ISOLATED PULMONARY METASTASES: EVOLUTION OF THE TREATMENT TECHNOLOGIES

2019 ◽  
Vol 65 (5) ◽  
pp. 645-652
Author(s):  
Aleksandr Mikhnin ◽  
T. Van ◽  
Tatyana Dubinina ◽  
Oleg Mamontov ◽  
Yelena Levchenko ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Regional Chemotherapy ◽  
High Dose ◽  
Primary Cancer ◽  
Isolated Lung ◽  
Metastatic Lung ◽  
Long Time ◽  
Treatment Technologies

The lung is the most commonly attacked organ in metastatic disease. In many patients who were successfully cured of primary cancer, pulmonary metastases for a long time may be the only, and sometimes the final manifestation of the disease. This kind of dissemination is known as isolated lung metastases. The prognosis for untreated patients with pulmonary metastases is unfavorable: 5-year survival does not exceed 5%. This survey considers the evolution of technologies for the treatment of isolated metastatic lung lesions from surgical metastasectomy to combined methods of high-dose regional chemotherapy.

scholarly journals Osteosarcoma with lung metastases

2019 ◽  
Vol 18 (4) ◽  
pp. 127-135 ◽  
Author(s):  
I. V. Zhilkin ◽  
D. G. Akhaladze ◽  
D. V. Litvinov ◽  
N. G. Uskova ◽  
M. V. Tihonova ◽  
...  
Keyword(s):  
Bone Tumor ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Lung Perfusion ◽  
Surgical Approaches ◽  
Lung Lesions ◽  
Isolated Lung Perfusion ◽  
Isolated Lung ◽  
Metastatic Lung ◽  
Additional Option

Osteosarcoma is the bone tumor that most commonly affects children and adolescents. Before the introduction of polychemotherapy > 90% of patients with osteosarcoma died from pulmonary metastases. Despite development of new protocols of therapy in 30–40% of patients the disease is recurrent, more than 80% of them detected pulmonary metastasis. In this review we discussed the problems of detection of metastatic lung lesions and current approaches of methods of detection and marking of small sized metastatic lung lesions. An additional option in the treatment of lung metastases is intraoperative isolated lung perfusion, surgical approaches of which were also discussed.

Multidisciplinary management of pancreatic adenocarcinoma with isolated pulmonary metastases.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 384-384
Author(s):  
Supriya K. Jain ◽  
Cheryl Meguid ◽  
Stephen Leong ◽  
Barish H. Edil ◽  
Martin McCarter ◽  
...  
Keyword(s):  
Overall Survival ◽  
Pancreatic Adenocarcinoma ◽  
Metastatic Disease ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Median Number ◽  
Metastatic Pancreatic Adenocarcinoma ◽  
Isolated Lung ◽  
Investigational Agents ◽  
Long Term Survivors

384 Background: Metastatic pancreatic adenocarcinoma (PAC) with isolated pulmonary metastases has recently been associated with prolonged overall survival. The purpose of this study was to review multi-disciplinary management and outcomes of these patients. Methods: Patients with PAC with pulmonary-only metastases were queried between 2012 to 2015 from a prospective single-institutional database. Results: Ten patients (median age: 71 yrs) were identified. Median number of lung metastases at diagnosis was 3 (range: 1 to innumerable). Seven patients had biopsy-proven lung metastases. Five presented with synchronous metastatic disease and five developed metachronous lung metastases as their first site of progression. Median time to progression between diagnosis of primary cancer to diagnosis of pulmonary metastases was 15 months (range: 4 to 31). Seven patients are alive as of this analysis. Median overall survival (OS) of this series (including two patients diagnosed 3 and 6 months ago) is 17 months, with longest overall survival = 40+ months (patient is still alive). All patients received gemcitabine-based chemotherapy; however, systemic regimens differed and included investigational agents. 3 of 5 patients with metachronous metastases underwent pancreaticoduodenectomy and are long-term survivors (34-40+ months). 2 of these 3 patients had diagnostic VATS of lung metastases and are alive with overall survival of 36+ months (resection of 2/3 nodules) and 34+ months (resection of all visible disease). Two patients with metachronous disease underwent neoadjuvant chemotherapy and pancreatic SBRT with progression to lung prior to planned surgery (OS: 30 months (deceased) and 6+ months (recently diagnosed)). 0 of 5 patients with synchronous metastatic disease had surgical resection; 3 of 5 received pancreatic SBRT. 3 of 10 patients are deceased due to visceral disease (14 months), pulmonary failure (18 months), and unknown causes (30 months). Conclusions: We report a recent single-institutional series of PAC with isolated lung metastases. Our data support that metastatic PAC patients with isolated pulmonary metastases have prolonged overall survival and suggest that local intervention may be beneficial.

Pulmonary Metastases

Chest Imaging ◽  
2019 ◽  
pp. 295-299
Author(s):  
Tyler H. Ternes
Keyword(s):  
Metastatic Disease ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Lung Parenchyma ◽  
Ground Glass Attenuation ◽  
Common Causes ◽  
Endobronchial Lesion ◽  
Lymphangitic Carcinomatosis ◽  
Lung And Kidney ◽  
Interlobular Septal Thickening

Pulmonary metastases represent spread of malignancy to the lung parenchyma. Patients with metastatic disease may present with dyspnea, cough, or hemoptysis. Alternatively, affected patients may be asymptomatic. The lungs are a common site for metastatic disease. Relatively common primary malignancies (breast, colon, lung, and kidney cancers) are the most common causes of pulmonary metastases. However, less common primary malignancies (choriocarcinoma, testicular cancers, melanoma, and sarcomas) have a higher likelihood to produce lung metastases. The vast majority of pulmonary metastases spread via the bloodstream. Hematogenous metastases are typically basilar predominant lung nodules. Metastatic nodules may be very small (miliary, < 3mm), or very large (cannonball), and may rarely be solitary. The presence of surrounding ground-glass attenuation (CT-Halo sign) often indicates surrounding hemorrhage. Some metastases may be cavitary or calcified. Pulmonary metastases may spread via the lymphatics. Asymmetric smooth or nodular interlobular septal thickening should raise concern for lymphangitic carcinomatosis. An uncommon mechanism is spread within the airways, which may result in an endobronchial lesion or post obstructive atelectasis.

scholarly journals How Do Synchronous Lung Metastases Influence the Surgical Management of Children with Hepatoblastoma? An Update and Systematic Review of the Literature

Cancers ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 1693 ◽  
Author(s):  
Roberta Angelico ◽  
Chiara Grimaldi ◽  
Carlo Gazia ◽  
Maria Cristina Saffioti ◽  
Tommaso Maria Manzia ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Metastatic Disease ◽  
Negative Impact ◽  
Lung Metastases ◽  
Current Management ◽  
Liver Tumours ◽  
Primary Liver Tumor ◽  
Metastatic Lung ◽  
Primary Liver Tumours ◽  
Unresectable Metastases

Approximately 20% of children with hepatoblastoma (HB) have metastatic disease at diagnosis, most frequently in the lungs. In children with HB, lung metastatic disease is associated with poorer prognosis. Its treatment has been approached with a variety of methods that integrate chemotherapy and surgical resection. The timing and feasibility of complete extirpation of lung metastases, by chemotherapy and/or metastasectomy, is crucial for the surgical treatment of the primary liver tumor, which can vary from major hepatic resections to liver transplantation (LT). In children with unresectable HB, which can be surgically treated only by LT, the persistence of unresectable metastases after neoadjuvant chemotherapy excludes the possibility of recurring to LT with consequent negative impact on patients’ outcomes. Due to limited evidence and experience, there is no consensus amongst oncologists and surgeons across institutions regarding the surgical treatment for HB with synchronous metastatic lung disease. This narrative review aimed to update the current management of pulmonary metastasis in children with HB and to define its role in the decision-making strategy for the surgical approach to primary liver tumours.

scholarly journals Does Surgical Technique Influence the Burden of Lung Metastases in Patients with Pathologic Long Bone Fractures?

2021 ◽  
Author(s):  
Joseph K. Kendal ◽  
Bryan J. Heard ◽  
Annalise G. Abbott ◽  
Scott W. Moorman ◽  
Raghav Saini ◽  
...  
Keyword(s):  
Lung Metastasis ◽  
Patient Survival ◽  
Bone Fractures ◽  
Lung Metastases ◽  
Lung Imaging ◽  
Long Bone ◽  
Fixation Method ◽  
Primary Cancer ◽  
Long Bone Fractures ◽  
Metastatic Lung

Abstract Background: The aims of this study are to (1) determine whether fixation of metastatic long bone fractures with an intramedullary nail (IMN) influences the incidence of lung metastasis in comparison to arthroplasty or ORIF (Arthro/ORIF); and (2) assess this relationship in primary tumor types; and (3) to assess survival implications of lung metastasis after surgery.Methods: Retrospective cohort study investigating 184 patients (107 IMN, and 77 Arthro/ORIF) surgically treated for metastatic long bone fractures. Patients were required to have a single surgically treated impending or established pathologic fracture of a long bone, pre-operative lung imaging (lung radiograph or computed tomography) and post-operative lung imaging within 6 months of surgery. Primary cancer types included were breast (n=70), lung (n = 43), prostate (n = 34), renal cell (n = 37). Statistical analyses were conducted using two-tailed Fisher’s exact tests, and Kaplan-Meier survival analyses.Results: Patients treated with IMN and ORIF/arthroplasty developed new or progressive lung metastases following surgery at an incidence of 34% and 26% respectively. Surgical method did not significant influence lung metastasis (p = 0.33). Furthermore, an analysis of primary cancer subgroups did not yield any differences between IMN vs Arthro/ORIF. Median survival for the entire cohort was 11 months and 1-year overall survival was 42.7% (95% CI: 35.4-49.8). Regardless of fixation method, the presence of new or progressive lung metastatic disease at follow up imaging study was found to have a negative impact on patient survival (p <0.001).Conclusions: In this study, progression of metastatic lung disease was not affected by long bone stabilization strategy. IM manipulation of metastatic long bone fractures therefore may not result in a clinically relevant increase in metastatic lung burden. The results of this study also suggest that lung metastasis within 6 months of surgery for metastatic long bone lesions is negatively associated with patient survival. Level of Evidence: III, therapeutic study

Evaluating survival in patients with pancreatic adenocarcinoma and lung metastasis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16237-e16237
Author(s):  
Jason Cham ◽  
Aren Ebrahimi ◽  
David Jacob Hermel ◽  
Samantha R. Spierling Bagsic ◽  
Darren Sigal
Keyword(s):  
Pancreatic Cancer ◽  
Health System ◽  
Pancreatic Adenocarcinoma ◽  
Lung Metastasis ◽  
Metastatic Disease ◽  
Lung Metastases ◽  
Secondary Outcome ◽  
Number Of Patients ◽  
Isolated Lung ◽  
Significant Difference

e16237 Background: Pancreatic adenocarcinoma most commonly metastasizes to the liver and peritoneum, yet can occasionally metastasize to the lungs in an isolated fashion. Anecdotal evidence suggests that patients who have isolated metastatic disease to the lungs have improved outcomes. We sought to investigate whether pancreatic cancer lung metastasis is associated with improved survival. Methods: We conducted a retrospective review of patients within the Scripps Health system with pathologically confirmed pancreatic adenocarcinoma from 2017 to 2020. Primary sites of metastatic disease were identified with imaging, and when available, confirmed by pathology. A subgroup of 101 patients from a total cohort of 598 patients was further refined to only include patients with lung and/or liver primary metastases (N=68). Analyses were conducted on subgroups defined by metastatic sites of disease in the liver only, lung only and combined liver+lung. Primary and secondary outcome analyses compared isolated lung versus liver/liver+lung. Overall survival (OS) was defined from the date of diagnosis to date of death or most recent follow up, and recurrence free survival (RFS) from the time of diagnosis to date of recurrence. Each survival outcome was analyzed using Cox Proportional Hazards tests. Additionally, proportions of each subgroup (lung v. liver/liver+lung) that had recurrence or were deceased were reported and compared by Fisher’s exact tests. Results: No significant differences were observed in OS (HR 1.91, CI 0.66 – 3.73; p= 0.311) or RFS (HR 0.98, CI 0.42 – 2.30; p= 0.968) between patients with primary lung metastases versus those with either liver or liver+lung metastases (reported as hazard ratios of liver/liver+lung relative to lung only). Although there was no overall statistically significant difference, the kaplan-meier curve for OS appears to show improved survival for patients with primary lung metastasis initially but then ultimately shows worse survival compared to liver only metastasis at later time points. Please see Table.Conclusions: We found no difference in survival outcomes among pancreatic cancer patients with only lung metastasis at diagnosis compared to patients with hepatic metastasis. However, we do observe that patients with lung metastases seem to have improved survival initially. This study was conducted on a small set of the total number of patients with pancreatic adenocarcinoma within the Scripps Health system. Further analysis is ongoing to confirm the trend we observe in this study.[Table: see text]

scholarly journals Minimally Invasive Local Treatments for Bone and Pulmonary Metastases

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Meena Bedi ◽  
David M. King ◽  
Sean Tutton
Keyword(s):  
Minimally Invasive ◽  
Bone Metastases ◽  
Metastatic Disease ◽  
Pulmonary Metastases ◽  
Alternative Therapies ◽  
Minimally Invasive Techniques ◽  
Invasive Techniques

Surgery and chemotherapy have historically been the mainstay of treatment in patients with metastatic disease. However there are many alternative therapies available to relieve the symptoms and morbidity of metastases. In this paper, we review the role and highlight the advantages of minimally invasive techniques employed in patients with pulmonary and bone metastases.

scholarly journals Breast Cancer Cell Re-Dissemination from Lung Metastases—A Mechanism for Enhancing Metastatic Burden

2021 ◽  
Vol 10 (11) ◽  
pp. 2340
Author(s):  
Lucia Borriello ◽  
John Condeelis ◽  
David Entenberg ◽  
Maja H. Oktay
Keyword(s):  
Breast Cancer ◽  
Cancer Cells ◽  
Cancer Cell ◽  
Metastatic Disease ◽  
Breast Cancer Cells ◽  
Lung Metastases ◽  
Primary Tumors ◽  
Metastatic Burden ◽  
First Time ◽  
Do So

Although metastatic disease is the primary cause of mortality in cancer patients, the mechanisms leading to overwhelming metastatic burden are still incompletely understood. Metastases are the endpoint of a series of multi-step events involving cancer cell intravasation, dissemination to distant organs, and outgrowth to metastatic colonies. Here we show, for the first-time, that breast cancer cells do not solely disseminate to distant organs from primary tumors and metastatic nodules in the lymph nodes, but also do so from lung metastases. Thus, our findings indicate that metastatic dissemination could continue even after the removal of the primary tumor. Provided that the re-disseminated cancer cells initiate growth upon arrival to distant sites, cancer cell re-dissemination from metastatic foci could be one of the crucial mechanisms leading to overt metastases and patient demise. Therefore, the development of new therapeutic strategies to block cancer cell re-dissemination would be crucial to improving survival of patients with metastatic disease.

581 Effects of acoustic immune priming with low-intensity focused ultrasound (LOFU) and trabectedin on a murine model of osteosarcoma

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A616-A616
Author(s):  
Shannon Keisling
Keyword(s):  
Radiation Therapy ◽  
Heat Shock ◽  
Combination Therapy ◽  
Murine Model ◽  
Heat Shock Response ◽  
Cell Activation ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Therapy Group ◽  
Shock Response

BackgroundOsteosarcoma is the most common primary bone tumor and has a peak incidence in adolescence. The prognosis for recurrent and metastatic disease is poor and over one-third of patients with localized disease at presentation will recur after treatment with metastases. LOFU produces non-lethal, transient mechanical and thermal stress to cause protein misfolding, endoplasmic reticulum stress, and induction of the heat shock response (refs). Trabectedin is directly tumoricidal through inhibiting transcription and DNA repair, modulates the tumor microenvironment by selectively depleting M2 macrophages, and inhibits the transcription factor heat shock factor 1 (HSF1) (refs). We hypothesized that combination therapy would synergistically intensify the unfolded protein response and heat shock response to facilitate antigen presenting cell activation and efficient presentation to cytotoxic T cells. To examine this, experiments are being conducted to investigate the effect of LOFU in combination with trabectedin and/or radiation therapy (RT) in a murine model of osteosarcoma.MethodsPalpable (<5 mm) subcutaneous K7M2 murine osteosarcoma tumors in BALB/c mice were treated with a) LOFU, b) trabectedin (intravenous (IV) or intratumoral (IT)), c) LOFU + trabectedin, and d) radiation. Tumor growth (ANOVA (Kruskal-Wallis) with Dunn’s test for multiple comparisons), pulmonary metastases (Fisher’s exact test) and survival (Kaplan-Meier) were measured and analyzed in GraphPad Prism.ResultsMean tumor volume in the combination therapy group (428 mm3) was less than nontreated controls (887 mm3), LOFU alone (670 mm3), trabectedin alone (1218 mm3, p=0.0386). Radiation therapy resulted in complete ablation of the tumors. None of the combination therapy mice had grossly detectable lung metastases at time of death but metastases were present in the trabectedin only (20%), LOFU only (50%), and control (50%) groups (not statistically significant).ConclusionsCombination therapy with trabectedin and LOFU yielded smaller tumor size and fewer pulmonary metastases compared to individual therapies alone.

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