Metachronous Lung Cancer Research Articles

Lung cancer Detected as a Metachronous Second Primary Malignancy in a patient with Pyriform Sinus Carcinoma during 18F FDG PET-CT scan

Pyriform sinus squamous cell carcinoma is the most prevalent type of hypopharyngeal carcinoma. The presence of a second primary malignancy in pyriform sinus carcinoma is uncommon. We present a case of metachronous second primary lung cancer detected by whole-body 18F-FDG PET-CT imaging during the follow-up evaluation in a treated case of well-differentiated squamous cell carcinoma of the left pyriform fossa. Bangladesh J. Nuclear Med. 24(1&2): 64-67, 2021

Prognostic Nomogram and Therapeutic Option of Cancer-Specific Death in the Patients with Metachronous Second Primary Lung Cancer.

With the increase of long-term primary lung cancer survivors, studies focused on metachronous second primary lung cancer (SPLC) have become very urgent. This study aimed to develop a prognostic nomogram and determine therapeutic options of cancer-specific death for patients with metachronous SPLC with and without the competing risk of other-specific death. Study population came from the SEER-18 database between 2006 and 2016. According to the clinical practice guideline of SPLC, the interval time of IPLC and metachronous SPLC was set to 4 years. We constructed nomograms with Lasso + Cox regression model and competing risk model to predict the prognosis and identify therapeutic options of metachronous SPLC patients with the assessment of model performance by the C-index, calibration plot, and decision curve analysis. In addition, two subgroup analyses stratified by histology and tumor size were used to better select therapeutic options for a certain population. 1300 patients with metachronous SPLC were incorporated in this study with 50.1% of the 5-year cumulative incidence in cancer-specific death. Compared with Lasso + Cox regression analysis, competing risk analysis harbored a higher C-index (0.811 vs. 0.76) and better net benefit in predicting cancer-specific death of metachronous SPLC. Two statistical analyses suggested that surgery alone was a preferentially therapeutic option of metachronous SPLC, whereas the effect of surgery + radiation in treating metachronous SPLC was similar to radiation alone. Subgroup analyses indicated that patients with metachronous SPLC were considered receiving different therapeutic options in different histology and tumor size but preferred to receive surgical treatment as the first choice. For primary lung cancer survivors, aggressive surgical treatment was the first-line selection of metachronous SPLC, followed by radiation alone, surgery + radiation, and no surgery + radiation.

Metachronous Lung Cancer in the Opposite Lung in a Patient with Long-survival Small Cell Lung Carcinoma

Metachronous Lung Cancer in the Opposite Lung in a Patient with Long-survival Small Cell Lung Carcinoma

Establishing a prognostic model for metachronous second squamous cell lung cancer in patients with resected squamous cell lung cancer.

BackgroundFor metachronous second pulmonary squamous cell carcinoma (msPSC) in patients with resected PSC, the method to distinguish tumour clonality has not yet been well established, which makes it difficult to determine accurate staging and predict prognosis.MethodsPatients who underwent surgery for first PSC and encountered msPSC were recruited from the Surveillance, Epidemiology, and End Results (SEER) database. We extracted overall survival 1 (OS1) for the first PSC, overall survival 2 (OS2) for msPSC, and interval survival for the time interval between the first and second PSC. The nomogram was calibrated for OS2, and recursive partitioning analysis (RPA) was performed for risk stratification.ResultsA total of 617 patients were identified. Several independent prognostic factors were identified and integrated into the nomogram for OS2, including gender, age (2nd), nodal status (1st), node metastasis (2nd), and extrapulmonary metastasis (2nd). The calibration curves showed optimal agreement between the predictions and actual observations, and the c-index was 0.678. Surgery was associated with longer survival for msPSC patients. The prognosis of sublobectomy was comparable and inferior to that of lobectomy in the low- and moderate-risk groups, respectively. Radiotherapy was associated with better outcomes in patients who did not undergo surgery.ConclusionsThe RPA-based clinical nomogram appears to be suitable for the prognostic prediction and risk stratification of OS2 in msPSC. This practical system may help clinicians make decisions and design clinical studies.

Efficacy and Safety of Local Radiotherapy to All Oligometastatic Sites in Elderly Patients with Metachronous Oligometastatic Cancers After Initial Treatment for the Primary Tumor.

Background and PurposeThis study aimed to investigate the efficacy and safety of maintenance therapy combined with local radiotherapy at all oligometastatic sites (LRTOS) in elderly patients with metachronous oligometastatic cancers (MOC).Patients and MethodsA total of 242 elderly patients with MOC (≤5 metastases) and primary tumor well controlled after definitive treatment was retrospectively analyzed between August 2014 and February 2020 at Beijing Geriatric Hospital and Air Force General Hospital. Patients were divided into maintenance therapy group (maintenance therapy alone) and local radiotherapy group (maintenance therapy combined with LRTOS).ResultsThere were 86 patients in the local radiotherapy group and 156 patients in the maintenance therapy group. The median length of follow-up was 36 months (range, 8.0–62 months). Median overall survival (mOS) was 25 months (95% CI: 21.1–28.9) in the local radiotherapy group and 16 months (95% CI: 14.5–17.6) in the maintenance therapy group (p < 0.001). Multivariate analyses demonstrated that LRTOS (hazard ratio (HR) = 0.49, 95% confidence interval (CI): 0.35–0.67, p < 0.001), good Eastern Cooperative Oncology Group Performance Status (ECOG PS, HR = 0.69, 95% CI: 0.49–0.97, p = 0.032), longer duration between diagnosis of primary tumor and occurrence of progression (HR = 0.87, 95% CI: 0.78–0.97, p = 0.015), and subsequent systemic treatment (HR = 0.52, 95% CI: 0.38–0.72, p < 0.001) were independent predictors of good OS. In patients who did not receive subsequent systemic treatment, their mOS was 21 months (95% CI: 12.8–29.2) for those treated with LRTOS and 14 months (95% CI: 11.4–16.6) for those who did not receive local radiotherapy (p = 0.001). Further multivariate analysis showed that LRTOS was the only independent factor for predicting good OS (HR = 0.47, 95% CI: 0.26–0.83, p = 0.010). Patients with metachronous oligometastatic lung cancer, colorectal cancer, prostate cancer, and breast cancer had higher survival benefits following LRTOS. Most patients suffered from grade 1–2 toxicities, but no treatment-related death was recorded.ConclusionThis retrospective study shows that elderly patients with MOC treated with LRTOS may have better survival outcomes.

Lung Metastases Versus Second Primary Lung Cancers in Patients with Primary Urothelial Carcinoma of the Bladder: A National Population-Based Assessment.

The work-up and diagnosis of indeterminate lung nodules at time of bladder cancer diagnosis may delay or change treatment. To quantify the incidence of synchronous and metachronous lung cancers in adults with bladder cancer and compare these rates to the incidence of bladder cancer metastases in the lung. We retrospectively analyzed all adults diagnosed with bladder cancer in the Surveillance, Epidemiology and End Results (SEER) registry (2010- 2015) and identified second primary lung cancers defined as being either synchronous (diagnosed within 6 months of bladder cancer diagnosis) or metachronous (more than 6 months following index bladder cancer diagnosis). The risk of second primary lung cancers were reported as a standardized incidence ratio (SIR) reflecting observed and expected case ratios. A total of 88,335 patients diagnosed with bladder cancer were included. Among adults with NMIBC (n = 66,071) and MIBC (n = 18,879), 0.3% and 3.9% had bladder cancer metastatic to the lungs at diagnosis. Synchronous second primary lung cancers were diagnosed in 0.4% and 0.7% of patients with NMIBC and MIBC, respectively. Compared to the general population, the SIR for synchronous lung cancers among adults with NMIBC was 2.5 (95% CI 2.3- 2.9) and was 4.7 (95% CI 4.0- 5.6) for adults with MIBC. Bladder cancer metastatic to the lung is more common in adults with MIBC compared to NMIBC. There are similar frequencies of synchronous second primary lung cancers regardless of initial bladder cancer stage.

Does irradiation for initial primary lung cancer affect the risk of metachronous second primary lung cancer?

Several studies have reported inconsistent results about second primary lung cancer (SPLC) after irradiation for initial primary lung cancer (IPLC). The present study aims to assess the effect of ionising radiation on the risk of SPLC. The study population came from SEER database, and included a population-based cohort of 21,397 individuals diagnosed with IPLC between 2004 and 2009 who survived more than 7 years after the initial diagnosis. The first aim was to estimate the risk of SPLC in different periods and the cumulative risk of SPLC. Subsequently, a generalized additive model with Poisson regression analysis and a proportional sub-distribution hazard model was used to determine whether radiation affected the risk of SPLC. Until Dec 2016, there were 488 individuals who developed SPLC, 5368 individuals who died, and there were 15,541 alive individuals, respectively. The risk of SPLC was found to gradually decline with the extent of follow-up time. Age and histology were the two main risk factors of developing SPLC in Poisson regression and competing risk analyses. In Poisson regression analysis, radiation had no significant effect on the risk of developing SPLC (adjusted OR = 0.80, 95% CI 0.54, 1.19, P = 0.28). When considered competing risk of all-cause death, the risk of SPLC in the radiation group was similar to that in the non-radiation group (adjusted sHR = 0.80, 95% CI 0.56, 1.13, P = 0.21). The risk of SPLC was different during different follow-up time. Irradiation for IPLC seemingly did not affect the risk of developing SPLC.

P06.01 Therapeutic Strategies for Metachronous Multiple Primary Lung Cancer

It is not uncommon to encounter metachronous primary lung cancer after surgical treatment along with the increase in the elderly patients. In consideration of increasing number of such patients, it is necessary to take various treatment strategies. Method: In order to establish a treatment strategy for multiple lung cancer, we retrospectively examined multiple lung cancer cases operated for primary lung cancer in our department from January 2013 to December 2018, and the future treatment strategy was examined. In order to establish a treatment strategy for multiple lung cancer, we retrospectively examined multiple lung cancer cases operated for primary lung cancer in our department from January 2013 to December 2018, and the future treatment strategy was examined. Of 821 patients who underwent surgery for primary lung cancer, 60 were multiple lung cancers, 31 were synchronous multiple lung cancers, and 29 were metachronous multiple lung cancers. Among the cases of metachronous multiple lung cancer, 27 cases had undergone lobectomy or more in the first operation, 1 case of segmental resection, and 1 case of partial resection. As for the treatment of secondary lung cancer lesions, 20 lesions were performed surgery (lobectomy; 1, segmental resection;5, partial resection; 14), 6 lesions of photodynamic therapy (PDT), and 3 lesions of SBRT. Among the surgical cases, there were 3 cases on the same side as the first cancer and 17 cases on the opposite side. The three cases underwent partial resection. Among 17 patients, postoperative home oxygen therapy was introduced in 2 patients. Regarding the prognosis, three patients who had surgical resection, died of recurrence of the first lesion. Two of the six PDT patients died of recurrence of the first lung cancer and one died of other disease. All three patients who underwent SBRT are alive without recurrence. If early detection and early diagnosis are made as a treatment strategy for metachronous multiple lung cancer, it may be possible to preserve lung function by reducing surgery or SBRT, PDT, and to cure without damaging the quality of life.

Surgical outcomes of ipsilateral metachronous second primary lung cancer.

The optimal surgical approach for metachronous second primary lung cancer (MSPLC), especially ipsilateral MSPLC, remains unclear. This study aimed to review postoperative complications and examine surgical outcomes based on the extent of resection after surgery for ipsilateral MSPLC. Clinical data from 61 consecutive patients who underwent pulmonary resection for ipsilateral MSPLC according to the Martini-Melamed criteria between January 2005 and December 2017 in 3 institutes were retrospectively reviewed. Postoperative complications were identified in 12 patients (19.7%). Regarding the combination of initial and second surgery, intraoperative bleeding was significantly greater in patients with anatomic-anatomic resection than in others (P < 0.001). Operation time was significantly longer in patients with anatomic-anatomic resection than in others (P < 0.001). However, postoperative complications showed no significant differences based on the combination of surgeries. Five-year overall survival rates in patients with anatomic resection and wedge resection after second surgery were 75.8% and 75.8%, respectively (P = 0.738), and 5-year recurrence-free survival rates were 54.2% and 67.6%, respectively (P = 0.368). Cox multivariate analysis identified ever-smoker status (P = 0.029), poor performance status (P = 0.011) and tumour size >20 mm (P = 0.001) as independent predictors of poor overall survival, while ever-smoker status (P = 0.040) and tumour size >20 mm (P = 0.007) were considered independent predictors of poor recurrence-free survival. Regarding postoperative and long-term outcomes for patients with ipsilateral MSPLC, surgical intervention is safe and offers good long-term survival. Wedge resection is an acceptable provided tumours ≤2 cm and ground-glass opacity-predominant as a second surgery for early-stage ipsilateral MSPLC.

LATE LIVER METASTASIS 20 YEARS AFTER THE INITIAL DIAGNOSIS: A CASE REPORT OF METACHRONOUS HORMONE DEPENDENT TUMORS OF BREAST AND ENDOMETRIUM

Breast cancer is the most common cancer and a significant cause of morbidity and mortality in female population worldwide. The liver is the third most common metastatic site for invasive breast malignancy besides bones, lungs and brain. Breast cancer has been linked with metachronous bone, endometrial, colon/rectal, connective tissue (sarcoma), leukemia, lung, ovary or thyroid cancer. Studies have shown an increased risk of secondary malignancies in women treated for breast malignancy in connection to adjuvant treatment in certain cases. We present a case of a 71 year old woman who was diagnosed with breast cancer 20 years ago. The primary diagnosis was invasive lobular breast cancer localized in left lower lateral quadrant. Micromorphological, histochemical and immunohistochemical analyses rendered diagnosis inconclusive due to lack of tissue so after 4 months rebiopsy was performed. Clinico-pathological correlation of the second biopsy was in favor of liver metastasis of partially hormone dependent breast cancer. Immunohistochemistry was vital for the diagnosis on the liver biopsy, in particular GATA3 positivity and vimentin negative staining which helped us exclude endometrial cancer metastasis which was diagnosed before the initial liver biopsy. GATA 3(+)/vimentin(-) panel proved to be superior to GCDFP-15 and mammaglobin in proving the breast origin of the secondary tumor deposit.Liver metastasis from primary breast cancer can in certain cases occur many years after the initial diagnosis which shows the importance and necessity for long term follow-up of these patients, while considering the possibility of metachronous tumors as well.

Surgical Outcomes in a Lung Cancer-Screening Program Using Low Dose Computed Tomography

ObjectiveLung cancer (LC) is the leading cause of death from cancer worldwide. More than 27,000 LCs are diagnosed annually in Spain, and most are unresectable. Early detection and treatment reduce LC mortality. This study describes surgical outcomes in a longstanding LC screening cohort in Spain. MethodsWe conducted a retrospective study of surgical outcomes in a LC screening (LCS) program using low dose computed tomography (LDCT) since the year 2000. A descriptive analysis of clinical and radiological parameters, presence or absence of a preoperative diagnosis, pathological staging, morbidity, mortality, and survival was performed. ResultsNinety-seven (2.5%) LC were diagnosed in 3825 screened. Twenty individuals with LC had no surgery due to advanced stage or small cell histology. Eighty-seven surgical procedures were carried out for suspected or biopsy proven LC, detected by LDCT. Most operated patients were male (57[85%]) aged 64±9.1 years. Nine patients underwent a second operation for a metachronous primary lung cancer. Mean tumor size was 15.2±7.6mm. Eight nodules were benign (9.2%). Lobectomy was performed in 56 cases (83.6%). Adenocarcinoma (n=39; 58.2%) was the most frequent histological type followed by squamous cell carcinoma (n=17; 25.4%). Fifty-nine (88%) tumors were in Stage I. Thirteen patients (15.4%) had 16 complications. The estimated survival rates at 5 and 10 years for stage I were 93% (95% CI: 79%–98%) and 83% (95% CI: 65%–92%), respectively. ConclusionLung cancer screening was associated with excellent surgical outcomes with 5 and 10-year survival rates exceeding 90 and 80%, respectively.

Metachronous, Ipsilateral Primary Lung Cancer: A Case Report

Lung cancer is the most common malignant tumor in men worldwide. It has been documented that patients can develop multiple primary lung cancer, with a 5% annual risk of a second primary (metachronous) cancer occurring after prior curative treatment. Moreover, there has been an increase in the incidence of metachronous primary lung cancer reflecting a longer survival after curative resection of the primary cancer and improvements in patient surveillance methods. Herein, we present a case of a patient diagnosed with a metachronous primary lung cancer presenting 1 year after treatment of a primary lung cancer at National Chest Hospital, Kingston, Jamaica. Through strict adherence to surveillance guidelines, this metachronous cancer was detected, enabling the patient to be promptly treated.

右肺下葉切除後に中葉温存残存右上葉切除を行った異時性肺癌の1例

右肺下葉切除後に中葉温存残存右上葉切除を行った異時性肺癌の1例

Cost-Effectiveness of Surveillance Scanning Strategies after Curative Treatment of Non-Small-Cell Lung Cancer.

BackgroundAfter curative treatment of primary non–small-cell lung cancer (NSCLC), patients undergo intensive surveillance with the aim to detect recurrences from the primary tumor or metachronous second primary lung cancer as early as possible and improve overall survival. However, the benefit of surveillance is debated. Available evidence is of low quality and conflicting. Microsimulation modeling facilitates the exploration of the impact of different surveillance strategies and provides insight into the cost-effectiveness of surveillance.MethodsA microsimulation model was used to simulate a range of computed tomography (CT)–based surveillance schedules, differing in the frequency and duration of CT surveillance. The impact on survival, quality-adjusted life-years, costs, and cost-effectiveness of each schedule was assessed.ResultsTen of 108 strategies formed the cost-effectiveness frontier; that is, these were the strategies with the optimal cost-health benefit balance. Per person, the discounted QALYs of these strategies varied between 5.72 and 5.81 y, and discounted costs varied between €9892 and €19,259. Below a willingness-to-pay threshold of €50,000/QALY, no scanning is the preferred option. For a willingness-to-pay threshold of €80,000/QALY, surveillance scanning every 2 y starting 1 y after curative treatment becomes the best option, with €11,860 discounted costs and 5.76 discounted QALYs per person. The European Society for Medical Oncology guideline strategy was more expensive and less effective than several other strategies.ConclusionModel simulations suggest that limited CT surveillance scanning after the treatment of primary NSCLC is cost-effective, but the incremental health-benefit remains marginal. However, model simulations do suggest that the guideline strategy is not cost-effective.

Metachronous lung cancer resection on extracorporeal membrane oxygenation in a pneumonectomized and mediastinum irradiated patient

Metachronous lung cancer resection on extracorporeal membrane oxygenation in a pneumonectomized and mediastinum irradiated patient

Outcomes of Local Ablative Therapy for Metachronous Oligometastatic Non-Small Lung Cancer

Outcomes of Local Ablative Therapy for Metachronous Oligometastatic Non-Small Lung Cancer

Contralateral pulmonary resection using selective bronchial blockade in postpneumonectomy patients.

BackgroundPulmonary resection is occasionally performed in postpneumonectomy patients with contralateral lung lesions, such as metachronous or metastatic lung cancer. Careful intraoperative respiratory management is essential in such patients. This study evaluated the respiratory management of postpneumonectomy patients who underwent contralateral pulmonary resection with selective bronchial blockade of the lobe or segment to be resected.MethodsWe retrospectively analyzed the surgical findings and safety of surgery in six patients who underwent contralateral pulmonary resection with selective bronchial blockade after pneumonectomy for non‐small cell lung cancer (NSCLC).ResultsThe percutaneous oxygen saturation did not decrease in any of the patients during bronchial blockade under high oxygen concentration. The median blockade time was 57.5 minutes. The operative field was tolerable secured under conditions of partial lung collapse, and partial pulmonary resection was performed as planned. Postoperatively, one patient developed acute respiratory distress syndrome due to acute exacerbation of interstitial pneumonia; however, no patients died within one month postoperatively. Two patients underwent pulmonary resection in order to obtain adequate tissue specimens to evaluate the biomarkers of multiple lung metastases. On histopathology, one patient tested positive for anaplastic lymphoma kinase (ALK) and was subsequently administered an ALK inhibitor, which prolonged survival.ConclusionsIn all patients, intraoperative respiratory condition under partial lung collapse remained stable, and all partial pulmonary resections were safely performed. However, surgical indications should be carefully reviewed preoperatively in patients with interstitial pneumonia.Key pointsSignificant findings of the study Contralateral partial pulmonary resection was performed using selective bronchial blockade in postpneumonectomy patients.Percutaneous oxygen saturation did not decrease during the bronchial blockade under high oxygen concentration, and the operative field was tolerable secured under conditions of partial lung collapse. What this study adds Oxygen concentration can be set to the minimum level, sufficient to maintain oxygenation, during contralateral partial pulmonary resection with selective bronchial blockade.

THREE METACHRONOUS PRIMARY LUNG CANCERS IN A CHRONIC SMOKER: A CASE REPORT

SESSION TITLE: Fellows Lung Cancer Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Lung cancer is the worldwide leading cause of cancer-related deaths. Patients once treated curatively for lung cancer can develop subsequent primary lung cancer. Smoking is the major risk factor for the development of lung cancer and contributes to a higher risk of developing a second lung cancer in patients who continue to smoke after diagnosis and treatment of the initial cancer. The subsequent primary lung cancer can be treated successfully, however, both treatment regimen and prognosis depend on whether it is synchronous or metachronous. CASE PRESENTATION: A 60-year-old smoker with 55 pack-year history, presented with cough and hemoptysis. His physical exam was remarkable for clubbing. His pulmonary function testing revealed moderately severe chronic obstructive pulmonary disease (COPD). A Computerized Tomographic (CT) scan revealed a right upper lobe spiculated mass. Positron emission tomography (PET) scan showed standard uptake value (SUV) of 4.5 in the primary tumor and ipsilateral hilar and paratracheal nodes in metastatic range. Histopathologic examination of a transthoracic needle biopsy showed poorly differentiated adenocarcinoma (ADC) of the lung, stage IIIA. The patient was curatively treated with chemotherapy and radiation. After nine years he developed a new posterior left upper lobe spiculated nodule. PET/CT showed it to have an SUV of 4. The patient underwent apical wedge resection of the left upper lobe. Histopathological examination showed moderately differentiated keratinizing squamous cell carcinoma (SCC), stage IA1. He was given extensive counseling on smoking cessation, but he was still not able to quit. Six months later, CT of the chest showed increased soft tissue density and adenopathy of the right hilum with perilymphatic nodules in the right upper and lower lobes consistent with lymphangitic carcinomatosis. The patient underwent transbronchial biopsy reporting a small cell carcinoma (SCLC). Due to poor performance status, he was not a candidate for systemic chemotherapy, and he decided to go into hospice care. DISCUSSION: We reviewed the clinical and pathological features of synchronous and metachronous lung cancers in previously described patients. These patients were below the average age at which first lung cancer diagnosis is made in most patients, had long smoking histories, and histological type occurred in random order. The patients with metachronous cancers continued to smoke after the first or second cancer diagnosis which placed them at a higher risk for subsequent cancer(s). CONCLUSIONS: We recommend that patients with lung cancer diagnosis must quit smoking to reduce the risk of a second primary cancer, and those who do not quit should remain on long-term surveillance. Reference #1: de Groot PM, Wu CC, Carter BW, Munden RF. The epidemiology of lung cancer. Transl Lung Cancer Res. 2018;7(3):220-233. Reference #2: Han SS, Rivera GA, Tammemagi MC, et al. Risk Stratification for Second Primary Lung Cancer. J Clin Oncol. 2017;35(25):2893-2899. Reference #3: Smith RA, Andrews KS, Brooks D, et al. Cancer screening in the United States, 2018: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2018;68(4):297-316 DISCLOSURES: No relevant relationships by Boris Betancourt, source=Web Response No relevant relationships by Lillian Chow, source=Web Response No relevant relationships by Dushyant Damania, source=Web Response No relevant relationships by Raavi Gupta, source=Web Response no disclosure on file for M Haseeb; no disclosure on file for Absia Jabbar; No relevant relationships by James Mahoney, source=Admin input No relevant relationships by gurinder sidhu, source=Web Response

TRIPLE THREAT: A CASE OF MULTIPLE PRIMARY LUNG CANCERS

SESSION TITLE: Medical Student/Resident Lung Cancer Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Multiple primary lung cancers (MPLC) are a rare occurrence and have 2 forms – synchronous (sMPLC) and metachronous (mMPLC). The sMPLCs are physically distinct with different histological subtypes. If they are the same subtype, they must be in different lobes of the lung, originating from carcinoma in situ, and no tumor in common lymphatics and extrapulmonary metastases. The mMPLCs tumors must be histologically different or if they are histologically identical, there must be a >2 year cancer free interval, originate from carcinoma in situ, and second cancer must be in a different lobe or lung with no carcinoma in the common lymphatics and no extrapulmonary metastases. mMPLC is common and secondary to treatment of initial lesions. Tobacco smoke may also create a “field effect” in which multicentric lung cancers manifest more frequently. CASE PRESENTATION: A 66-year-old female presented for follow up of sMPLC Stage IB left upper lobe adenocarcinoma/Stage IA right middle lobe squamous cell carcinoma. Patient was treated in 2015 via left upper lobectomy and right middle lobe pulmonary wedge resection. Patient history includes 40-pack-years of smoking, COPD, and continued smoking after treatment of prior sMPLC. Surveillance chest CT showed increase in size of subcarinal lymph node and right lymph node conglomerate encasing the right upper lobe pulmonary artery, consistent with metastasis. Fine needle aspiration of level 4R lymph nodes revealed cells clusters with nuclear molding, high nuclear to cytoplasmic ratio, inconspicuous nuclei, minimal cytoplasm, and crush artifacts. Immunohistochemically tumor cells were positive for TTF-1 and synaptophysin, and negative for P40 – confirming diagnosis of small cell carcinoma. DISCUSSION: Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are known to be linked with tobacco, creating a “field effect” that promotes the possibility of MPLCs. NSCLC include adenocarcinoma and squamous cell carcinoma (SCC). SCLC and NSCLC are differentiated based on morphology and immunohistochemical staining, the results of which confirmed diagnosis of small cell carcinoma and thus qualified as mMPLC in our case. Treatment of mMPLC is often surgical resection, however, feasibility must be assessed based on pulmonary reserve. Limited resections should be attempted in all cases as segmentectomies have similar outcomes to lobectomies in terms of recurrence-free survival, notably in tumors under 3 cm. CONCLUSIONS: In patients with a history of MPLC associated with smoking, physicians should be cognizant of additional malignancies different from the original lesion subtype. Biopsy and histopathology are the gold standard for diagnosis. Surgery is the standard treatment in MPLC, but clinicians should assess for sufficient pulmonary reserve to ensure viability. Reference #1: Chen C, Huang X, Peng M, Liu W, Yu F, Wang X. Multiple primary lung cancer: a rising challenge. Journal of thoracic disease. 2019; 11(Suppl 4):S523-S536. Reference #2: Chen TF, Xie CY, Rao BY, et al. Surgical treatment to multiple primary lung cancer patients: a systematic review and meta-analysis. BMC surgery. 2019; 19(1):185. Reference #3: Jiang L, He J, Shi X, et al. Prognosis of synchronous and metachronous multiple primary lung cancers: systematic review and meta-analysis. Lung cancer (Amsterdam, Netherlands). 2015; 87(3):303-10. DISCLOSURES: No relevant relationships by jayanth keshavamurthy, source=Web Response No relevant relationships by Diana Kozman, source=Web Response No relevant relationships by Samantha Mattox, source=Web Response No relevant relationships by Rohit Munagala, source=Web Response No relevant relationships by Nikhil Patel, source=Web Response No relevant relationships by Kanwar Singh, source=Web Response No relevant relationships by Asad Ullah, source=Web Response

Surgery or stereotactic body radiotherapy for metachronous primary lung cancer? A propensity score matching analysis.

We compared outcomes after surgery or stereotactic body radiotherapy (SBRT) among patients with metachronous primary lung cancer (MPLC). Patients with MPLC were treated with either surgery (2008-2018) or SBRT (2010-2018). We used propensity score matching (PSM) to reduce bias from various clinicopathological factors. MPLC was defined by the Martini and Melamed criteria. Of 77 patients, 51 underwent surgery and 26 received SBRT. Most median clinicopathological characteristics did not significantly differ between the surgery and SBRT groups (male sex: 67% vs 65%; age: 73 vs 77years; time after first surgery: 6.2 vs 4.7years; lobectomy as first procedure: 82% vs 85%; second tumor size: 11 vs 12mm; clinical stage I: 96% vs 100%; CEA: 2.9 vs 3.0ng/ml). However, the surgery group had significantly more ipsilateral second tumors (n = 71, 58%, P = 0.003), better performance status (P = 0.03), and preserved lung function (P = 0.02). Surgery, thus, tended to be selected for patients with good physical function and for the MPLC in the contralateral side. Five-year overall survival did not significantly differ between the surgery and SBRT groups, either before PSM (86.5% vs 65.8%, P = 0.24, log-rank) or after PSM (100% vs 84.4%, P = 0.73). Surgery and SBRT for MPLC patients are safe and feasible treatments with similar outcomes. However, this finding should be verified by a random controlled trial with a larger study cohort.