Thoracic Imaging 2003 - Society of Thoracic Radiology

WEDNESDAY
230
Tumour – Embolic Pulmonary Arterial Hypertension
Selection of Patients for Pulmonary Resection
• Primary tumour is controlled or controllable
• No extrapulmonary tumour (except primary colon cancer
with liver mets)
• No better method of proven treatment value is available (ie,
chemosensitive tumours)
• Adequate medical status for planned resection
• Complete resection is possible based on CT
• Stable disease (no new lung mets during staging)
Probability of New Primary Cancer vs. Metastasis in
patients presenting with a Solitary Lung Nodule after Prior
Treatment for Malignant Tumour
Prior Tumour New Primary (%) Metastasis Total
Wilms 0 8 8
Sarcoma 5 (8) 55 60
Melanoma 7 (19) 29 36
Testis 6 (33) 12 18
Kidney 11 (55) 9 20
Colon – rectum 30 (58) 22 52
Breast 40 (63) 23 63
Ovary 6 (66) 3 9
Bladder 25 (89) 3 28
Lung 47 (92) 4 51
Head & Neck 158 (94) 10 168
Other (oesophagus,
prostate, pancreas,
skin, lymphoma,
leukemia 140 (100) 0 140
Rationale of Metastasectomy in Various Primary Tumours
Primary Site Aim Usual Application
Sarcoma Permanent cure Whenever possible
Germ Cell Confirm complete Systematic
remission
Residual teratoma
Colon-rectum Permanent cure Selective
± Liver resection
Kidney Occasional cure Highly selective
Melanoma Occasional cure Only single lesion
New primary Controversial
Breast Hormone receptors Only single lesion
New primary
Head & Neck New primary Single lesion
Highly selective with
multiple nodules
Results of Surgery (International Registry of Lung
Metastases)
• Aim is cure, not debulking
5 yr 10 yr 15 yr
• Actuarial survival rate after Complete resection 36% 26% 22%
Incomplete resection 13% 7% --
Prognostic Factors
• Tumour doubling time – inconclusive results
• Disease-free interval – conflicting results
• Number of metastases – survival decreased as number increases
• Hilar-mediastinal nodes – unknown
• Macroscopically complete resection – most important factor