Summary
Background
The majority of patients with lung cancer are diagnosed in a metastatic state, in which prognosis is rather poor. Chemotherapy can improve median overall survival by only a few months, but a small percentage of these patients suffer only from oligometastatic diseases and may therefore be treated with curative intend. In this study, we compared two groups of patients with oligometastatic lung cancer, who received palliative treatment or multimodal treatment with a surgical approach.
Methods
We conducted a retrospective review of all patients with synchronous extrapulmonary oligometastatic disease diagnosed between 2010 and 2013. All data were extracted from the medical database of our department and further analysed.
Results
There were 52 patients diagnosed with oligometastatic lung cancer between 2010 and 2013. A cohort of 32 patients was treated surgically in a multimodal approach, but 19 patients refused surgery. These patients were treated by palliative chemotherapy or other palliative treatments, such as radiochemotherapy etc. Median overall survival was 18 months in the surgically treated group and 6 months in the palliative group (p < 0.001). In the surgically treated group, survival was correlated to pathologic T stage (pT1 29 months, pT2 13 months and pT3 13 months median overall survival, p < 0.05) and lymph node involvement (with mediastinal lymph node involvement 13 months and without mediastinal lymph node involvement 28 months median overall survival).
Conclusion
We conclude that surgery may have a beneficial effect in multimodal treatment of oligometastatic lung cancer. A prospective randomized study is necessary and may be feasible.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Jemal A, Center MM, DeSantis C, Ward EM. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev. 2010;19(8):1893–907.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29.
Sánchez de Cos Escuín J, Abal Arca J, Melchor Íñiguez R, Miravet Sorribes L, Núñez Ares A, Hernández Hernández JR, et al. Tumor, node and metastasis classification of lung cancer – M1a versus M1b – analysis of M descriptors and other prognostic factors. Lung Cancer. 2014;84(2):182–9.
Nieder C, Tollali T, Reigstad A, Pawinski A, Haukland E, Dalhaug A. Oligometastatic non-small cell lung cancer: A significant entity outside of specialized cancer centers? Med Princ Pract. 2014;23(6):526–31.
Plönes T, Osei-Agyemang T, Krohn A, Passlick B. Surgical treatment of extrapulmonary oligometastatic non-small cell lung cancer. Indian J Surg. 2012. doi:10.1007/s12262-012-0771-6.
Cha YK, Lee HY, Ahn MJ, Choi YL, Lee JH, Park K, et al. Survival outcome assessed according to tumor burden and progression patterns in patients with epidermal growth factor receptor mutant lung adenocarcinoma undergoing epidermal growth factor receptor tyrosine kinase inhibitor therapy. Clin Lung Cancer. 2015;16(3):228–36.
Tseng SE, Chiou YY, Lee YC, Perng RP, Jacqueline WP, Chen YM. Number of liver metastatic nodules affects treatment options for pulmonary adenocarcinoma patients with liver metastases. Lung Cancer. 2014;86(2):225–30.
Salama J, Schild S. Radiation therapy for oligometastatic non-small cell lung cancer. Cancer Metastasis Rev. 2015. doi:10.1007/s10555-015-9559-z.
Hasselle MD, Haraf DJ, Rusthoven KE, Golden DW, Salgia R, Villaflor VM, et al. Hypofractionated image-guided radiation therapy for patients with limited volume metastatic non-small cell lung cancer. J Thorac Oncol. 2012;7(2):376–81.
Groome PA, Bolejack V, Crowley JJ, Kennedy C, Krasnik M, Sobin LH, et al. The IASLC Lung Cancer Staging Project: Validation of the proposals for revision of the T, N, and M descriptors and consequent stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol. 2007;2(8):694–705.
Travis WD, Colby TV, Corrin B. Histological typing of lung and pleural tumours (international histological classification of tumours). Heidelberg: Springer; 1999.
Brunelli A, Charloux A, Bolliger CT, Rocco G, Sculier JP, Varela G, et al. ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy). Eur Respir J. 2009;34(1):17–41.
Billing PS, Miller DL, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Surgical treatment of primary lung cancer with synchronous brain metastases. J Thorac Cardiovasc Surg. 2001;122(3):548–53.
Bonnette P, Puyo P, Gabriel C, Giudicelli R, Regnard JF, Riquet M, et al. Surgical management of non-small cell lung cancer with synchronous brain metastases. Chest. 2001;119(5):1469–75.
Pfannschmidt J, Dienemann H. Surgical treatment of oligometastatic non-small cell lung cancer. Lung Cancer. 2010;69(3):251–8.
Salah S, Tanvetyanon T, Abbasi S. Metastatectomy for extra-cranial extra-adrenal non-small cell lung cancer solitary metastases: Systematic review and analysis of reported cases. Lung Cancer. 2012;75(1):9–14.
Tanvetyanon T, Robinson LA, Schell MJ, Strong VE, Kapoor R, Coit DG, et al. Outcomes of adrenalectomy for isolated synchronous versus metachronous adrenal metastases in non-small-cell lung cancer: A systematic review and pooled analysis. J Clin Oncol. 2008;26(7):1142–7.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
T. Ploenes, A. Lopez-Pastorini and E. Stoelben declare that they have no competing interests.
Additional information
An erratum to this article is available at http://dx.doi.org/10.1007/s10353-016-0445-x.
Rights and permissions
About this article
Cite this article
Plönes, T., Lopez-Pastorini, A. & Stoelben, E. Surgical approach is superior to palliative treatment in oligometastatic lung cancer. Eur Surg 48, 342–346 (2016). https://doi.org/10.1007/s10353-016-0437-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10353-016-0437-x