Abstract
Simple SummaryWith the wide application of computed tomography and lung cancer screening, the incidence of multiple primary lung cancer, that is, the occurrence of two or more primary malignant lung tumors in a patient, has been increasingly reported. The optimal strategy for the diagnosis and treatment of multiple primary lung cancers is controversial. Surgery remains the main treatment modality, whereas other treatment methods, including radiotherapy and local ablation, are also feasible, particularly for inoperable patients. Next-generation sequencing and novel therapies, such as targeted agents and immune-checkpoint inhibitors, have provided new insights into this topic.With the wide application of computed tomography in lung cancer screening, the incidence of multiple primary lung cancer (MPLC) has been increasingly reported. Despite the established criteria, the differentiation between MPLC and intrapulmonary metastasis remains challenging. Although histologic features are helpful in some circumstances, a molecular analysis is often needed. The application of next-generation sequencing could aid in distinguishing MPLCs from intrapulmonary metastasis, decreasing ambiguity. For MPLC management, surgery with lobectomy is the main operation method. Limited resection does not appear to negatively affect survival, and it is a reasonable alternative. Stereotactic ablative radiotherapy (SABR) has become a standard of care for patients refusing surgery or for those with medically inoperable early-stage lung cancer. However, the efficacy of SABR in MPLC management could only be found in retrospective series. Other local ablation techniques are an emerging alternative for the control of residual lesions. Furthermore, systemic therapies, such as targeted therapy for oncogene-addicted patients, and immunotherapy have shown promising results in MPLC management after resection. In this paper, the recent advances in the diagnosis and management of MPLC are reviewed.
Highlights
Introduction conditions of the Creative CommonsLung cancer is the leading cause of cancer-related death worldwide [1]
Most patients with multiple primary lung cancer (MPLC) are diagnosed with multiple ground glass opacities (GGOs) simultaneously, and surgery is the mainstay of management in the early stages of the disease [10,11]
We review relevant English language journal articles indexed in PubMed as of October 2021
Summary
Lung cancer is the leading cause of cancer-related death worldwide [1]. With the advances in modern treatment, the 2-year survival rate has increased from 34% to 42%. Multiple primary lung cancer (MPLC) is increasing due to the use of computed tomography scanning [2]. Most patients with MPLC are diagnosed with multiple ground glass opacities (GGOs) simultaneously, and surgery is the mainstay of management in the early stages of the disease [10,11]. The proportion of patients with sMPLC and 5-year survival rate is increasing, whereas the postoperative mortality is decreasing [12]. With the increase in life expectancy, some patients with lung cancer develop a second primary lung malignancy, namely mMPLC, with a cumulative incidence of approximately. The diagnosis and management of MPLC have greatly improved recently due to the advancement of novel technologies and therapies, next-generation sequencing (NGS). We review relevant English language journal articles indexed in PubMed as of October 2021 (using the search terms “multiple primary lung cancer” OR “multiple ground-glass opacities”) and discuss the recent advances in this field
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