TY  - CHAP
M1  - Book, Section
TI  - Pulmonary Metastasis
A1  - Ceppa, DuyKhanh P.
A1  - Tong, Betty C.
A2  - Yuh, David D.
A2  - Vricella, Luca A.
A2  - Yang, Stephen C.
A2  - Doty, John R.
Y1  - 2014
N1  - 
T2  - Johns Hopkins Textbook of Cardiothoracic Surgery
AB  - Metastatic  disease  to  the  lung  is  the  second-most  common  pulmonary  malignancy,  affecting  20  to  54  percent  of  patients  with  cancer.  A  subset  of  patients  with  metastatic  disease  present  with  disease  confined  to  the  lung.  Complete  resection  of  this  pulmonary  burden  of  disease  can  result  in  5-year  survival  rates  as  high  as  40  to  50  percent.Pulmonary  metastases  are  typically  found  on  surveillance  imaging.  Very  rarely  are  patients  symptomatic  with  cough,  pain,  hemoptysis,  or  dyspnea.Helical,  thin-sliced  computed  tomography  is  the  gold  standard  for  detecting  pulmonary  metastases.  Pulmonary  nodules  as  small  as  3  mm  can  be  detected  with  a  sensitivity  as  high  as  75  percent.Treatment  options  for  secondary  pulmonary  malignancies  include  systemic  chemotherapy,  isolated  lung  perfusion  or  suffusion,  radiofrequency  ablation,  stereotactic  body  radiation  therapy,  and  surgical  resection.Isolated  lung  perfusion  (ILuP)  and  suffusion  are  investigational  and  should  be  restricted  to  institutions  with  active  research  protocols.The  application  of  radiofrequency  ablation  (RFA)  and  stereotactic  body  radiation  therapy  (SBRT)  is  limited  by  the  size  and  location  of  the  nodule.  These  modalities  are  typically  reserved  for  patients  who  are  poor  operative  candidates  or  who  refuse  surgery.Pulmonary  metastasectomy  is  the  treatment  of  choice  for  patients  with  metastatic  colon  cancer,  renal  cell  carcinoma,  sarcoma,  melanoma,  and  nonseminomatous  germ  cell  tumor.  Surgery  should  also  be  considered  for  select  patients  with  metastatic  breast  and  head  and  neck  cancer.Patients  considered  for  pulmonary  metastasectomy  should  meet  the  following  criteria:Primary  site  of  disease  is  controlled  or  controllable.Absence  of  extrathoracic  metastases  (or,  in  cases  of  oligometastases,  extrathoracic  sites  of  metastases  are  controlled  or  controllable).The  patient  has  the  pulmonary  reserve  to  tolerate  the  appropriate  parenchymal  loss  for  a  complete  resection.Mediastinal  and  intrathoracic  lymphadenectomy  is  advocated.Pulmonary  metastasectomy  is  associated  with  the  following  survival  rates:Colorectal  cancer  40  to  68  percent  (5  years),  renal  cell  carcinoma  47  to  74  percent  (5  years),  sarcoma  40  percent  (5  years),  melanoma  22  to  27  percent  (5  years),  and  nonseminomatous  germ  cell  tumor  (NSCGT)  74  to  94  percent  (5  years)Pancreatic  adenocarcinoma  40  percent  (2  years),  hepatocellular  carcinoma  41  percent  (5  years),  breast  carcinoma  35  to  80  percent  (5  years),  and  head  and  neck  squamous  cell  carcinoma  26  to  50  percent  (5  years)Disease-free  interval,  number  of  pulmonary  metastases,  and  completeness  of  resection  are  significant  predictors  of  long-term  survival.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/20
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1104585575
ER  -