Modern approaches to the treatment of primary multiple unilateral synchronous lung tumors (literature review)

Abstract

The review article focuses on recent approaches to the treatment of primary multiple unilateral synchronous and metachronous lung tumors. Unilateral primary multiple lung cancer is diagnosed relatively rare. The introduction of modern computed tomography into clinical practice made it possible to diagnose a peripheral tumor at the initial stages. The second synchronous, usually central lung cancer is more often detected during surgery or during bronchoscopy. Despite the established criteria, differential diagnosis of primary tumor and intrapulmonary metastasis in synchronous PMRL remains a difficult task. Often histological signs do not allow differentiating the primary tumor from metastasis. The use of next generation genomic sequencing (NGS) makes it possible to distinguish a primary tumor from a metastasis. To date, there are no unambiguous recommendations for staging primary multiple unilateral lung cancer. There is no clear understanding of what criteria and classification to use to determine the stage of primary multiple cancer, and the type of surgical intervention depends on it. Based on the 8th classification of staging according to the TNM system, patients with primary multiple lung cancer often need to undergo extensive surgical interventions, up to pneumonectomy. Staging each tumor separately allows us to expand the indications for anatomical segmentectomies and reconstructive plastic surgery. For the treatment of PMLC, the main type of surgery is an operative manual with lobectomy. Reconstructive plastic surgeries and anatomical segmentectomies have little effect on increase in frequency of local relapses, on worsening of survival rates. However, the methods are a reasonable alternative for some types of tumors and poor functional indicators. Stereotactic radiation therapy is the standard of treatment for patients who refuse surgery or in patients with functional limitations with early stage primary multiple lung cancer. Moreover, systemic therapies such as targeted therapy in patients with driver mutations and immunotherapy have shown outstanding results.