P1.16-54 The Significance of Multiple Lung Cancer Occurrence in Surgically-Treated Clincal Stage I Lung Cancer

Abstract

Advancements in lung cancer early detection and treatment are leading to an increase in patients with diagnoses of multiple primary lung cancers or lung cancers with multiple pulmonary sites of involvement. While lobectomy is considered the standard for surgical treatment in early stage non-small cell lung cancer, the optimal treatment strategies in such cases are not well known. From February 2012 to February 2017, 370 consecutive c-stage I non-small cell lung cancer patients were surgically treated with lobectomy or segmentectomy and systematic lymph node dissection. A retrospective review was conducted for cases with multiple lung cancers. Multiple lung cancers (MLC) were defined as multiple pulmonary nodules with no clear evidence of either lesion to be a metastasis from the other, and with no lymph node or distant metastases at presentation of the secondary lesion. Cases with multiple pulmonary nodules with ground glass features were also considered MLC if they met the above criteria. Clinical characteristics and outcomes were reviewed. Sixty-five cases (17%) were considered (synchronous and/or metachronous) MLC. The secondary lesion occupied the opposite lung in 32 cases, the same lobe in 24 cases, and other lobes of the same lung in 17 cases. Multiple adenocarcinomas with ground glass features were frequently seen as synchronous lesions (33/40), and the majority (69%) of synchronous cases were found in the same lobe. MLC were resected in a single surgical procedure in 22 cases. A second procedure was given in 21, and a third in 2. The initial surgery was lobectomy in 53% of cases and segmentectomy in 47%. The second procedure was segmentectomy in 14 (67%) cases, partial resection in 6, and lobectomy in 1. In 12 cases, multiple sites of lung cancer were treated with initial surgery and a subsequent non-surgical procedure (SBRT, cryotherapy, etc.). Lung cancer recurrence following surgical resection for MLC occurred in 3 cases, two of which had lymph node involvement at time of surgery. Three-year survival following final surgery was 89.5% (median follow-up 1142 days) in all cases, and was 94.6% in cases with MLC. Multiple lung cancer occurrence is not rare among c-stage I lung cancer cases. Repeated lung-sparing resections seem feasible as part of their treatment. Aggressive local therapy may lead to prolonged survival.