LAPM in various primary cancers

LAPM IN OSTEOSARCOMA AND SOFT TISSUE SARCOMA

  • All patients should be considered for pulmonary metastasectomy. Pulmonary metastasectomy can improve overall survival and some patients may even be cured.
  • The number of lung metastases is not a contraindication to metastasectomy, nor a poor prognostic factor if it is assessed the metastases can be resected.
  • Recurrence of lung metastases after pulmonary metastasectomy should be treated with repeat pulmonary metastasectomy if complete resection can be achieved. (Cancer Forum, Volume 34, Issue 3, November, 2010)
  • These tumours are less sensitive to chemotherapy; surgery is the best hope.
  • Failure to control thoracic disease is the cause of death of nearly all patients with metastatic osteosarcoma.
  • 5-year survival rates between 29% and 43% can be expected after surgery in osteosarcoma.
  • The presence of a pleural effusion is not a negative prognostic factor and therefore should not preclude surgery. (Pulmonary metastasectomy for Sarcoma, Royal Brompton Hospital, London )

 

LAPM IN CARCINOMA BREAST

  • Only one third nodules in lungs are metastatic, the rest are non-cancerous nodules or second primary cancer i. e. cancer of lung. LAPM is necessary for making perfect diagnosis so that correct treatment can be decided.
  • With 15-year survival rates of 26%, the statement that a curative approach is not possible in lung metastases from breast cancer is not tenable (European Journal of Cardio-Thoracic Surgery 2002; 22:335-344).
  • Lung metastasectomy should be offered to breast cancer patients with pulmonary metastasis. It is the best treatment option available today (Sivaruban Kanagaratnam, University of Saskatchewan, Canada, June, 2007).

 

LAPM IN COLORECTAL CANCER

  • Surgical resection of pulmonary metastases is the only potentially curative treatment.
  • Repeat resection for recurrent disease and resection after resection of liver metastases also gives good results.
  • Overall 5- and 10-year survival after resection is 40 and 35 % respectively.

 

LAPM IN RENAL CELL CARCINOMA (KIDNEY CANCER)

There is 5-year survival rate between 31% and 53% from renal cell carcinoma after pulmonary metastasectomy.

 

LAPM IN MELANOMA

5-year survival between 22 to 33% can be expected after resection of lung metastases. Without surgery, it will be less than 5%.

 

LAPM IN HEAD AND NECK TUMOURS

  • Most authors advocate resection if the patient fulfils the standard criteria for pulmonary metastasectomy.
  • 5-year survival after pulmonary metastasectomy for adenoid cycstic carcinoma is 84%, for glandular carcinoma 64% and for squamous carcinoma 34%.

 

LAPM IN TESTICULAR CANCER

  • Non-seminomatous germ cell tumors –There is solid evidence for metastesectomy after chemotherapy for non-seminomatous germ cell tumors.
  • 5-year survival after resection is 5-year survival 42% to 64%.

 

LAPM IN FEMALE GENITAL TRACT (UTERUS, CERVIX) TUMOURS

  • Surgical treatment of lung metastases originating from tumours of genital tract is associated with high long-term survival. This is especially true for endometrial carcinoma.
  • 5-year survival for uterine cancer is almost 100% and for cervical cancer it is 62.5%.

 

LAPM IN LIVER CANCER

  • Surgical resection for pulmonary metastasis from liver cancer is beneficial in selected patients.
  • 5-year survival after resection is 26%.

 

LAPM IN THYROID CANCER

Pulmonary resection for thyroid metastasis is safe with low morbidity and mortality. Retrospective analysis demonstrates improved long-term survival in patients with papillary histology, longer disease-free interval (>3 years) and younger age at diagnosis of initial thyroid malignancy. Excellent long-term survival was also achievable in selected patients with medullary thyroid metastasis.

 

LAPM IN PAEDIATRIC SOLID TUMOURS

Resection of pulmonary metastases of paediatric solid tumours is a safe and effective treatment that offers improved survival benefit in carefully selected patients within a multidisciplinary approach for paediatric cancer.

 

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