In conclusion, thrombocytosis is an independent prognostic factor of survival in patients with primary lung cancer. We suggest that platelet counts should be included in future multivariate analyses of survival in patients with lung cancer. PMID: 8880098 



Cancer 1996 Aug 1;78(3):441-7 
Natural history of patients with pulmonary metastases from uterine cancer. 
Bouros D, Papadakis K, Siafakas N, Fuller AF Jr. 
Department of Thoracic Medicine, Medical School, University of Crete, Heraklion Greece. 

... Endometrial cancer is the most common female genital cancer and approximately 90% of the cases are diagnosed while they are still confined to the uterus. However, the natural history and treated course after the development of pulmonary metastasis (PM) have not been studied systematically in a large series of patients. ... Between 1962 and 1992, 100 patients (6%) with PM were identified by computerized search of the medical records from 1.665 patients admitted to our hospitals with the diagnosis of uterine cancer. The median age of the patients was 65.5 years (range: 42-87 yrs). The usual histologic types of the uterine neoplasms were 59 adenocarcinomas , 21 sarcomas, and 14 adenosquamous carcinomas. Of the 83 patients with reported tumor grade, 11 had Grade 1 tumor, 12 Grade II, and 60 Grade III. ... Lung metastases were found at the time of diagnosis of the primary tumor in 22 patients. Hemoptysis was the first symptom of 3 of the 22; the majority had no respiratory symptoms. In the remaining 78 patients with PM appearing after primary therapy, the mean interval time between primary diagnosis and PM was 29.4 months, whereas between PM and death was 15.7 months. Of all patients with lung metastases, 75% did not survive 1 year; however 6% survived more than 5 years after diagnosis of metastatic disease. Patients with isolated PM had prolonged survival (36.1 mos, P=0.001), whether treated medically or with pulmonary resection. ... Asymptomatic pulmonary metastases represent a common site of extra pelvic spread of disease. The majority of patients with PM (75%) do not survive 1 year. Low grade uterine tumors are more likely to respond to progestin therapy and do so for extended periods of time. PMID: 8697389 



Cancer 1996 Feb 15;77(4):675-82 
Surgical treatment of lung metastases: The European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group study of 255 patients. 
van Geel AN, Pastorino U, Jauch KW, Judson IR, van Coevorden F, Buesa JM, Nielsen OS, Boudinet A, Tursz T, Schmitz PI. Dr. Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
 
... Several reports have shown a prolonged survival after surgical treatment of pulmonary metastases from soft tissue sarcomas. However, it is still unclear which prognostic factors predict a favorable outcome. Series are not comparable and the data are conflicting. Therefore, a multi-institutional study was undertaken to analyze prognostic factors in selecting patients for resection of pulmonary metastases from soft tissue sarcomas. ... This report is a retrospective study of the European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group. Two hundred fifty-five patients underwent complete resection of lung metastases from soft tissue sarcomas. Cases with chondrosarcoma and small round cell sarcomas like Ewing sarcoma were excluded. ...
The 3 year and 5 year overall postmetastasectomy survival rates were 54% and 38%, respectively. 
The disease free postmetastasectomy survival rates were 42% and 35%, respectively. 
* Analysis of prognostic factors for a more favorable outcome revealed 
* disease free intervals of 2.5 years or more, 
* following a resection with microscopically free margins, 
* age less than 40 years, and 
* Grade I and II tumors. 
These prognostic factors have an independent influence on overall survival, using a multivariate Cox regression model. ... Surgical excision of lung metastases from soft tissue sarcomas is well accepted and should be considered as a first line of treatment if preoperative evaluation indicates that complete clearance of the metastases is possible. Further investigation is needed before chemotherapy can be recommended as additional therapy. Multicenter study PMID: 8616759 



Ann Thorac Surg 1994 Oct;58(4):1151-5 
Primary sarcoma of the lung: a clinical study with long-term follow-up. 
Janssen JP, Mulder JJ, Wagenaar SS, Elbers HR, van den Bosch JM. 
Department of Pulmonary Diseases, St. Antonius Hospital, Nieuwegein, The Netherlands. 

Primary pulmonary sarcoma is an extremely rare tumor. In more than 30 years, only 22 patients with PPS were seen in our hospital; 18 patients (82%) underwent operation. Radical resection is the only curative treatment in patients with primary pulmonary sarcoma. All 4 patients (18%) who did not undergo operation died within 17 months. All 7 patients (32%) in whom no radical resection could be performed died between 10 months and 16 years after operation. Total resection of the tumor could be performed in 11 patients (50%). Of these, 7 are still alive (64%), and 1 patient died of an unrelated cause after 25 years (mean follow-up, 13.5 years). Histologic diagnosis in these patients was leiomyosarcoma in 4, ... Median survival for all patients was 24 months. Actuarial 5-year survival was 44% for all patients. Small tumor diameter and low-grade malignancy are statistically significant favorable prognostic factors. No patient with grade 1 tumor died; the median survival was 60 months for grade 2 sarcomas, and 17 months for grade 3 sarcomas. No patient with a completely resected small primary pulmonary sarcoma had recurrence or metastasis. PMID: 7944769 


Am J Respir Crit Care Med 1994 Feb;149(2 Pt 1):469-76 
Surgical resection of pulmonary metastases. Up to what number? 
Girard P, Baldeyrou P, Le Chevalier T, Lemoine G, Tremblay C, Spielmann M, Grunenwald D. Department of Thoracic Surgery, Centre Medico-Chirurgical de la Porte de Choisy, Paris, France. 

Specific results on the surgical resection of a large number of pulmonary metastases (PM) are currently unavailable, and the risk-benefit ratio of this aggressive approach may appear questionable. A systematic review of the records of 456 adult patients who underwent thoracic surgery for PM between 1979 and 1990 led to the identification of 44 patients who underwent at least one resection of eight or more PM (range eight to 110), of whom 33 (75%) had PM from osteogenic or soft tissue sarcoma. These 44 patients underwent a total of 77 operations, of which 47 (61%) were bilateral and nine (12%) incomplete resections. The 3- and 5-yr probabilities of survival after the first resection of eight or more PM were 36 and 28%, respectively, and were not significantly different from those of the 412 other patients who underwent surgery for PM over the same period. In this small group of patients, only the quality of resection (complete or incomplete) was found to be a highly significant prognostic factor (p < 0.01). A critical analysis of the reported data supports the view that, at least in patients with osteogenic or soft tissue sarcoma, the prognostic value of the number of PM seems to be more dependent on associated resectability than on the number per se and that, after careful preoperative patient selection, PM that can be resected should be resected, whatever their number. PMID: 8306048 



Pneumologie 1994 Jul;48(7):469-74 
[Surgery of lung metastasis--indications, results and prognostic factors as an interdisciplinary concept]. [Article in German] 
Schirren J, Wassenberg D, Krysa S, Branscheid D, di Rienzo G, Drings P, Vogt-Moykopf I. 
Thoraxklinik Heidelberg-Rohrbach. 
Surgical therapy of lung metastases nowadays is an established procedure. The operation's purpose is the radical and therefore potential curative resection. Beside there are diagnostic and palliative indications. Beside there are diagnostic and palliative indications. Median sternotomy is the standard approach for revision of both lungs even in unilateral seeming disease. Preoperative staging is not reliable concerning number and extension of metastases. From 1972 to 1991 843 operations for lung metastases were carried out in 729 patients in the surgical department of the "Thoraxklinik Heidelberg-Rohrbach". 30-day-mortality amounted to 2.9%, 5-year-survival-rate was 33% overall from date of metastases resection. The best results were achieved in testicular cancer with 67% 5-years-survival-rate, poorest survival was observed in melanomas with 12% 3-years-survival. Beside the primary tumor and partly dependent on it several prognostic factors were relevant: radicality, sarcoma vs carcinoma in favour of carcinomas, disease-free interval, type of resection, thoracic lymph node involvement. As figured out by multivariate analysis the prognostic influence of the factors varies considerably due to the kind of primary tumor. Surgery of lung metastases is part of an interdisciplinary oncological therapeutical concept and offers a prolonged survival to most of the patients and the possibility of cure to some. Even if prolongation of life is not feasible an improved quality and therefore a good palliation is obtained. PMID: 7524062 




Ann Surg 1993 Dec;218(6):705-12 
Comment in: Ann Surg. 1993 Dec;218(6):703-4 
Development and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma. 
Gadd MA, Casper ES, Woodruff JM, McCormack PM, Brennan MF. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York. 

... The authors reviewed a series of adult patients with extremity soft tissue sarcoma to determine the incidence of pulmonary metastases and outcome after treatment. ... Of 716 patients admitted between January 1983 and December 1990, 135 (19%) had isolated pulmonary metastases as the initial site of distant recurrence. Fifty-eight percent (78 of 135) of the patients were treated surgically, and 83% of them had their tumors completely resected. ...The median survival after complete resection was 19 months; incomplete resection, 10 months; and no operation, 8 months (p = 0.005). The 3-year survival rate after complete resection was 23%, compared with a 2% rate (1 of 57) in those treated nonsurgically (p < 0.001). Factors associated with an increased risk of pulmonary metastases included high tumor grade, tumor size greater than 5 cm, lower extremity site, and histologic type (spindle cell, tendosynovial, and extraskeletal osteosarcoma). ... Complete surgical resection remains the only possibility for cure from pulmonary metastases in soft tissue sarcoma; however, only 11% of the 19% of patients with an extremity sarcoma whose first distant recurrence is in the lung will be alive at 3 years, despite therapy. Complete resection and the development of more effective adjuvant treatments are imperative to improve outcome for this group of patients. Publication Types: Review Review, multicase PMID: 8257219 



J Surg Oncol 1993 May;53(1):54-9 
Selected benefits of thoracotomy and chemotherapy for sarcoma metastatic to the lung. Mentzer SJ, Antman KH, Attinger C, Shemin R, Corson JM, Sugarbaker DJ. Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115. 

To determine the benefit of aggressive surgical therapy, we studied 77 consecutive patients presenting to our sarcoma registry with pulmonary metastases. Detailed follow-up was available on all patients; the median follow-up of the 13 long-term survivors was 72 months from the date of diagnosis of the primary tumor. Survival of these 77 patients with metastatic disease was independent of the size, location, and histology of the primary tumor. 

* Once metastases developed, survival of patients with pulmonary metastases was not influenced by the extent of surgical resection of the primary tumor or by the use of radiation therapy. 
* Pulmonary metastases were initially treated with thoracotomy and metastasectomy in 34 patients. 
* The median survival after thoracotomy was 26 months. Seven patients were alive more than 4 years after their diagnosis. 
* Pulmonary metastases were treated with chemotherapy alone in 43 patients. Although the survival was shorter (median survival 14 months) in patients treated with chemotherapy, an objective response to chemotherapy was obtained in 13 (30%) patients. Four of these patients were alive 4 years after their diagnosis. 
* These data demonstrate that both thoracotomy and chemotherapy are associated with long-term survival of patients with sarcoma metastatic to the lung. PMID: 8479198 [These data also demonstrate that metastasectomy gives a longer median survival.  However, it is not mentioned here whether those patients chosen for metastasectomy were in better condition, in terms of numbers of lung metastases, number of other metastases, sarcoma subtype, and/or additional medical conditions. Ed.]



Gynecol Oncol 1992 May;45(2):202-5 
Resection of pulmonary metastases from uterine sarcomas. 
Levenback C, Rubin SC, McCormack PM, Hoskins WJ, Atkinson EN, Lewis JL Jr. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. 

Long-term survival following resection of pulmonary metastases has been well documented. Variables that are believed to have an effect on survival are site of primary tumor, number and size of metastases, resectability, laterality of the metastases, doubling time, and disease-free interval.... We reviewed 45 patients whose pulmonary metastases from uterine sarcomas were resected at Memorial Sloan Kettering Cancer Center between 1960 and 1989. All cases met carefully defined criteria at time of thoracotomy: prior hysterectomy for uterine sarcoma, no extrathoracic tumor, known disease thought to be resectable, histology consistent with uterine sarcoma, and no medical contraindication to thoracotomy. Seventy-one percent had unilateral lesions, fifty-one percent had one lesion, and seventy percent had nodules greater than 2 cm. Thirty-six percent had incomplete resection at thoracotomy. Actuarial 5- and 10-year survival from hysterectomy for uterine sarcoma was 65 and 50%, respectively, with a mean follow-up of 89 months. Five- and ten-year survival from resection of pulmonary metastases was 43 and 35%, respectively, with a mean follow-up of 25 months. Unilateral vs bilateral disease was a significant predictor of survival after pulmonary resection (P = 0.02). Metastases size, number of metastases, disease-free interval, and patient age were not significant.  Among this carefully selected group of patients undergoing resection of pulmonary metastases from uterine sarcomas, long-term survival was achieved by a substantial proportion of patients. No single risk factor is sufficiently accurate to exclude an individual patient from consideration for pulmonary resection. PMID: 1592288 




Int Surg 1992 Jul-Sep;77(3):173-7 
Metastatic lung tumors and extended indications for surgery. 
Ishida T, Kaneko S, Yokoyama H, Maeda K, Yano T, Sugio K, Sugimachi K. Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan. 

>From 1973 to 1989, 110 thoracotomies for metastatic lung tumors were done on 85 patients, in our institution. The overall actuarial five-year survival rate was 31%. The five-year survival rate for carcinoma was 40% and for sarcoma was 11%(less than 0.05). .... The outcome for patients with bone and soft tissue tumors was poor. The significant predictors of a better long-term survival for metastatic lung tumors were disease-free interval (DFI) greater than 12 months, tumor size less than or equal to 30 mm in diameter, and tumor doubling time (TDT) greater than 40 days (p less than 0.05). The number of nodules and the laterality of the sites of recurrence did not relate to survival time. Of 22 patients undergoing regional lymph node dissection, seven (32%) had positive nodes. Even in cases of a recurrent pulmonary metastasis, the three-year survival in those with multiple thoracotomies was 16%. We wish to draw attention to the finding that a prolonged survival time can be achieved for patients undergoing regional lymph node dissection or even repeated resections for a recurrent pulmonary metastases. PMID: 1399363 



Cancer 1992 Feb 1;69(3):662-8 
Five-year survival after pulmonary metastasectomy for adult soft tissue sarcoma. 
Casson AG, Putnam JB, Natarajan G, Johnston DA, Mountain C, McMurtrey M, Roth JA. 
Department of Thoracic Surgery, University of Texas M. D. Anderson Cancer Center, Houston 77030. 

Determinants of 5-year survival were evaluated after complete resection of pulmonary metastases from adult soft-tissue sarcomas. Fifty-eight patients had complete resection (median survival 25 months, P = 0.0002), with a 25.8% absolute 5-year survival (15 of 58 patients); six patients had unresectable disease (median survival 6 months) and were excluded from additional analysis. Eleven patients remain disease free, with a median follow-up of 76 months.  

Significant independent prognostic indicators associated with improved survival (P less than 0.05) included metastasis doubling time of 40 days or greater (median survival 37 months versus 15 months if less than 40 days); unilateral disease on preoperative radiography (33 months versus 15 months if bilateral disease); three or fewer nodules on preoperative computed tomography (40 months versus 14 months if 4 or more nodules); two nodules or fewer resected (40 months versus 17 months if 3 or more nodules resected), and tumor histology (33 months for malignant fibrous histiocytoma versus 17 months for all others). Multivariate analysis identified the number of nodules detected by computed tomography preoperatively as having significant prognostic value. PMID: 1730117 



Cancer 1990 Apr 15;65(8):1805-11 
Cystic pulmonary metastatic sarcoma. 
Traweek T, Rotter AJ, Swartz W, Azumi N. Sylvia Cowan Laboratory of Surgical Pathology, Division of Pathology, Duarte. 

Neoplastic cavitary lesions are an unusual type of pulmonary metastases. The authors report two cases of cystic metastatic sarcoma of the lungs that illustrate the clinical, radiologic, and pathologic difficulties encountered in the diagnosis of these lesions. In one patient, multiple small, thin-walled cystic metastases from a lower leg leiomyosarcoma were the only manifestation of metastatic disease. The cystic lesions did not change over an 8-month period and a diagnosis of malignancy was not established until spontaneous pneumothorax, presumably due to rupture of the malignant blebs, prompted a thoracotomy. In the second patient, three thin-walled bullae developed after treatment of noncystic pulmonary metastases from a lower-leg synovial sarcoma. In both patients, the cystic lesions were not evident on chest radiographs, but were well visualized with computed tomography (CT), where they mimicked benign bullous disease. However, additional small cavitary lesions not seen with CT were present in resected pulmonary wedge specimens from both patients. A great degree of variability in the cellular composition of the cyst wall lining in both cases, and a lack of any solid neoplastic tissue masses in one case, led to histopathologic difficulties that required immunohistochemical studies for definitive diagnosis of the metastatic disease. These cases show that pulmonary bullae, even though thin-walled and benign-appearing on CT, may be a manifestation of pulmonary metastases. These lesions must therefore be surgically removed from patients in whom a curative resection of pulmonary metastases is warranted. PMID: 2156605 



Acta Oncol 1987;26(3):189-92 Erratum in: Acta Oncol 1987;26(6):496 
Growth rate of pulmonary metastases from soft tissue sarcoma. 
Rooser B, Pettersson H, Alvegard T. Department of Orthopaedics, University Hospital, Lund, Sweden. 

The growth rate of pulmonary metastases was analyzed in eleven patients with soft tissue sarcoma. In cases where more than two examinations were available the growth rate seemed to be exponential. In all but one case microscopic pulmonary spread was calculated to be present when the primary tumor was diagnosed. Tumor doubling time varied between 8 and 198 days in different patients. The variation in growth rate between various nodules in the same patient was much less pronounced but nevertheless considerable, which might, at least partly, be explained by tumor cell polyclonality. Computed tomography of the chest may detect pulmonary metastases earlier than conventional radiography and is therefore recommended in the preoperative work-up in soft tissue sarcoma. PMID: 2820448 



Minerva Med 1986 Nov 30;77(45-46):2159-62 
[Cryotherapeutic destruction of invasive tracheo-bronchial tumors. Personal case histories]. [Article in Italian] 
Astesiano A, Aversa S, Ciotta D, Galietti F, Gandolfi G, Giorgis GE, Oliaro A, Scappaticci E, Pepino E. 
Data are presented on 15 cases of invasive tracheobronchial tumours subjected to cryotherapy in 1984-85. The technique is indicated in patients who cannot be given surgical or radiation treatment and in cases of asphyxial syndrome requiring faster deobstruction than is obtainable with radiation treatment. PMID: 3025779 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3025779&dopt=Abstract



Clin Radiol 1986 Nov;37(6):579-81 
Soft tissue sarcoma: two cases of solitary lung metastasis more than 15 years after diagnosis. 
Going JJ, Brewin TB, Crompton GK, McLelland J. 
Soft tissue sarcomas may behave unpredictably. We present two adult cases in which solitary pulmonary metastases have occurred, 18 and 16 years after diagnosis. In both cases the primary disease was successfully controlled by conservative surgery combined with radiotherapy. PMID: 3791857 



Cancer 1985 Mar 15;55(6):1361-6 
Differing determinants of prognosis following resection of pulmonary metastases from osteogenic and soft tissue sarcoma patients. 
Roth JA, Putnam JB Jr, Wesley MN, Rosenberg SA. 

A study was performed to determine if prognostic factors could be used preoperatively to predict outcome following resection of metastases. Sixty-seven soft tissue sarcoma (STS) patients (median follow-up, 36 months) and 39 osteogenic sarcoma patients (OGS) (median follow-up, 29 months) underwent thoracic exploration at the first indication of pulmonary metastases, and the results for each group were reviewed. 
For the STS group:
* The number of metastatic nodules, disease-free interval (DFI), and tumor doubling time (TDT) significantly correlated with postoperative survival for STS patients. 
* Patients with four or fewer nodules on preoperative linear tomograms survived longer (median, 23 months) than patients with more than four nodules (median, 6 months; P less than 0.005). 
* Patients with a DFI greater than 12 months had a longer survival (median, 30 months) than patients with a DFI less than or equal to 12 months (median, 10 months; P less than 0.005). 
* Patients with a TDT greater than or equal to 20 days had a longer survival (median, 22 months) than patients with a TDT less than 20 days (median, 6 months; P less than 0.005). 
...  PMID: 3855684 



J Clin Oncol 1985 Mar;3(3):353-66 
Patterns of recurrence in patients with high-grade soft-tissue sarcomas. 
Potter DA, Glenn J, Kinsella T, Glatstein E, Lack EE, Restrepo C, White DE, Seipp CA, Wesley R, Rosenberg SA. 

>From July 1975 to December 1982, 563 patients were referred to the Surgery Branch of the National Cancer Institute with the diagnosis of soft-tissue sarcoma. Three hundred and seven of these patients had fully resectable, localized high-grade soft-tissue sarcomas and were treated at the National Cancer Institute using standard protocols with surgery alone, or in combination with chemotherapy and/or radiotherapy. An aggressive surgical approach was undertaken in the management of patients who subsequently developed recurrent disease. These 307 cases have been reviewed, with a median duration of follow-up of 30 months, to determine the frequency of recurrent disease, the patterns of recurrence, and the impact of surgery on the survival of patients who developed recurrent disease. 

* Disease recurred in one hundred seven patients (107/307, 35%), with a median disease-free interval of 18 months (range, 0.5 to 72.0 months). 
* The frequency of recurrence by site of primary sarcoma was extremity, 31% (65/211); head and neck, 33% (4/12); trunk, 40% (17/42); retroperitoneum, 47% (17/36); and breast, 67% (4/6). 
* Isolated pulmonary metastatic disease was the most common pattern of initial recurrence (56/107, 52%) followed by isolated local recurrence (21/107, 20%). 
* Single other sites of recurrence and multiple concurrent sites of recurrence each accounted for 14% (15/107) of all initial recurrences. The relative frequency of each of these four patterns of recurrence varied with the site of the primary sarcoma. 
* The outcome for patients with recurrent disease depended on the site of recurrence, rather than on the site of the primary sarcoma.  
* Sixty-six patients (66/107, 62%) with recurrent disease were rendered surgically disease-free with the first recurrence, including 40 (40/56, 72%) patients with isolated pulmonary metastases, 20 patients (20/21, 96%) with isolated local recurrences, five patients (5/15, 33%), with isolated other sites of recurrence and one patient (1/15, 7%) with multiple sites of initial recurrence. Following surgical resection, the actuarial three-year survival for the 66 patients rendered disease-free was 51%. 
* The median survival for the 41 patients not rendered surgically disease-free with the first recurrence was only 7.4 months. 
* Thirty of the sixty-six patients (30/66, 45%) rendered disease-free with the first recurrence remained disease-free at follow-up, with a median follow-up of 28 months from the time of resection of the first recurrence. 
* The remaining 36 patients (36/66, 55%) subsequently recurred, with a median disease-free interval of 7.3 months.   
                            PMID: 3973646 



Arch Intern Med 1983 Jul;143(7):1462-4 
Pulmonary metastatic leiomyosarcoma coexisting with pulmonary chondroma in Carney's triad. 
Chahinian AP, Kirschner PA, Dikman SH, Rammos KS, Holland JF. 
The diagnosis of Carney's triad requires the coexistence of at least two of three rare disorders, including gastric epithelioid leiomyosarcoma, pulmonary chondroma, and functioning extra-adrenal paraganglioma. Seventeen cases have been reported so far, occurring predominantly in young female patients. We report herein the 18th case of this entity and the first case, to our knowledge, where pulmonary metastases from a gastric leiomyosarcoma coexisted in a patient with benign pulmonary chondromas. PMID: 6307197 



Am J Surg Pathol 1979 Aug;3(4):325-42 
Pulmonary metastases (with admixed epithelial elements) from smooth muscle neoplasms. Report of nine cases, including three males. 
Wolff M, Silva F, Kaye G. 
This study pertains to an entity characterized by the presence of multiple intrapulmonary nodules, which consist of an admixture of bundles of well-differentiated smooth muscle cells and epithelial-lined spaces. These lesions have been frequently interpreted as a variant of hamartomas. However, in this review of the literature, and careful analysis of nine cases of this entity, we concluded that they should be considered metastases from smooth muscle tumors which incorporate some structures of mature lung parenchyma as they slowly expand. We affirm that the designation "fibroleiomyomatous hamartoma" should be discarded. Our cases occurred in six female and three male patients. In all but one female the primary source for lung metastases was uterus, while the male patients had primary lesions in the saphenous vein, diaphragm, and soft tissues. These lung lesions increase in size and number and are potentially fatal, though this may take many years. Even though the smooth muscle cells of the lung nodules appear bland on light microscopy, we were always able to demonstrate mitotic activity; electron microscopy indicated immaturity of the cells. For these reasons, we believe the tumors to represent metastatic leiomyosarcomas. Review PMID: 395847 


Am J Roentgenol 1976 Sep;127(3):441-6 
Pulmonary metastases from benign-appearing smooth muscle tumors of the uterus. 
Bachman D, Wolff M. 
A 42-year-old woman was found to have multiple pulmonary nodules 7 years after hysterectomy for leiomyoma. Thoracotomy revealed multiple well differentiated smooth muscle masses containing epithelial inclusions. This patient is similar to others previously reported as examples of "multiple pulmonary fibroleiomyomatous hamartoma" on the basis of slow-growth, benign-appearing histology, and the presence of epithelial elements. Evidence is presented which suggests that these cases represent metastasis from well differentiated leiomyosarcomas. There is a frequent association with uterine smooth-muscle tumor, cases with equally benign-appearing histology have shown lymph node metastasis, the nonmesenchymal elements have been shown to represent engulfed bits of adjacent pulmonary tissue, and the histologic differentiation of benign from malignant mesenchymal tumors is known to be unreliable in some cases. Unlike more anaplastic leiomyosarcomas, this condition may be associated with few symptoms and prolonged survival despite widespread disease. PMID: 183531 



Cancer 1975 Aug;36(2):471-4 
Growth rate of pulmonary metastases in human sarcomas. 
Band PR, Kocandrle C. 
The growth rate of spherical pulmonary metastases was studied in 15 patients with osseous and soft tissue sarcoma. The median volume doubling time (Dt) was 25 days. The time from diagnosis of the primary tumor to occurrence of pulmonary metastases correlated directly with the length of Dt. No correlation between Dt and tumor histology was observed. The effect of therapy on the tumor growth curve was studied in 1 patient. The therapeutic implications derived from the quantitative evaluation of tumor growth rate are discussed. PMID: 1057449 





Go To Top



Radio Frequency Ablation [RFA]

For a description of RFA, please see the separate web page dedicated to this technique:

www. link to the RFA  page here, Webmeister! :) 

For latest Pubmed information on RFA and lung metastases:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=PubMed&term=radio%20frequency%20ablation%20pulmonary%20metastases




Go To Top




Repeat Resections of Pulmonary Metastases


If pulmonary metastases are completely resected with clear surgical margins, survival time is extended.  Resection of RECURRENT pulmonary metastases, again with clear margins, also extends survival time significantly.  See articles described below.

Also, most recent Pubmed Search for recurrent sarcoma pulmonary metastasectomy:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=PubMed&term=sarcoma%20pulmonary%20metastectomy%20recurrent



Repeat Resections of Pulmonary Metastases
Selected Medical Journal Annotated References



J Am Coll Surg 2000 Aug;191(2):184-90; discussion 190-1 Comment in: J Am Coll Surg. 2000 Aug;191(2):193-5 
Repeat resection of pulmonary metastases in patients with soft-tissue sarcoma. 
Weiser MR, Downey RJ, Leung DH, Brennan MF. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. 

...Even after an apparent complete resection of sarcomatous pulmonary metastases, 40% to 80% of patients will re-recur in the lung. The benefit of subsequent re-resection is poorly defined. This study examines patient survival after repeat pulmonary exploration for re-recurrent metastatic sarcoma at a single institution. STUDY ... Between July 1982 and December 1997, data on 3,149 adult in-patients with soft tissue sarcoma were prospectively gathered. Of these, pulmonary metastases were present or developed in 719 patients and 248 underwent at least one resection. Of the patients relapsing in the lung after an apparently complete resection, 86 underwent reexploration. Disease-specific survival (DSS) after re-resection was the end point of the study.... 

* The median DSS after re-resection for all patients undergoing at least two pulmonary resections was 42.8 months with an estimated 5-year survival of 36%. 

* The median DSS in patients with complete reresection was 51 months (n = 68) compared with 6 months in patients with an incomplete re-resection (n = 16, p<0.0001). 

* Patients with one or two nodules at re-resection (n = 39) had a median DSS of 51 months compared with 20 months in patients with three or more nodules (n = 40, p = 0.003). 

* Patients in whom the largest metastasis re-resected was less than or equal to 2 cm (n = 33) had a median DSS of 44 months compared with 20 months in patients with metastasis greater than 2 cm (n = 43, p = 0.033). 

* Patients with primary tumor high-grade histology (n = 75) had a median DSS of 32 months and patients with low-grade histology (n = 11) had a median DSS that was not reached (p = 0.041). 

* Three independent prognostic factors associated with poor outcomes may be determined preoperatively: > or =3 nodules, largest metastases > 2 cm, and high-grade primary tumor histology. 

* Patients with either zero or one poor prognostic factor had a median DSS > 65 months and patients with three poor prognostic factors had a median DSS of 10 months. 

* ...Re-exploration for recurrent sarcomatous pulmonary metastases appears beneficial for patients who can be completely re-resected. 

* Outcomes are described by factors that may be determined preoperatively, including metastasis size, metastasis number, and primary tumor histologic grade. 

* Patients who cannot be completely re-resected or those with numerous, large metastasis and high-grade primary tumor pathology have poor outcomes and should be considered for investigational therapy. 
PMID: 10945362 

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10945362&dopt=Abstract




Am J Surg 2000 Feb;179(2):122-5 
Importance of the control of lung recurrence soon after surgery of pulmonary metastases. 
Maniwa Y, Kanki M, Okita Y. Department of Surgery, Division II, Kobe University School of Medicine, Kobe, Japan. 

...In this study, we investigated factors that determined prognosis in patients who underwent surgery for metastatic lung tumors, focusing on early relapse of metastatic lung lesions after surgery, and considered countermeasures for improving long-term results based on this study. ...This study was performed in patients with metastatic lung tumors who underwent surgery during the 22 years after November 1975 in this department. ... The 1-year, 3-year, and 5-year survival rates in all patients were 70%, 42%, and 37%, respectively. On comparison among the groups, there were no significant differences by gender, age, organ with the primary lesion, disease-free interval, number of metastases, or surgical procedure. However, prognosis was significantly poorer in patients with recurrent metastatic lung lesions. Prognosis was especially poor in patients with recurrence within 6 months after pneumonectomy, and this was an important factor that worsened the surgical results. ... As the mechanism of early recurrence of lung metastasis after surgery for metastatic lung tumor, multiple micrometastases (dormancy) that cannot be detected during surgery for metastatic lung tumor may be present in the lung. Establishment of a method of controlling an increase in dormant metastasis may lead to improvement of surgical results of metastatic lung tumors. PMID: 10773147



Nippon Geka Gakkai Zasshi 1998 Dec;99(12):855-60 
[Surgical management of pulmonary metastases].[Article in Japanese] 
Hara S, Otsuka H, Hirohata T, Nishi K, Yasutomi M. First Department of Surgery, Kinki University School of Medicine, Osakasayama, Japan. 

The results of surgical resection for pulmonary metastases from ..., soft tissue sarcoma, and osteosarcoma are reviewed. The number of pulmonary metastases, the presence of hilar or mediastinal involvement, and extrapulmonary foci are discussed in terms of surgical treatment. The size of pulmonary tumors or tumor doubling time has no significant effect on survival, while the number of metastatic foci does.... Higher relapse rates have been reported in patients with soft tissue sarcoma and osteosarcoma, although patients with these metastases can achieve long-term survival after a second metastasectomy. VATS is not be recommended for metastatic cancer surgery, because intraoperative identification of metastatic foci is often difficult. Publication Types: Review PMID: 10063499 



Ann Thorac Surg 1998 Apr;65(4):909-12 Comment in: Ann Thorac Surg. 1998 Sep;66(3):989 
Long-term results after repeated surgical removal of pulmonary metastases. 
Kandioler D, Kromer E, Tuchler H, End A, Muller MR, Wolner E, Eckersberger F. Department of Cardio-Thoracic Surgery, University of Vienna Medical School, Austria
. 
... Although surgical resection is accepted widely as first-line therapy for pulmonary metastases, few data exist on the surgical treatment of recurrent pulmonary metastatic disease. In a retrospective study, we analyzed patients who were operated on repeatedly for recurrent metastatic disease of the lung with curative intent over a 20-year period. ... From 1973 to 1993, 396 metastasectomies were performed in 330 patients. The study population included patients with any histologic tumor type who had undergone at least two (range, 2 to 4) complete surgical procedures because of recurrent metastatic disease. Surgical and functional resectability of the recurrent lung metastases and control of the primary lesion served as objective criteria for reoperation. A subgroup of 35 patients that included patients with histologic findings such as epithelial cancer and osteosarcoma then was analyzed retrospectively to calculate prognosis and define selection criteria for repeated pulmonary metastasectomy. ... The 5- and 10-year survival rates after the first metastasectomy were 48% and 28%, respectively. The overall median survival was 60 months. A mean disease-free interval (calculated for all intervals, with a minimum of two) of greater than 1 year was significantly associated with a survival advantage beyond the last operation. Univariate analysis failed to show size, number, increase or decrease in number or size, or distribution of metastases as factors related significantly to survival. ...Although patients with different histologic tumor types were included, the study population appeared to be homogeneous in terms of survival benefit and prognostic factors, and it probably represented the selection of biologically favorable tumors in which histology, size, number, and laterality are of minor importance. We conclude that patients who are persistently free of disease at the primary location but who have recurrent, resectable metastatic disease of the lung are likely to benefit from operation a second, third, or even fourth time.  PMID: 9564899 



Eur J Cardiothorac Surg 1997 Nov;12(5):703-5 
Survival after surgical treatment of recurrent pulmonary metastases. 
Groeger AM, Kandioler D, Mueller MR, End A, Eckersberger F, Wolner E. Department of Cardio-Thoracic Surgery, University of Vienna, Austria. 

...Resection of lung metastases is a generally accepted therapeutic strategy today. This retrospective study was performed in order to estimate the value of an aggressive surgical approach in recurrent metastatic disease of the lung. ... The survival rates of 42 patients undergoing repeated resectional treatment for recurrent lung metastases (group A) were compared to the outcome of a total of 288 patients after a single surgical intervention for lung metastases (group B). Survival rates and the relative effects of the various prognostic factors were calculated according to Kaplan-Maier and Mantel Cox or Wilcoxon test. Histology of the primary tumors in group A consisted of 18 carcinomas, 22 sarcomas and two melanomas, in group B the distribution was 64% carcinoma, 27% sarcoma and 9% melanoma. The mean follow-up period was 88.5 months for group A and 27 months for group B.... The overall survival rate for group A was 48% at 5 years and 30% at 10 years, the survival rate for group B was 34% at 5 years. ... Long-term survival rates superior to those after single resectional treatment for lung metastases encourage an aggressive surgical approach for this disease. PMID: 9458139  



Am J Respir Crit Care Med 1994 Feb;149(2 Pt 1):469-76 
Surgical resection of pulmonary metastases. Up to what number? 
Girard P, Baldeyrou P, Le Chevalier T, Lemoine G, Tremblay C, Spielmann M, Grunenwald D. Department of Thoracic Surgery, Centre Medico-Chirurgical de la Porte de Choisy, Paris, France. 

Specific results on the surgical resection of a large number of pulmonary metastases (PM) are currently unavailable, and the risk-benefit ratio of this aggressive approach may appear questionable. A systematic review of the records of 456 adult patients who underwent thoracic surgery for PM between 1979 and 1990 led to the identification of 44 patients who underwent at least one resection of eight or more PM (range eight to 110), of whom 33 (75%) had PM from osteogenic or soft tissue sarcoma. These 44 patients underwent a total of 77 operations, of which 47 (61%) were bilateral and nine (12%) incomplete resections. The 3- and 5-yr probabilities of survival after the first resection of eight or more PM were 36 and 28%, respectively, and were not significantly different from those of the 412 other patients who underwent surgery for PM over the same period. In this small group of patients, only the quality of resection (complete or incomplete) was found to be a highly significant prognostic factor (p < 0.01). A critical analysis of the reported data supports the view that, at least in patients with osteogenic or soft tissue sarcoma, the prognostic value of the number of PM seems to be more dependent on associated resectability than on the number per se and that, after careful preoperative patient selection, PM that can be resected should be resected, whatever their number. PMID: 8306048


Go To Top




VATS:   Video Assisted Thoracoscopic Surgery




Harefuah 2001 Feb;140(2):91-4, 192 
[Video-assisted thoracic surgery--experience with 586 patients]. [Article in Hebrew] 
Galili R, Nesher N, Sharony R, Uretzy G, Saute M. 
Dept. of Cardiothoracic Surgery, Carmel Medical Center and Rappaport Faculty of Medicine, Technion, Haifa. 

Recent advances in optics, video systems and endoscopic operating instruments have led to increasing application of thoracoscopic surgery, as it has become easier to perform and more accurate. We performed ... 380 cases of operative thoracoscopy included pulmonary wedge resection (for interstitial lung disease, benign and malignant pulmonary tumors and pulmonary metastases) .... Recently we have had good experience in evacuating blood and blood clots from the thorax which accumulated after cardiac and thoracic surgery. Patients were placed in the lateral thoracotomy position and were ventilated with a double-lumen endotracheal tube, enabling collapse of the operated lung. The operating approach was through 1-3 thoracic ports. Mean operation time was 55 minutes, chest-tubes remained for 2.2 days (mean) and mean hospitalization was 3.3 days. There were no wound infections or significant postoperative complications. 5 patients had air leaks longer than 7 days; none required further surgical intervention. ... In cases in which localizing the parenchymal lesion was difficult, the lung was palpated directly by inserting a finger through a small incision or a mini-thoracotomy. Conversion to thoracotomy was performed when primary malignancy of lung was diagnosed by frozen section. Only 2 patients had thoracotomy for uncontrolled bleeding. Thoracoscopy is a minimally invasive surgical technique with very low morbidity and high diagnostic accuracy. Postoperative recovery is brief and uneventful. PMID: 11242935 




Surgery 1999 Oct;126(4):636-41; discussion 641-2 
Diagnostic and therapeutic video-assisted thoracic surgery resection of pulmonary metastases. 
Lin JC, Wiechmann RJ, Szwerc MF, Hazelrigg SR, Ferson PF, Naunheim KS, Keenan RJ, Yim AP, Rendina E, DeGiacomo T, Coloni GF, Venuta F, Macherey RS, Bartley S, Landreneau RJ. 
Allegheny University Hospitals, Allegheny General, Pittsburgh, PA 15212, USA. 

... We reviewed our experience with VATS wedge resection for peripheral lung metastases to determine the efficacy and potential adverse consequences of this approach for pulmonary metastasectomy. ... One hundred seventy-seven patients underwent VATS resection of pulmonary metastases. Diagnostic resection (VATS-dx) was performed for 78 patients when percutaneous biopsy was unsuccessful or not feasible. Potentially curative resections (VATS-rx) were performed for 99 patients. The histologic findings in this group included ..., sarcoma (6), .... The average number of lesions resected was 1.4 (range, 1-7). ... VATS resection was successfully performed for all VATS-dx and VATS-rx patients. There were no perioperative deaths. 
Longitudinal follow-up demonstrated a mean survival of 18 months in the VATS-dx group and 28 months in the VATS-rx group. In the VATS-rx group, 37 (37%) of 99 were free of disease, at a mean follow-up interval of 37 months. Of the 57 recurrences, 5% were local, 26% were regional, and 69% were distant. ... Results with VATS resection of peripheral pulmonary metastases for diagnostic and potentially curative intentions appear comparable with historical results by "open" thoracotomy. Careful patient selection based on high-resolution helical CT scanning is important to avoid compromise of therapeutic intent. Conversion to thoracotomy is indicated when lesions identified preoperatively are not found or when technical problems encountered may compromise surgical margins when resecting lung metastases for potential cure. Publication Types: Clinical trial PMID: 10520909



Nippon Geka Gakkai Zasshi 1998 Dec;99(12):855-60 
[Surgical management of pulmonary metastases].[Article in Japanese] 
Hara S, Otsuka H, Hirohata T, et al. First Department of Surgery, Kinki University School of Medicine, Osakasayama, Japan. 
They found that "the size of pulmonary tumors or tumor doubling time has no significant effect on survival, while the number of metastatic foci does." 
They also concluded, "VATS is not be recommended for metastatic cancer surgery, because intraoperative identification of metastatic foci is often difficult". Publication Types: Review PMID: 10063499 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10063499&dopt=Abstract



Chest 1992 Nov;102(5):1450-4 Comment in: Chest. 1993 Nov;104(5):1642-3 
Thoracoscopic resection of pulmonary metastases. 
Dowling RD, Ferson PF, Landreneau RJ. Department of Cardiothoracic Surgery, University of Pittsburgh. 

... To describe the use of thoracoscopic techniques to achieve parenchymal sparing wedge resection of peripheral lung lesions in patients with a history of malignancy, and to describe the morbidity, mortality, and hospital course associated with this approach... [Subjects are] Patients with a history of malignancy and lesions on computerized tomography in the outer one third of the lung parenchyma. .... ... Twenty-one thoracoscopic resections of pulmonary parenchymal lesions were performed on 15 patients. All peripheral lesions identified by computerized tomography were found at thoracoscopy and successfully resected with the Nd:YAG laser (n = 7), an endoscopic stapler (n = 10), or both (n = 4). The mean diameter of the lesions was 0.8 cm (range 0.2 to 1.5 cm). Histologic analysis revealed metastatic disease in 13 patients and benign disease in 2 patients. All resection margins were free of tumor. The mean duration of chest tube drainage and postoperative hospital stay were 1.8 +/- 0.1 and 3.3 +/- 0.1 days, respectively. Mean operative time was 111 min (range 45 to 155 min). One patient who underwent a right thoracoscopic resection developed a transient left vocal cord paresis. There were no other complications and no deaths. ... Thoracoscopy was successful in identifying peripheral lung lesions and allowed for parenchymal sparing resection identical in extent to that performed with open approaches. For select patients with peripheral lung nodules felt to be metastases, thoracoscopic resection may result in reduced morbidity, cost, hospital stay and allow for more rapid institution of therapy for the primary disease. PMID: 1424866 




J Surg Oncol 2001 Jan;76(1):47-52 
Pulmonary metastasectomy: might the type of resection affect survival? 
Mineo TC, Ambrogi V, Tonini G, Nofroni I. Thoracic Surgery Tor Vergata University, Rome, Italy. mineo@med.uniroma2.it 

 Metastasectomy proved to be the choice treatment in the case of pulmonary metastasis. In this study we assessed the impact on survival of three types of resection: minimal by laser or conventional device and lobectomy. ...We considered 85 patients who underwent lung metastasectomy for tumors that originated from various sites. Fifty-two minimal resections were accomplished in 34 patients by conventional (diathermy dissection or stapler suture line) device, 59 resections in 29 by Nd:YAG laser. Lobectomies were 22. Minimum follow up required was 2 years. ... The 3-year Kaplan-Meier survival rate was 63%, 44%, 53% for laser, conventional resections and lobectomy. The 5-year survival was 40%, 28%, 26% respectively. Among the groups there was no significant difference (P = 0.15). Laser patients showed shorter periods of air leakage and hospital stay. ... The type of resection did not disclose statistically significant differences on survival. Minimal surgery, especially by laser device, is recommended for less morbidity. PMID: 11223824 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11223824&dopt=Abstract


Surg Today 1997;27(9):806-11 
Surgery for multiple lung metastases from alveolar soft-part sarcoma. 
Kodama K, Doi O, Higashiyama M, Yokouchi H, Kuriyama K, Ueda T, Yoshikawa H. 
Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan. 

Between 1985 and 1993, six patients were surgically treated for alveolar soft-part sarcoma (ASPS) arising from the thighs or buttocks, four of whom underwent aggressive excision of multiple metastases using a neodymium:yttrium-aluminum garnet (Nd:YAG) laser. In total, 333 tumors were removed from these four patients during eight pulmonary operations. In patients 1, 3, and 4, uncontrollable extrapulmonary involvement and/or local recurrence at the primary site were noted during their treatment course, and they died of tumor progression 40, 68, and 46 months after excision of the primary lesion, .... On the other hand, patient 2, a 23-year-old woman who underwent excision of 130 pulmonary and three brain metastases during four thoracotomies and two craniotomies, is still alive without any symptoms 98 months after excision of the primary lesion. These data suggest that repeated excisions of lung metastases from ASPS may influence long-term survival or maintenance of good performance status in patients in whom extrapulmonary metastasis and recurrence are either absent or controlled. PMID: 9306602


Go To Top





Pulmonary Metastases & Chemotherapy

If the pulmonary metastases are operable, but there are other tumor deposits which are inoperable.....
Or if the pulmonary metastases are inoperable and not ablatable....
Then systemic chemotherapy might be the treatment of choice.
For further discussion of chemotherapy and chemotherapy agents, see the appropriate web pages under Metastatic Disease-Systemic Control.   




Pulmonary Metastases & Chemotherapy 
Selected Medical Journal Annotated References 



Gan To Kagaku Ryoho 1998 Sep;25(11):1701-6 
[Chemotherapy for pulmonary metastases of soft tissue sarcoma]. [Article in Japanese] 
Kito M, Umeda T. Dept. of Orthopedic Surgery, National Cancer Center Hospital East. 

The role and value of chemotherapy for soft tissue sarcomas remain unclear. Seventeen patients with pulmonary metastatic soft tissue sarcomas underwent treatment with chemotherapy, and the clinical efficacy and prognosis were studied. ... 3 patients with leiomyosarcoma, ..... The chemotherapy agents were ifosfamide in 10 cases, combination of ifosfamide and adriamycin in 5 cases, or cisplatin and adriamycin in 2 cases. Of the 17 patients, seven had partial responses radiographically and five had pulmonary metastases from synovial sarcoma. Eight patients underwent resection of pulmonary metastases following chemotherapy.... Twelve of the patients died of disease at 6-108 months (median, 30 months) from the time of the initial therapy, and five patients have survived from 1-53 months (median, 30 months). The absolute three-year survival rate, ..., for all 17 patients was 39%. In the two cases with no change and progressive disease, all patients were dead within 2 years, while in the seven partial response cases, two patients were dead, four were alive with pulmonary metastases, and only one case was disease-free at this writing. The survival rate for patients with partial response was significantly higher than for patients with no response. Although the cure rate of pulmonary metastatic soft tissue sarcomas is still low, the combination of chemotherapy and surgery has been shown to result in prolonged survival. PMID: 9757195 

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9757195&dopt=Abstract



J Surg Oncol 1993 May;53(1):54-9 
Selected benefits of thoracotomy and chemotherapy for sarcoma metastatic to the lung. Mentzer SJ, Antman KH, Attinger C, Shemin R, Corson JM, Sugarbaker DJ. Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115. 
To determine the benefit of aggressive surgical therapy, we studied 77 consecutive patients presenting to our sarcoma registry with pulmonary metastases. Detailed follow-up was available on all patients; the median follow-up of the 13 long-term survivors was 72 months from the date of diagnosis of the primary tumor. Survival of these 77 patients with metastatic disease was independent of the size, location, and histology of the primary tumor. Once metastases developed, survival of patients with pulmonary metastases was not influenced by the extent of surgical resection of the primary tumor or by the use of radiation therapy. Pulmonary metastases were initially treated with thoracotomy and metastasectomy in 34 patients. The median survival after thoracotomy was 26 months. Seven patients were alive more than 4 years after their diagnosis. Pulmonary metastases were treated with chemotherapy alone in 43 patients. Although the survival was shorter (median survival 14 months) in patients treated with chemotherapy, an objective response to chemotherapy was obtained in 13 (30%) patients. Four of these patients were alive 4 years after their diagnosis. These data demonstrate that both thoracotomy and chemotherapy are associated with long-term survival of patients with sarcoma metastatic to the lung. PMID: 8479198 



Go To Top



Pulmonary Metastases & Isolated Lung Perfusion
Selected Medical Journal Annotated References 
See Isolated Liver Perfusion for explanation of this procedure. 



Anticancer Res 1998 Sep-Oct;18(5D):3899-905 
TNF alpha in isolated perfusion systems: success in the limb, developments for the liver credits, debits and future perspectives. 
Eggermont AM. 
University Hospital Rotterdam, Daniel den Hoed Cancer Center, The Netherlands. eggermont@chih.azr.nl 

The clinical applicability of Tumor Necrosis Factor-a pi (TNF) is under renewed investigation because of its successful use in the isolated limb perfusion in patients with irresectable soft tissue extremity sarcomas. The high response rate of > 80% with a similarly successful limb salvage rate in this patient population has led to the submission of TNF for registration for this indication in Europe. Similarly, the agent has been shown to be successful in the isolated limb perfusion setting for tumors other than sarcomas, e.g. melanoma, carcinomas. This has caused renewed interest in TNF alpha and in its application in isolated organ perfusions, such as isolated hepatic perfusion. At the Rotterdam Cancer Center a preclinical-clinical interactive development program has been established dedicated to isolated limb, kidney, liver and lung perfusions and the application of new drugs such as TNF and TNF-mutants in these systems. Moreover a program dedicated to reduce the magnitude of surgical procedures by using occlusion balloon catheters is investigating the techniques and pharmacokinetics of procedures such as balloon catheter mediated hypoxic pelvic perfusions (HPP) and isolated hypoxic hepatic perfusions (IHHP). Here we present an overview of these developments. Publication Types: Review Review, tutorial PMID: 9854502 



J Thorac Cardiovasc Surg 1995 Aug;110(2):368-73 
Lung perfusion with chemotherapy in patients with unresectable metastatic sarcoma to the lung or diffuse bronchioloalveolar carcinoma. 
Johnston MR, Minchen RF, Dawson CA. 
Division of Thoracic Surgery, Mt. Sinai Hospital, Toronto, Canada. 

Eight patients with metastatic sarcoma to the lung (n = 4) or diffuse bronchioloalveolar carcinoma of the lung (n = 4) underwent isolated lung perfusion with chemotherapy in a pilot study. Ages ranged from 18 to 60 years and half were female. The left lung was perfused in three patients (single lung perfusion) and both lungs in five patients (total lung perfusion). Perfusions ranged from 45 to 60 minutes at ambient or normothermic temperatures. One patient received perfusion at moderate hyperthermia (40 degrees C). Escalating doses of doxorubicin (1 to 10 micrograms/ml perfusate) was used in six patients, whereas two received cisplatin (14 and 20 micrograms/ml perfusate). There were two major complications and no objective responses. The isolated perfusion systems gave excellent separation between systemic and pulmonary circulations with zero to 15% of the measured peak drug concentration of the pulmonary perfusate detected in the systemic circulation. Drug concentrations in normal lung and tumor generally increased with higher drug dosages and drug was detectable in mediastinal lymph nodes of three out of four patients in whom sampling was done. Isolated lung perfusion with chemotherapy can be done safely in patients with lung malignancies and evidence suggests that higher drug dosages should be well tolerated. Publication Types: Clinical trial PMID: 7637354 



Ned Tijdschr Geneeskd 1995 Apr 22;139(16):833-7 
[Consensus soft tissue tumors. Dutch Workgroup Soft-Tissue Tumors]. [Article in Dutch] 
Van Geel AN, Van Unnik JA, Keus RB. Dr. Daniel den Hoed Kliniek, afd. Chirurgische Oncologie, Rotterdam. 

Soft-tissue sarcomas constitute a rare group of malignant tumours with histopathological features of connective, muscular, fatty or peripheral nervous tissue. The prognosis at manifestation depends on only two factors: the spread, both local and remote, and the biological behaviour of the tumour. The latter factor cannot be influenced but the former can: by inexpert manipulation. Consequently, tumours suspected of being soft-tissue sarcomas require multidisciplinary management from the beginning, with the team members familiar with each other's diagnostic and therapeutic skills. Imaging diagnostic methods should precede invasive methods for collection of material for pathological examination. The number of mitotic figures observed at microscopical examination of the tissue is an important prognostic feature. Surgical resection is the treatment of first choice. Radiotherapy is indicated in grade 3 tumours, after recurrence surgery, and when radical resection would involve too much mutilation. Chemotherapy is only given in the context of clinical trials. Surgical treatment of lung metastases may be indicated in selected patients. Regional isolated perfusion with tumour necrosis factor may be an alternative for limb amputation.  Publication Types: Consensus development conference Review PMID: 7731476 



Med Pediatr Oncol 1994;22(6):393-7 
Hyperthermic isolated limb perfusion with cis-diamminedichloro-platinum. II. An experimental study in dogs with a balloon-occlusion technique for repeated high-dose treatment. 
Wessalowski R, Wilhelm M, Torsello S, Sager M, Guttler J, Jurgens H, Gobel U. 
Department of Pediatrics, Heinrich-Heine University, Dusseldorf, Germany. 

Isolated organ perfusion is attractive for regional high-dose chemotherapy because of its advantage to reduce whole body toxicity. Intraoperative hyperthermic isolated perfusion procedures involving a heart-lung machine have been developed, but repeated treatments carry a high risk of vessel and tissue damage. Therefore, a study of isolated hyperthermic limb perfusion in four dogs was conducted using a balloon-occlusion technique including a hyperthermia unit, two low-flow rotary pumps, a bubble oxygenator, and two polyurethane balloon catheters. ... Repeated isolated limb perfusions with the balloon-occlusion technique were performed in three dogs without systemic side effects. This model of regional chemotherapy may be useful for preoperative chemotherapy in malignant tumors of the limbs.  PMID: 8152401 



Verh K Acad Geneeskd Belg 1999;61(4):517-50 
Isolated lung perfusion for the treatment of pulmonary metastases an experimental study in the rat. 
Van Schil P, Hendriks J. Department of Surgery, University Hospital of Antwerp, Edegem. 

The lung is a common site of metastatic involvement and 5-year survival rates after complete surgical resection of lung metastases vary between 16 and 42%. As isolated limb or liver perfusion, isolated lung perfusion offers a new therapeutic option to deliver high-dose chemotherapy with minimal systemic side-effects ..... Clinical studies are necessary to determine its effect on pulmonary metastases in man, especially in case of unresectable disease or possibly as adjuvant therapy after surgical resection. PMID: 10500475 



Cancer 1993 May 15;71(10):2962-70 
In situ lung perfusion with cisplatin. An experimental study. [ed. in PIGS.] 
Ratto GB, Esposito M, Leprini A, Civalleri D, De Cian F, Vannozzi MO, Romano P, Canepa M, Zaccheo D. Department of Patologia Chirurgica, University of Genoa, Italy. 

....This study provides the pharmacokinetic rationale for the application of lung perfusion to patients with pulmonary metastases. PMID: 8490824 



J Surg Res 1991 Feb;50(2):124-8 
Pharmacokinetics and toxicity of isolated perfusion of lung with doxorubicin. 
Baciewicz FA Jr, Arredondo M, Chaudhuri B, Crist KA, Basilius D, Bandyopadhyah S, Thomford NR, Chaudhuri PK. 
Department of Surgery, Medical College of Ohio, Toledo 43699-0008. 

The treatment of pulmonary metastases from soft tissue sarcomas with chemotherapy has an overall response rate of less than 30%, and the majority of these responses are short lived. It is postulated that increased drug delivery to the pulmonary metastases may improve the outcome of these patients. An isolated perfusion system would have the ability of delivering increased levels of drug to target tissue without the systemic toxic effect of the drug. The purpose of this study was to establish the pharmacokinetics of doxorubicin delivery, lung toxicity, and the ideal dose for clinical application in an in vivo isolated perfusion model. Our results suggest that normothermic isolated perfusion of the lung with doxorubicin using a dose level up to 6 micrograms/ml in the perfusate can be accomplished without histologic lung injury, systemic toxicity, or adverse clinical outcome. Perfusate concentration of greater than 7 micrograms/ml caused significant histologic injury and adverse clinical outcome without systemic toxicity. The technique may be utilized in selective settings to improve treatment in mesenchymal tumors metastatic to the lung. PMID: 1990216 



The information on this site is not a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with your doctor. Please consult your doctor with any questions or concerns you may have regarding your condition. 





