Editing Lung metastases


Isolated pulmonary metastases are often treatable, essentially regardless of underlying tumour type

== Requirements for consideration of resection: ==

* Pulmonary parenchymal nodules consistent with metastasis
* Absence of uncontrolled or untreated extra-thoracic metastases
* Control of the primary tumour
* Sufficient physiologic and pulmonary reserve to tolerate the procedure
* Probability of complete resection
* Other potential situations
** A new primary lung cancer cannot be excluded
** Symptomatic metastases that cannot be managed in any other way
** Tissue needs to be obtained to enable a novel therapeutic strategy

If patients do not meet those criteria, consider stereotactic radiotherapy, RFA, or cryoablation

== Contraindications: ==

* Brain metastases
* N2 nodal involvement for tumours other than RCC
* Inability to completely resect all pulmonary involvement
* Prior pneumonectomy (relative contraindication)

== Unfavourable prognostic indicators that may influence decision to resect: ==

* Short disease-free interval following resection of the primary
* 4 or more pulmonary mets
* Involved lymph nodes

== Pre-operative workup ==

* CT chest
* PET
* Brain imaging

== Prognosis ==

* Long-term survival (>5 years) may be expected in 20-30% of all patients with resectable pulmonary metastases
* Favourable indicators:
** Disease-free interval greater than 3 years
** Solitary pulmonary nodule
** Germ cell histology
* See UTD article 'Surgical resection of pulmonary metastases: outcomes by histology'

[[Category:Thoracics]]