Stereotactic body radiotherapy (SBRT) or surgery in early stage (I & II) non small cell lung cancer (NSCLC).

99 Background: For patients with NSCLC clinical stages I and II disease with no medical contraindications, surgery is treatment of choice showing 5-year survival rates of about 60–80% for stage I and 40–50% for stage II, respectively. However, for patients who are medically or technically unfit for surgery and for patients refusing surgery, SBRT is an alternative with local control rates > 90% at 3 years. Methods: Medical journals in all patients with stage I or II NSCLC who were underwent surgery and treated with SBRT at the Department of oncology or thoracic surgery, Karolinska University Hospital, Sweden from 2003 to 2010 were retrospectively reviewed. Results: In all, 267 (74.8%) underwent surgery and 90 (25.2%) were treated with SBRT. Mean, median and range of age among the surgery group was 69.2, 70.0 and 41-85 years, while in the SBRT group, these figures were 77.6, 79.0 and 52-90 years. The difference in age between the groups was significant (p < 0.001).There were significantly more comorbidites in the SBRT group. Among the surgery group, 90.2% were smokers or former smokers. The figures for SBRT group was 91.1%. The difference in smoking habits between the groups was not significant (p < 0.713). There was a significant difference in performance status (PS) between the groups (p < 0.001) with with PS 0-1 in 99.3% in the surgery group compared with 66.7% in the SBRT group. There was a significant difference in lung function with median FEV1 2.11 liter in surgery group compared to 1.3 in the SBRT group. The figures for median FEV1% was 85.0% respectively 57.0%. The median overall survival was 7.7 years for the surgery group and 3.72 years for the SBRT group (p < 0.001). Five years survival was 65.5% in the surgery group and 31.6% in the SBRT group (p < 0.001). Conclusions: The much worse median overall survival in the SBRT group can be explained by the selection of patients, but still, a median survival for nearly 4 years in an elderly group with so many comorbidities and a poor PS indicates that SBRT has been of value.

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Survival rates and prognostic factors in right- and left-sided colon cancer stage I–IV: an unselected retrospective single-center trial

International Journal of Colorectal Disease ◽

10.1007/s00384-021-04005-6 ◽

2021 ◽

Author(s):

Claudius E. Degro ◽

Richard Strozynski ◽

Florian N. Loch ◽

Christian Schineis ◽

Fiona Speichinger ◽

...

Keyword(s):

Colon Cancer ◽

Overall Survival ◽

Blood Level ◽

Proportional Hazards ◽

Survival Rates ◽

Cox Proportional Hazards ◽

Stage I ◽

Cancer Stage ◽

Single Center ◽

Significant Difference

Abstract Purpose Colorectal cancer revealed over the last decades a remarkable shift with an increasing proportion of a right- compared to a left-sided tumor location. In the current study, we aimed to disclose clinicopathological differences between right- and left-sided colon cancer (rCC and lCC) with respect to mortality and outcome predictors. Methods In total, 417 patients with colon cancer stage I–IV were analyzed in the present retrospective single-center study. Survival rates were assessed using the Kaplan–Meier method and uni/multivariate analyses were performed with a Cox proportional hazards regression model. Results Our study showed no significant difference of the overall survival between rCC and lCC stage I–IV (p = 0.354). Multivariate analysis revealed in the rCC cohort the worst outcome for ASA (American Society of Anesthesiologists) score IV patients (hazard ratio [HR]: 16.0; CI 95%: 2.1–123.5), CEA (carcinoembryonic antigen) blood level > 100 µg/l (HR: 3.3; CI 95%: 1.2–9.0), increased lymph node ratio of 0.6–1.0 (HR: 5.3; CI 95%: 1.7–16.1), and grade 4 tumors (G4) (HR: 120.6; CI 95%: 6.7–2179.6) whereas in the lCC population, ASA score IV (HR: 8.9; CI 95%: 0.9–91.9), CEA blood level 20.1–100 µg/l (HR: 5.4; CI 95%: 2.4–12.4), conversion to laparotomy (HR: 14.1; CI 95%: 4.0–49.0), and severe surgical complications (Clavien-Dindo III–IV) (HR: 2.9; CI 95%: 1.5–5.5) were identified as predictors of a diminished overall survival. Conclusion Laterality disclosed no significant effect on the overall prognosis of colon cancer patients. However, group differences and distinct survival predictors could be identified in rCC and lCC patients.

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Early stage ovarian cancer: a randomized clinical trial comparing whole abdominal radiotherapy, melphalan, and intraperitoneal chromic phosphate: a National Cancer Institute of Canada Clinical Trials Group report.

Journal of Clinical Oncology ◽

10.1200/jco.1988.6.8.1254 ◽

1988 ◽

Vol 6 (8) ◽

pp. 1254-1263 ◽

Cited By ~ 75

Author(s):

D Klaassen ◽

W Shelley ◽

A Starreveld ◽

M Kirk ◽

D Boyes ◽

...

Keyword(s):

Proportional Hazards ◽

Residual Disease ◽

Early Stage ◽

Performance Status ◽

Survival Rates ◽

Disease Free Survival ◽

Target Volume ◽

Significant Difference ◽

Abdominal Radiotherapy ◽

Multifactor Analysis

Two hundred fifty-seven eligible patients with stage I, IIA "high risk" ovarian carcinoma and IIB, IIIO (disease confined to pelvis), were randomized to either total abdominal radiotherapy (arm A) 2,250 rad in 20 fractions (107 patients), melphalan (arm B) 8 mg/m2/d X 4 every 4 weeks X 18 courses (106 patients), or intraperitoneal chromic phosphate (arm C) 10 to 20 mCi (44 patients). All patients were initially treated with pelvic radiotherapy; arm A, 2,250 rad in ten fractions; and arms B and C, 4,500 rad in 20 fractions. Entry to arm C was discontinued early because of toxicity. In a multifactor analysis using proportional hazards models, no significant difference in survival was observed although there was a marginally significant difference in disease-free survival (P = .015) with arm B being superior to arm A. Stage (P less than .0001), grade (P less than .0001), and histology (P less than .008) were predictors of survival in the multifactor analysis. Performance status, age, and residual disease were significant predictors in the single factor analysis but were not predictive when correction was made for the effects of stage, grade, and histology. Five-year survival rates are 62% for arm A, 61% for arm B, and 66% for arm C. Median duration of follow-up is 8 years. Long-term complications of radiotherapy were seen in 19 patients on arm A, 11 on arm B, and 11 on arm C. Four patients who had received melphalan developed either a myelodysplastic syndrome or acute leukemia. Violations in covering the whole abdominal target volume were correlated with survival.

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Extranodal NHL- A retrospective review of clinico-pathologic features and outcome and comparison with nodal NHL. Single institution experience years: 1988–2004

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.17542 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 17542-17542

Author(s):

A. Lal ◽

S. Adil ◽

N. Masood

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Early Stage ◽

Univariate Analysis ◽

International Prognostic Index ◽

Prognostic Index ◽

Primary Site ◽

Stage I ◽

Pathologic Features ◽

Significant Difference

17542 Background: Non-Hodgkin’s lymphoma (NHL) arising in an extra nodal (EN) site is not uncommon and its natural history and treatment is clearly characterized in the literature. Data on EN-NHL and comparison with N-NHL with relation to survival and prognostic factors is scarce in our part of the world. The primary objective of this study was to analyze the anatomic distribution, clinical features and outcome of DLBCL patients according to the primary site with applicability of International Prognostic Index (IPI). Methods: From 1988 to 2004, 557 patients were analyzed for the clinico-pathologic characteristics, treatment outcome and prognostic factors affecting overall survival. Results: Median age was 48.7 ± 15.3 years ; the M: F ratio was 2:1. The distribution according to the primary site was: lymph node, 322 cases (58%) of these 145 cases (44%) stage IV, 76 cases (23%) Stage III, 60 cases (18%) stage II and 47 cases(15%) stage I ; and EN sites, 235 (42%), including GIT (44%) followed by upper aerodigestive tract (19%), bones (08%), spine (05%), and 3% each as breast, CNS, testis,lungs. The median survival rate was 4.8 and 6.3 years in NL and ENL respectively vary according to primary site/stage of the lymphoma. In the univariate analysis age less than 60 years, early stage I-II, extra nodal involvement primarily gastric or bone, 0–1 extra nodal site, 0–1 PS, lack of B symptoms, normal LDH level has been associated with good prognosis. In the multivariate analysis age, PS, stage and level of LDH were the main variables to predict OS; no nodal or extranodal site maintained their prognostic value. Conclusion: Our data correspond with series from west increasing incidence extranodal lymphoma due to improved diagnostic techniques and superior results with chemotherapy by preserving the organ. Few patients with bowel obstruction or cord compression lymphoma required surgery for diagnosis or relief of symptoms. There is significant difference from western data in histologies DLBC-NHL is the most common histologies in our study. Overall survival patients with EN-NHL were similar to nodal NH-Lymphoma but largely depended on IPI. No significant financial relationships to disclose.

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Comparison of single- and five-fraction schedules of stereotactic body radiation therapy for central lung tumours: a single institution experience

Journal of Radiotherapy in Practice ◽

10.1017/s1460396917000061 ◽

2017 ◽

Vol 16 (2) ◽

pp. 148-154 ◽

Cited By ~ 5

Author(s):

Sung Jun Ma ◽

Yusef A. Syed ◽

Charlotte I. Rivers ◽

Jorge A. Gomez Suescun ◽

Anurag K. Singh

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Stereotactic Body Radiation Therapy ◽

Early Stage ◽

Survival Rates ◽

Study Data ◽

Single Institution ◽

Lung Tumours ◽

Stereotactic Body Radiation ◽

Significant Difference

AbstractBackgroundStereotactic body radiation therapy (SBRT) is a treatment option for patients with early-stage non-small cell lung cancer who are medically inoperable or decline surgery. Here we compare the outcome of patients with centrally located lung tumours who underwent either single fraction (SF)- or five-fraction (FF-) SBRT at a single institution over 5 years.MethodsBetween January 2009 and October 2014, patients with centrally located lung tumours who underwent SBRT were included in this study. Data were retrospectively collected using an institutional review board-approved database. For analysis, the Kaplan–Meier method and competing risks method were used.ResultsIn total, 11 patients received 26–30 Gy in 1 fraction, whereas 31 patients received 50–60 Gy (median 55 Gy) in 5 fractions. After a median follow-up of 12 months for SF-SBRT and 17 months for FF-SBRT groups (p=0·64), 1-year overall survival rates were 82 and 87%, respectively. SF- and FF-SBRT groups showed no significant difference in grade 3+ toxicity (p=0·28). The only grade 4 toxicity (n=1) was reported in the SF-SBRT group. All toxicities occurred >12 months after the SBRT.ConclusionsSF- and FF-SBRT have comparable overall survival. SF-SBRT may have some utility for patients unable to have multi-fraction SBRT.

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Extranodal-NHL: Outcomeand Comparison with Nodal NHL. Single Institution Experience Year: 1988–2004.

Blood ◽

10.1182/blood.v108.11.4755.4755 ◽

2006 ◽

Vol 108 (11) ◽

pp. 4755-4755

Author(s):

Amar Lal ◽

Nehal Masood ◽

Salman Adil

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Early Stage ◽

Univariate Analysis ◽

International Prognostic Index ◽

Prognostic Index ◽

B Cell Lymphoma ◽

Primary Site ◽

Stage I ◽

Significant Difference

Abstract Background & Objective: Non-Hodgkin’s lymphoma (NHL) arising in an extra nodal (EN) site is not uncommon and its natural history and treatment is clearly characterized in the literature. Data on EN-NHL and comparison with N-NHL with relation to survival and prognostic factors is scarce in our part of the world. The primary objective of this study was to analyze the anatomic distribution, clinical features and outcome of Diffuse large B-cell lymphoma (DLBCL) patients according to the primary site (extra nodal vs nodal) with applicability of International Prognostic Index (IPI). Methods: From 1988 to 2004, 711 cases of NHL were diagnosed at our Institute. Out of these 145 (20%) patients were excluded as they were other than DLBCL hitopathology. Five hundreds fifty-seven (80%) patients were analyzed for the clinico-pathologic characteristics, treatment outcome and prognostic factors affecting overall survival. Ann Arbor staging system was used for staging with bone marrow biopsy, chest and abdominal radiography/CT. Results: Median age was 48.7 ± 15.3 years; the M: F ratio was 2:1. The distribution according to the primary site was: lymph node, 322 cases (58%) of these 145 cases (44%) stage IV, 76 cases (23%) Stage III, 60 cases (18%) stage II and 47 cases(15%) stage I; and EN sites, 235 (42%), including gastro-intestinal tract (44%) followed by upper aerodigestive tract (19%), bones (08%), spine (05%), and unusual sites less than 3% each as breast, CNS, testis, lungs and skin. The median survival rate was 4.8 and 6.3 years in NL and ENL respectively vary according to primary site/stage of the lymphoma. In the univariate analysis age less than 60 years, early stage I -II, extra nodal involvement primarily gastric or bone, 0–1 extra nodal site, 0–1 PS, lack of B symptoms, normal LDH level has been associated with good prognosis. In the multivariate analysis age, PS, stage and level of LDH were the main variables to predict OS; no nodal or extranodal site maintained their prognostic value. Conclusion: Our data correspond with series from west increasing incidence extranodal lymphoma due to improved diagnostic techniques and superior results with chemotherapy by preserving the organ. Few patients with bowel obstruction or cord compression lymphoma required surgery for diagnosis or relief of symptoms. There is significant difference from western data in histologies DLBC-NHL is the most common histologies in our study. Overall survival patients with EN-NHL were similar to nodal NH-Lymphoma but largely depended on IPI.

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Does presence of chronic obstructive pulmonary disease (COPD) influence clinical behavior in patients with early-stage non-small cell lung cancer (ESNSCLC)?

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e18530 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e18530-e18530

Author(s):

Satomi Yamamoto ◽

Tomoya Kawaguchi ◽

Taro Tamura ◽

Kazuhiro Asami ◽

Kyoichi Okishio ◽

...

Keyword(s):

Lung Cancer ◽

Early Stage ◽

Smoking Status ◽

Performance Status ◽

Disease Free Survival ◽

Lymphatic Invasion ◽

Stage I ◽

Chronic Obstructive ◽

Wild Type ◽

Significant Difference

e18530 Background: CDPD and lung cancer sometimes occurs simultaneously. COPD has been recognized as an inflammatory disease and may potentially affect biology of the accompanying tumor. It is not fully understood whether presence of CDPD influences clinical characteristics, pathological findings and/or clinical outcomes in patients with ESNSCLC. Methods: Retrospective and consecutive data were collected from the medical records of patients who underwent surgical resections at Kinki-chuo Chest Medical Center, Japan, between January 2009 and December 2010. CDPD status was classified as absence of COPD, stage I and II COPD based on the criteria of Global Initiative for Chronic Obstructive Lung Disease (GOLD). Histology, vascular / lymphatic invasion and the status of epidermal growth factor receptor (EGFR) were determined using the surgical materials. Results: A total of 319 cases was included with median age of 67 (range, 36 - 89). There were 81 cases of relapse and 40 cases of death during the median follow up of 28 months (11 days to 49 months). In the subgroup of non-COPD, stage I and II COPD, the median age, the number of case in gender (male/female), performance status (PS, 0/1), histology (squamous cell carcinoma [SQ] /non SQ), smoking status (never/ever), and EGFR status (wild type/mutant) were 67, 72, 72 (p<0.001) and 105/110, 48/12, 38/6 (p<0.001) and 170/40, 53/7, 27/14 (p=0.029) and 31/184, 12/48, 14/28 (p<0.001) and 89/122, 7/53, 2/39 (p=0.002) and 47/37, 21/3, 9/3 (p=0.013), respectively. No significant difference was observed in disease-free survival (DFS, log-rank p=0.411) and overall survival (OS, log-rank p=0.127) between the patients with and without COPD. In multivariate analysis adjusted for age, gender, PS, histology, smoking status, pathological stage, vascular / lymphatic invasion and EGFR status, presence of COPD did not affect DFS (HR=1.457, p = 0.279) nor OS (HR=0.993, p = 0.990).Conclusions: Although COPD was significantly associated with the elderly, male gender, presence of symptoms, SQ histology, ever smoking, and wild type EGFR, it did not add values of prognostic factors in patients with ESNSCLC.

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Long-term analysis of bilateral versus unilateral neck dissection in the treatment of early-stage supraglottic laryngeal cancer

Praxis of Otorhinolaryngology ◽

10.5606/kbbu.2021.43660 ◽

2021 ◽

Vol 9 (3) ◽

pp. 81-86

Author(s):

Selin Ünsaler

Keyword(s):

Overall Survival ◽

Neck Dissection ◽

Cancer Patients ◽

Early Stage ◽

Survival Rates ◽

Survival Outcomes ◽

Tumor Site ◽

Significant Difference ◽

Overall Survival Rates

OBJECTIVE: This study aimed to investigate the effect of routine bilateral neck dissection on the survival outcomes of supraglottic laryngeal cancer patients with lateralized tumors and clinically negative necks. METHODS: The data of 234 patients surgically treated for supraglottic squamous cell carcinoma between January 2000 and September 2014 were retrospectively collected. Patients treated previously for head and neck cancer, patients who could not be contacted, and those with missing data were excluded. Of the remaining 187 patients, 124 patients with early-stage primaries (T1-T2) (116 males, 8 females; mean age: 55.5±9.5 years; range, 33 to 82 years) were included. Age and sex of the patients, site of the primary tumor, TNM stage, type of the neck dissection, length of follow-up, and survival rates were evaluated. The tumors were classified into three groups according to their relationship with the median line of the larynx, and the neck dissections were recorded as unilateral or bilateral. Recurrences and survival outcomes were evaluated. RESULTS: There was no statistically significant difference in the recurrences according to tumor site groups (p=0.39). Similarly, there was no statistically significant difference in 10-year overall survival rates in patient groups according to the tumor site (p=0.072). We found no statistically significant difference in 10-year overall survival rates between the patients who underwent unilateral and bilateral neck dissection (p=0.580). CONCLUSION: Long-term survival analysis of 124 patients with supraglottic carcinoma did not show a survival benefit of elective contralateral neck dissection in lateralized supraglottic cancer with contralateral clinically negative neck.

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RARE-17. PRIMARY DIFFUSE LEPTOMENINGEAL GLIOMATOSIS OF HIGH GRADE TUMORS

Neuro-Oncology ◽

10.1093/neuonc/noz175.940 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi225-vi225

Author(s):

Ji-Eyon Kwon ◽

Gyung-Oh Ko ◽

Gi Hwan Hwang ◽

In Ah Kim ◽

Chan Woo Wee ◽

...

Keyword(s):

Overall Survival ◽

Median Overall Survival ◽

Group Performance ◽

Performance Status ◽

Survival Rates ◽

Eastern Cooperative Oncology Group ◽

High Grade ◽

Primary Diffuse Leptomeningeal Gliomatosis ◽

Leptomeningeal Gliomatosis ◽

Overall Survival Rates

Abstract Primary diffuse leptomeningeal gliomatosis(PDLG) of high grade glioma(HGG) is a rarely documented phenomenon observed in less than 5% of glioblastoma(GBM). Purposes of this study are to investigate the clinical outcomes of PDLG of HGG and to analyze the results according to the procedures of operations. We retrospectively reviewed the medical records of 469 patients of HGG at our institute between 2004 and 2019 and 9 of who with PDLG were enrolled in our study. These 9 patients satisfying the condition of Karnofsky performance status ≥70 and Eastern Cooperative Oncology Group performance status ≤2 were conducted the primary surgical biopsy with or without intracranial pressure control. All patients finished the surgery within about 11 days after the detection of leptomeningeal seeding(LMS) on preoperative MRI images and completed the concurrent chemoradiotherapy(CCRT) with temozolomide(TMZ). Among 9 patients, 7 patients started adjuvant temozolomide and 3 patients completed the six cycles of it. 7 patients had done ICP control operation such as ommaya reservoir insertion, extraventricular drainage, and ventriculoperitoneal shunt within 23.3 days after defined as PLDG and survived nearly 10 months. Their pathologic findings were turned out to be seven glioblastomas and two anaplastic astrocytomas. Their median overall survival was 14 months and the 1- and 2-year overall survival rates were 50.8±17.7% and 16.9±15%, respectively. Compared to the 10-year study of GBM in the same institute between 2004 and 2011, in which 67 patients finished with CCRT with TMZ, the median overall survival was 19 months and the 1- and 2-year overall survival rates were 78.3% and 41.7%. The results indicate that PLDG has a worse outcome and overall survival rate is lower than GBM without LMS, so the earlier start of standard CCRT right after aggressive control of increased ICP like conducting CSF diversion might be helpful for the elongation of life expectancy.

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Survival Outcomes following LINAC based Stereotactic Radiosurgery/Stereotactic Radiotherapy (SRST) treatment of brain metastases: The Wessex Experience

Neuro-Oncology ◽

10.1093/neuonc/noab195.029 ◽

2021 ◽

Vol 23 (Supplement_4) ◽

pp. iv12-iv13

Author(s):

Mark Noble ◽

Jeng Ching ◽

Enrico Clarke

Keyword(s):

Overall Survival ◽

Brain Metastases ◽

Median Overall Survival ◽

Karnofsky Performance Status ◽

Performance Status ◽

Group Analysis ◽

University Hospital ◽

Unknown Primary ◽

Kaplan Meier ◽

Extracranial Disease

Abstract Aims Since 2016, the University Hospital Southampton NHS Foundation Trust (UHSFT) has been commissioned by NHS England to deliver SRST to brain metastases. At UHSFT, all referrals are discussed at the Wessex Neurosciences multidisciplinary team meeting. Referrals that satisfy the criteria set by NHS England (estimated prognosis greater than 6 months, absence or controlled extracranial disease or potentially controllable extracranial disease with a Karnofsky Performance Status >70%) will be offered SRST. This retrospective study was performed to assess overall survival rates of patients with brain metastases treated with SRST with further tumour subtype analysis. We also benchmarked our results with other SRST centres. Method Retrospective data collection was performed for all the patients who have been treated with SRST. Patients who received SRST to a single metastasis, multiple metastases and/or to the resection cavity between 01/01/2017 to 30/09/2019 were included in this study. All treatment was delivered using a LINAC based SRST platform. Prescription doses ranged from 13.5 Gy to 21 Gy in a single fraction, 21 to 24 Gy in 3 fractions and 25 Gy in 5 fractions. Patients are treated using a stereotactic thermoplastic immobilisation shell and dynamic conformal arc therapy with ExacTrac TM and Cone Beam CT imaging. Dates of death were obtained from the NHS Digital Spine and survival analysis using median overall survival was performed using the Kaplan Meier Method. Results 277 patients were treated between 01/01/17 and 30/9/2019. The median overall survival from the Kaplan Meier Method was shown to be 14.7 months and the 6-month overall survival was 71% for all patients. Sub-group analysis of individual tumour sites showed: lung (n=110) median OS 12.1 months, melanoma (n=58) median OS 26.4 months, breast (n=46) median OS not reached (67% still alive) but 18 months survival was 70%, renal (n=22) median OS 15.4 months and colorectal (n=19) median OS 6 months. “Other” tumour sites (n=22) included patients with ovarian, neuroendocrine, sarcoma, testis, oesophagus, unknown primary and gallbladder which were grouped together due to small patient numbers. 41% of patients treated were alive at the time of analysis. Conclusion Patients with brain metastases treated with SRST at UHFST have similar outcomes compared to other SRST centres. These patients have a median overall survival of 14.7 months. However, 29% of patients analysed did not survive more than 6 months. Further collection and analysis of the data might improve patient selection and their outcomes.

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Significance of indeterminate pulmonary nodules in resectable pancreatic adenocarcinoma—a review

Langenbeck s Archives of Surgery ◽

10.1007/s00423-020-02049-w ◽

2021 ◽

Author(s):

Li Lian Kuan ◽

Ashley R. Dennison ◽

Giuseppe Garcea

Keyword(s):

Overall Survival ◽

Pancreatic Adenocarcinoma ◽

Median Overall Survival ◽

Current Knowledge ◽

Pulmonary Nodules ◽

Preoperative Imaging ◽

Significant Finding ◽

Comprehensive Overview ◽

Significant Difference ◽

Clinical Dilemma

Abstract Background The clinical significance of indeterminate pulmonary nodules (IPN) in patients with resectable pancreatic adenocarcinoma (PDAC) is unknown. The rate of detection on IPN has risen due to enhanced staging investigations to determine resectability. IPNs detected on preoperative imaging represent a clinical dilemma and complicate decision-making. Currently, there are no recommendations on the management of IPN. This review provides a comprehensive overview of the current knowledge on the natural history of IPN detected among patients with resectable PDAC. Methods A systematic review based on a search in Medline and Embase databases was performed. All clinical studies evaluating the significance of IPN in patients with resectable PDAC were included. PRISMA guidelines were followed. Results Five studies met the inclusion criteria. The total patient population was 761. The prevalence of IPN reported ranged from 18 to 71%. The median follow-up duration was 17 months. The median overall survival was 19 months. Patients with pre-operative IPN which subsequently progressed to clinically recognizable pulmonary metastases, ranged from 1.5 to 16%. Four studies found that there was no significant difference in median overall survival in patients with or without IPNs. Conclusion This is a first review on the significance of IPN in patients with resectable PDAC. The preoperative presence of IPN does not demonstrate an association with overall survival after surgery. The identification of IPN is a significant finding however it should not preclude patients with resectable PDAC from undergoing curative resection.

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