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• W2024015976 abstract "D the past 40 years, surgical resection has become a standard approach to the management of pulmonary metastases in selected patients. The generally accepted selection criteria for surgery, namely control of the primary tumor, ability to achieve a complete resection of all metastases, absence of extrathoracic metastases, cardiopulmonary function sufficient to allow the planned resection, and lack of more effective alternative systemic therapy were developed through careful analyses of long-term clinical experience. These analyses also showed that other variables, including disease-free interval between treatment of the primary tumor and detection of pulmonary metastases, the number of metastases, elevated serum markers (eg, carcinoembryonic antigen level in colorectal cancer patients), and intrathoracic lymph node metastases, have some impact on prognosis but are less important in patient selection. The efforts to refine these clinical selection criteria culminated in the development of the International Registry of Lung Metastases (IRLM), discussed by Dr. Pastorino in this issue. Because of the large number of patients entered from multiple thoracic surgical groups, the IRLM provides the most definitive analysis of clinical prognostic factors after pulmonary metastasectomy. Despite efforts to refine the clinical selection criteria for metastasectomy, our ability to determine which patients will truly benefit from surgical intervention remains imperfect. Roughly 20% to 40% of patients will survive 5 or more years after pulmonary metastasectomy, but most patients develop and die of recurrent lung disease. Clearly, we need better selection methods. The rapidly emerging techniques of molecular profiling of tumors through array analysis will probably change our approach to this issue entirely. It is not irrational to expect that within the next 15 years we will be able to determine whether patients should undergo pulmonary metastasectomy based on the molecular profile of either the original primary tumor or a biopsy of a metastasis. Improvements in systemic therapy and in our understanding of tumor biology have led to changes in the role of pulmonary metastasectomy. For instance, in the 1960s and 1970s before the development of effective chemotherapy for breast cancer, many of these patients were considered for pulmonary metastasectomy. Evolutions in breast cancer care including earlier diagnosis, better chemotherapy, and a recognition that breast cancer is frequently a widely systemic disease now mean that these patients are rarely considered for pulmonary metastasectomy. Surgery is usually considered in breast cancer patients when the appearance of a solitary pulmonary nodule is thought to be a second primary tumor. Another dramatic example is the evolution in the treatment of testicular cancers. The introduction of cisplatinbased chemotherapy in the late 1970s led to large increases in cure rates, even in patients with widely disseminated metastases. As a result, pulmonary metastasectomy now serves as an adjuvant therapy to chemotherapy, performed to determine whether active cancer is present after systemic therapy and to remove residual benign teratoma. Although resection is still performed as primary treatment for pulmonary metastases from some diseases such as colon cancer, renal cell cancer, or melanoma, emerging systemic therapies will probably alter management of these malignancies also. For instance, drugs such as irinotecan and the antiepidermal growth factor receptor (EGFR) monoclonal antibody C-225 are offering improved outcomes in metastatic colon cancer. In the future, pulmonary metastasectomy may be integrated into a broader treatment program that includes these systemic therapies rather than being used as sole treatment. It is important that thoracic surgeons be aware of these rapidly evolving areas in oncology and have a thorough understanding of the management of Copyright 2002, Elsevier Science (USA). All rights reserved. doi:10.1053/stcs.2002.32060" @default.
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• W2024015976 title "Metastatic Neoplasms to the Lung: Introduction" @default.
• W2024015976 doi "https://doi.org/10.1053/stcs.2002.32060" @default.
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