Metachronous Lung Cancer Research Articles

De novo malignant eccrine spiradenoma and metachronous lung cancer

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Unal D, Tasdemir A, Oguz A, Koc A, Benderli Y. Case reportDe novo malignant eccrine spiradenoma and metachronous lung cancer. Contemporary Oncology/Współczesna Onkologia. 2014. doi:10.5114/wo.2014.40598. APA Unal, D., Tasdemir, A., Oguz, A., Koc, A., & Benderli, Y. (2014). Case reportDe novo malignant eccrine spiradenoma and metachronous lung cancer. Contemporary Oncology/Współczesna Onkologia. https://doi.org/10.5114/wo.2014.40598 Chicago Unal, Dilek, Arzu Tasdemir, Arzu Oguz, Ali Koc, and Yasemin Cihan Benderli. 2014. "Case reportDe novo malignant eccrine spiradenoma and metachronous lung cancer". Contemporary Oncology/Współczesna Onkologia. doi:10.5114/wo.2014.40598. Harvard Unal, D., Tasdemir, A., Oguz, A., Koc, A., and Benderli, Y. (2014). Case reportDe novo malignant eccrine spiradenoma and metachronous lung cancer. Contemporary Oncology/Współczesna Onkologia. https://doi.org/10.5114/wo.2014.40598 MLA Unal, Dilek et al. "Case reportDe novo malignant eccrine spiradenoma and metachronous lung cancer." Contemporary Oncology/Współczesna Onkologia, 2014. doi:10.5114/wo.2014.40598. Vancouver Unal D, Tasdemir A, Oguz A, Koc A, Benderli Y. Case reportDe novo malignant eccrine spiradenoma and metachronous lung cancer. Contemporary Oncology/Współczesna Onkologia. 2014. doi:10.5114/wo.2014.40598.

Second primary non-small-cell lung cancer: implications of the new adenocarcinoma classification in the challenging decision of the best surgical strategy

Zuin et al. [1] have recently reported an interesting retrospective analysis on a relative large series of second primary non-small-cell lung cancers (NSCLCs), comparing the long-term outcomes between patients treated with a lobectomy and those where a sub-lobar resection was performed, which prompted a series of reflections by us, discussed here. The best therapeutic strategy for synchronous/metachronous primary NSCLCs remains an open subject of discussion in the scientific community, particularly regarding the surgical approach. By commenting on the paper by Zuin et al. [1], we wish to contribute to this debate. The International Association for the Study of Lung Cancer (IASLC) has issued a revised adenocarcinoma classification [2] jointly with the American Thoracic Society (ATS) and the European Respiratory Society (ERS). Briefly, the confusing term ‘bronchioloalveolar carcinoma’ has been discontinued and the entire category of pulmonary adenocarcinomas has been reclassified into three different subgroups: adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinomas (IA). As remarked in detail by Van Schil et al. [3], this new classification has profound implications for thoracic surgeons in the management of ‘early-stage’ adenocarcinomas; indeed the ‘early-stages’ AIS and MIA should have 100% or near 100% disease-specific survival after sub-lobar resection and mediastinal sampling, respectively, where the oncological need to perform a lobar resection and mediastinal lymph nodal systematic resection is reserved for IAs only. By extreme simplification we may infer that such relevant new evidence deserves focal attention when planning the best surgical strategy in second primary NSCLCs. First, we would like to encourage the authors to abandon the ‘old’ histopathological classification when matching data with the most updated TNM framework (7th). In particular, it would be extremely helpful to reclassify the vast amount of precious data according to the new classification to get significant clues (albeit with the limitations of a retrospective analysis exercise) for further prospective evaluations. Secondly and more generally, when an ‘early-stage’ adenocarcinoma is detected and rightfully classified as a synchronous or metachronous primary lung tumour, the decision-making process and the best strategy of treatment should mandatorily take into the account the new IASLC/ATS/ERS classification. Indeed, the same profound implications in the management of ‘early-stage’ adenocarcinomas (summarized above) may have a crucial value (or even more) in the management of ‘early-stage’ second adenocarcinomas too. Basically, the different surgical outcomes between lobar vs sub-lobar resections in a ‘second adenocarcinoma’ may be potentially influenced by the different prognostic pattern at the base of the new categories (AIS, MIA and IA). Thirdly and finally, as correctly remarked by the authors, ‘. . . the possibility that some cases of solitary pulmonary metastasis always exist within the group of patients with synchronous and early metachronous lung cancers could be included.’. In this context, although the IASLC/ATS/ERS classification recommended testing only patients with advanced adenocarcinomas for epidermal growth factor receptor (EGFR) mutations, we strongly advocate the assessment of EGFR mutations also in patients with synchronous/ metachronous primary adenocarcinomas, also, because the eventual differences in clonality may indeed be a helpful tool for the differential diagnosis of pulmonary metastases vs secondary lung neoplasms [4]. We would greatly appreciate the authors reflections and reactions to the points raised.

Metachronous lung cancer that presented as bilateral synchronous lung cancer.

Every patient undergoing curative treatment for primary lung cancer is a candidate for metachronous lung cancer, with a reported risk of 5% per year. The majority of cases are stage I patients. Patients who undergo resection for lung cancer should be followed regularly. A metachronous lung cancer that develops as bilateral synchronous lung cancer is very rare.

Special Treatment Issues in Non-small Cell Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

This guideline updates the second edition and addresses patients with particular forms of non-small cell lung cancer that require special considerations, including Pancoast tumors, T4 N0,1 M0 tumors, additional nodules in the same lobe (T3), ipsilateral different lobe (T4) or contralateral lung (M1a), synchronous and metachronous second primary lung cancers, solitary brain and adrenal metastases, and chest wall involvement. The nature of these special clinical cases is such that in most cases, meta-analyses or large prospective studies of patients are not available. To ensure that these guidelines were supported by the most current data available, publications appropriate to the topics covered in this article were obtained by performing a literature search of the MEDLINE computerized database. Where possible, we also reference other consensus opinion statements. Recommendations were developed by the writing committee, graded by a standardized method, and reviewed by all members of the Lung Cancer Guidelines panel prior to approval by the Thoracic Oncology NetWork, Guidelines Oversight Committee, and the Board of Regents of the American College of Chest Physicians. In patients with a Pancoast tumor, a multimodality approach appears to be optimal, involving chemoradiotherapy and surgical resection, provided that appropriate staging has been carried out. Carefully selected patients with central T4 tumors that do not have mediastinal node involvement are uncommon, but surgical resection appears to be beneficial as part of their treatment rather than definitive chemoradiotherapy alone. Patients with lung cancer and an additional malignant nodule are difficult to categorize, and the current stage classification rules are ambiguous. Such patients should be evaluated by an experienced multidisciplinary team to determine whether the additional lesion represents a second primary lung cancer or an additional tumor nodule corresponding to the dominant cancer. Highly selected patients with a solitary focus of metastatic disease in the brain or adrenal gland appear to benefit from resection or stereotactic radiosurgery. This is particularly true in patients with a long disease-free interval. Finally, in patients with chest wall involvement, provided that the tumor can be completely resected and N2 nodal disease is absent, primary surgical resection should be considered. Carefully selected patients with more uncommon presentations of lung cancer may benefit from an aggressive surgical approach.

Outcomes of oral squamous cell carcinoma arising from oral epithelial dysplasia: rationale for monitoring premalignant oral lesions in a multidisciplinary clinic

Surveillance of oral epithelial dysplasia results in a number of newly diagnosed cases of oral squamous cell carcinoma (SCC). The clinical stage of oral SCC at diagnosis influences the magnitude of treatment required and the prognosis. We aimed to document the stage, treatment, and outcome of oral SCC that arose in patients who were being monitored for oral epithelial dysplasia in a dedicated multidisciplinary clinic. Those with histologically diagnosed lesions were enrolled on an ethically approved protocol and molecular biomarker study. Details of clinical and pathological TNM, operation, radiotherapy, recurrence, second primary tumour, and prognosis, were recorded in patients whose lesions underwent malignant transformation. Of the 91 patients reviewed (median follow-up 48 months, IQR 18-96), 23 (25%) had malignant transformation. All were presented to the multidisciplinary team with stage 1 disease (cT1N0M0). Of these, 21 were initially treated by wide local excision, 2 required resection of tumour and reconstruction, and 2 required adjuvant radiotherapy. At follow-up 3 had local recurrence, one had regional recurrence, one had metachronous lung cancer, and 5 had second primary oral SCC. There were further diagnoses of oral dysplasia in 5 during follow-up, and it is estimated that 76% of patients will have one or other event in 5 years. Disease-specific survival was 100% and overall survival was 96% (22/23). Median follow-up after diagnosis of oral SCC was 24 months (IQR 11-58). Specialist monitoring of oral epithelial dysplasia by a multidisciplinary team allows oral SCC to be detected at an early stage, and enables largely curative treatment with simple and usually minor surgical intervention. The high incidence of second primary oral SCC in high-risk patients with oral epithelial dysplasia further supports intensive targeted surveillance in this group.

Surgical treatment of metachronous second primary lung cancer after complete resection of non–small cell lung cancer

To clarify the perioperative and oncologic outcome of pulmonary resection for a metachronous second primary lung cancer (MSPLC) following resection of an initial non-small cell lung cancer (NSCLC). Retrospective chart review identified 161 patients (88 men and 73 women) with a median age of 70 years (range, 34-88 years) who underwent pulmonary resection for MSPLC between January 2000 and December 2009. Operative morbidity, mortality, and relevant factors were analyzed with χ(2) test or Fisher exact test and Mann-Whitney U test. Survival was analyzed with Kaplan-Meier and Cox proportional hazard method. The median interval between the initial and subsequent resection for MSPLC was 42.7 months (range, 7-205 months). There was no operative mortality and postoperative complication rate was 29%. In multivariate analysis, ipsilateral operation (P = .0002) and a lower predicted preoperative percent forced expiratory volume in the first second (P = .0035) were significant risk factors for postoperative complications. Five-year overall survival rates after resection of the initial and second metachronous NSCLC were 87.4% and 60.8%, respectively. Significant negative long-term prognostic factors for survival following resection of a MSPLC in multivariate analysis were tumor size >2 cm (P = .003) and number of pack years of smoking (P = .005). Metastatic nodal disease (P = .19) or a sublobar resection (P = .17) were not associated with worse survival. Surgical treatment of a MSPLC can be undertaken with 5-year survival rate of 60%. Expected operative morbidity and mortality are comparable to primary surgery. Tumors 2 cm or smaller are associated with improved survival and freedom from recurrence. Close long-term follow-up of patients who have undergone resection of NSCLC is recommended.

Metachronous lung cancer in a patient who cured small cell lung cancer

Metachronous lung cancer in a patient who cured small cell lung cancer

A Case of Three Different Synchronous and Metachronous Primary Lung Cancers

Multiple primary lung cancers are characterized as either synchronous (detected or resected simultaneously) or metachronous (defined by a time interval between the detection of a subsequent primary lesion). The diagnosis of multiple primary lung cancers requires the temporal, histologic, and anatomic classification of tumors or simultaneous detection of two tumors. The incidence of multiple primary lung cancers has been increasing recently due to the widespread use of imaging modalities and life extension. Here, we report a 65-year-old male patient with multiple primary lung cancers comprising three different cell types (adenocarcinoma, squamous cell carcinoma, and small cell carcinoma). (Korean J Med 2013;85:639-643)

Pulmonary Resection for Metachronous Lung Cancer Following Contralateral Pneumonectomy

Patients who undergo pneumonectomy for lung cancer are at risk of recurrent disease and metachronous tumours in the remaining lung. Establishing a diagnosis can be difficult as biopsy may induce a pneumothorax, whilst resection is limited by remaining lung function. However, pneumonectomy should not be a contraindication to further lung resection. We report two cases of lung cancer resection in the residual lung 6 and 11 years following pneumonectomy respectively. A limited resection can be safely performed for a new pulmonary parenchymal lesion on a background of a previous pneumonectomy.

Solitary pulmonary metastasis from lung cancer harboring EML4–ALK after a 15-year disease-free interval

It is often difficult to differentiate metachronous primary lung cancers from local pulmonary recurrences when the histopathological findings are similar. A 43-year-old man underwent right upper lobectomy with lymph node dissection for primary lung adenocarcinoma (p-T2aN0M0, stage IB). Fifteen years later, he developed a lung nodule in his right middle lobe. The tumor was preoperatively thought to be a metachronous second primary lung adenocarcinoma, and was surgically resected. Histopathological findings for both tumors were of poorly differentiated adenocarcinoma with mucus production. Both tumors also harbored the EML4 (echinoderm microtubule-associated protein-like 4)–ALK (anaplastic lymphoma kinase) fusion gene (variant 3a+b). Based on this molecular finding, the pulmonary nodule was considered to be a recurrence after very long latent period.

The third primary-the second metachronous lung cancer in the same patient

Having more than one lung carcinoma in an organism is called as multiple primary lung carcinoma. The probability of having a second primary lung carcinoma in the same patient at the different times is very rare.Third primary lung carcinoma has not been reported in literature before. A sychronous mass was determined on a 67 years old man about eight years ago. The mass was localized on the left upper lobe and it's histologic type was squamous cell carcinoma/adenosquamous cell carcinoma (bronchioalveolar component). A left upper lobectmy was performed with a left thorocotomy. Thirty nine months after that operation a metachronous epidermoid carcinoma was determined on the right upper lobe, consequently a right upper lobectomy was performed to him. A squamous cell carcinoma was determined on the right intermedier bronch as a third time and second metachronous 49 months later after the first operation. After all he underwent chemotherapy. We reported this case because of a second metachronous tumour in the same patient has not been reported before and to emphasize the effects of postoperative follow up on the prognosis.

Surgical Treatment for Metachronous Second Primary Lung Cancer after Radical Resection of Primary Lung Cancer

We retrospectively reviewed our experience of surgical resection for second primary lung cancer (SPLC) in our institute. And to clarify whether periodic follow-up after resection of first primary lung cancer (FPLC) is associated with earlier detection of SPLC. From January 2003 to March 2011, a total of 386 patients underwent surgical resection for primary lung cancer in our institute. Of these patients, 21 (5.4%) with SPLC were observed during follow-up after surgery. Radiation therapy was selected instead of surgical resection in 7 patients to preserve respiratory function. The other14 patients are reviewed in this paper. Histological types were different between FPLC and SPLC in only one patient(FPLC: adenosquamous carcinoma, SPLC: squamous cell carcinoma). The average SPLC tumor size (18±8 mm) was smaller (P = 0.07) than the average FPLC tumor size (26±14 mm). Recurrence was not observed in these patients.The follow-up period after resection of SPLC was 31±30 (5-94) months. During followup, 2 patients died of de novo malignancies, and the other 12 patients were alive without recurrence. Systematic and periodic long-term follow-up after FPLC probably resulted in earlier detection of SPLC and yielded this good prognosis.

Clinical Outcomes and Prognostic Factors for Surgically Resected Second Primary Lung Cancer

This study was designed to analyze the predictive factors for survival in second primary lung cancer patients following operation. A total of 1852 patients who underwent resection for primary lung cancer between January 1990 and December 2008 were reviewed, retrospectively. Nineteen patients were treated for synchronous second primary lung cancer and 23 patients were treated for metachronous cancer. The overall 5-year survival rate for patients with synchronous second primary lung cancer was comparable to that of patients with single-lung cancer (51.4 vs. 48.7%, p = 0.755). The overall 5-year survival rate after the first tumor resection in patients with metachronous second primary lung cancer was significantly better than that of patients with single-lung cancer (85.4 vs. 48.7%, p = 0.003), but was not significantly different after the second tumor resection (77.0 vs. 48.7%, p = 0.057). Surgically resected second primary lung cancer had a survival comparable with single-lung cancer. Histologic concordance between the first and second tumors, and the pathological stage were important prognostic factors in second primary lung cancer.

Results of Long-Term Follow-Up of Patients With Completely Resected Non-Small Cell Lung Cancer

In patients with completely resected non-small cell lung cancer, recurrence-free survival, postrecurrence survival, and metachronous primary lung cancer have not been well studied at the same time. A total of 315 patients with non-small cell lung cancer who underwent complete resection between 2001 and 2005 were examined. Patients were routinely assessed with computed tomography of the chest and physical checkups every 4 months for the first 2 years and every 6 months from the third to the fifth year. After that, they were examined annually. The overall 5-year survival was 70%. Of all 315 patients, 107 had recurrent disease. The median recurrence-free survival was 15.7 months. Multivariate analysis showed that pathologic stage and pleural invasion were associated with decreased recurrence-free survival. The median postrecurrence survival was 18.7 months. Multivariate analysis indicated that male sex, pleural invasion, extrathoracic recurrence, and supportive care for recurrence were associated with decreased postrecurrence survival. The cumulative rate of metachronous primary lung cancer at 5 years was 3.7%, and it developed even 8 years after the initial operation. Only pleural invasion of the original lung cancer was related to both recurrence-free survival and postrecurrence survival. Moreover, postrecurrence survival was related to both site and treatment of the initial recurrence. The incidence of metachronous primary lung cancer was stable over time after the initial operation.

Metachronous lung cancer in a patient after successfully treated small cell lung cancer

Metachronous lung cancer in a patient after successfully treated small cell lung cancer

Invited Commentary

Invited Commentary

Repeat mediastinoscopy in all its indications: experience with 96 patients and 101 procedures

To evaluate the accuracy of repeat mediastinoscopy (reMS) in all its indications, and to analyse survival in the group of patients who underwent induction chemotherapy or chemoradiotherapy for pathologically proven stage III-N2 non-small-cell lung cancer (NSCLC). From July 1992 to February 2009, 96 patients (87 men; median age: 61.3 years), underwent 101 reMSs (five patients required a second reMS) for the following indications: restaging after induction therapy for pathologically proven N2 disease (84 cases), inadequate first mediastinoscopy (five), metachronous second primary (six) and recurrent lung cancer (six). Patients with N2-NSCLC, who had received induction therapy and had positive reMS, underwent definitive chemotherapy or chemoradiotherapy. Patients in whom reMS was negative underwent thoracotomy for lung resection and systematic nodal dissection (SND). SND was considered the gold standard to compare the negative results of reMS. Pathologic findings were reviewed and staging values were calculated using the standard formulas. Follow-up data were completed in January 2010, and survival analysis was performed by the Kaplan-Meier method. In the group of reMS for restaging after induction therapy, the staging values were: sensitivity 0.74, specificity 1, positive predictive value 1, negative predictive value 0.79 and diagnostic accuracy 0.87. We also determined the diagnostic value of this technique according to the type of induction treatment. In terms of accuracy, no statistically significant differences were found. Median survival time in patients with true negative reMS was 51.5 months (95% confidence interval (CI) 0-112), and in the combined group of patients with positive and false-negative reMS, median survival time was 11 months (95% CI 7.6-14.1) (p=0.0001). In the group of miscellaneous indications, all staging values were 1. ReMS is feasible in all the indications described. After induction therapy, it is a useful procedure to select patients for lung resection with high accuracy, independently of the induction treatment used or the intensity of the first mediastinoscopy. The persistence of lymph node involvement after induction therapy has a poor prognosis. Therefore, techniques providing cytohistological evidence of nodal downstaging are advisable to avoid unnecessary thoracotomies.

Analysis of Second Primary Lung Cancers in the SEER Database

We sought to examine the outcomes of second primary lung cancers in the large population-based Surveillance Epidemiology and End Results (SEER) database. We also sought to study the outcomes of synchronous second non-small-cell lung cancers (NSCLCs), classified as stage IVA (M1A) according to the seventh edition of the TNM staging for lung cancer. Data of patients with at least two primary lung cancers were obtained. All available variables potentially associated with the incidence of a second primary lung cancer were examined. The overall survival of patients with synchronous NSCLC was compared with those with metachronous and stage IV NSCLC. A small proportion (1.5%) of patients with lung cancer developed a second primary. A second primary is associated with younger age, female gender, earlier stage, and white race. The median survival of patients with metachronous NSCLCs (n = 3352) was worse than those with synchronous NSCLCs (n = 1858) (median survival 22 mo versus 29 mo, respectively; P < 0.01). After adjusting for age, race, gender, stage, and histology of both primaries, this difference in survival between patients with synchronous and metachronous second primary lung cancers was not statistically significant, but was better than those with stage IV NSCLC (n = 127,654; median survival 4 mo). The incidence of second primary lung cancer is lower than that previously reported. Factors associated with good prognosis predict a second primary. Synchronous NSCLCs have an outcome better than a stage IV (M1a) designation. These patients should receive appropriate stage-specific multi-modality therapy suitable for the independent stage of each cancer without considering them unresectable.

Management of Multiple Primary Lung Cancer in Patients with Centrally Located Early Cancer Lesions

Patients with centrally located early lung cancer (CLELC) are often heavy smokers with a considerably high risk of multiple primary lung cancer (MPLC) lesions; treatment strategies for such patients must preserve the cardiopulmonary function. Between July 2004 and July 2008, patients with CLELC underwent photodynamic therapy (PDT) using NPe6, second-generation photosensitizer at Tokyo Medical University Hospital. Among these patients, we retrospectively analyzed MPLC, which was treated by surgery plus PDT or PDT alone and examined the effectiveness of PDT, and we propose a treatment strategy for patients with MPLC. A total of 64 patients with CLECL received NPe6-PDT, and MPLCs were found in 22 patients (34.4%) using sputum cytology and a bronchoscopical examination using autofluorescence bronchoscopy. Among these 22 patients, 10 patients underwent surgery for primary lung cancer and underwent NPe6-PDT for the treatment of secondary primary CLELC, one patient underwent PDT for CLELC as a primary lesion followed by an operation for peripheral-type lung cancer as a secondary primary lesion, and 11 patients underwent PDT alone for MPLC lesions (28 lesions) that were roentgenographically occult lung cancers. Among these 22 patients with MPLC including peripheral-type lung cancers, which were resected by surgery, all 39 CLELC lesions exhibited a complete response after PDT, and all patients were alive. For patients with lung cancer with a long-term history of smoking, careful follow-up examinations after surgical resection are needed considering the incidence of metachronous primary lung cancers. PDT can play an important role for the treatment strategy for MPLC.

Sarcoidosis and Lung Cancer

Although sarcoidosis as well as lung cancer are frequently encountered common diseases, their metachronous or synchronous occurrence in the same patient is very rare. The charts of lung cancer patients, diagnosed between 1980 and 2007 in our hospital, were reviewed. We found 3 cases with sarcoidosis and lung cancer. The first case had lung cancer 16 years after the diagnosis of sarcoidosis. The second case had two different metachronous lung cancers 18 and 10 years after the diagnosis of sarcoidosis. The third case detected these two diseases simultaneously. In simultaneously detected cases, it is difficult to determine whether noncaseating epithelioid cell granulomas coexisting with lung cancer represent sarcoid reaction or genuine systemic sarcoidosis. Either causality or coincidence, lung cancer, a condition that can be observed in patients with sarcoidosis, should be considered in the differential diagnosis when suspicious findings of it are discovered.