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'