Secondary Pulmonary Malignancies Research Articles

Rare lung cancers—Primary pulmonary leiomyosarcoma: A case report

SummaryPrimary pulmonary sarcomas (PPS) are rare mesenchymal lung cancers, which do not present clinically or radiological different to lung carcinomas. Definite PPS diagnosis can only be made by histological analysis and detailed staging examinations in order to exclude a secondary pulmonary malignancy such as metastatic soft tissue sarcoma or another solid tumour. Here we present the case of a 66-year-old woman with a pulmonary mass infiltrating the diaphragm and the mediastinal adipose tissue, which was identified as leiomyosarcoma. The patient received curative surgery with complete tumour R0 resection. The prognosis of PPS is defined by tumour size, lymph node status and histological grading. Surgery is the mainstay of therapy and there is no definitive indication for adjuvant therapy for R0-resected and lymph-node-negative patients like in our case. However, multimodal therapy approaches such as (neo)adjuvant chemo- and radiotherapy can contribute to improving locoregional tumour control, which is the most important prognostic factor. With our case report we want to raise awareness for pulmonary sarcomas as a relevant proportion of rare lung cancers which have to be kept in mind during the differential diagnosis. Moreover, we aim to discuss the complex and individual interdisciplinary management.

Secondary pulmonary malignancies requiring interventional bronchoscopic procedures.

Background In this study, we aimed to share our singlecenter experience and to investigate the effect of interventional bronchoscopic procedures on secondary pulmonary malignancies in terms of complications, success, and survival rates. Methods A total of 83 patients (42 males, 41 females; mean age: 57.8±15.2 years; range, 18 to 94 years) with secondary pulmonary malignancies who underwent interventional bronchoscopic procedures between January 2009 and December 2019 were retrospectively reviewed. Data including demographic and clinical characteristics of the patients, complications, and success and survival rates were recorded. Results The most common secondary pulmonary malignancies were kidney and thyroid tumors with the complaints of cough, shortness of breath, and hemoptysis. The mean duration before the diagnosis was 34.7±52.8 (range, 0.1 to 219.3) months, and the mean survival after the diagnosis were 10±13.1 (range, 0.2 to 44.4) months. A total of 92% of the patients had an airway obstruction of >50% and the interventional bronchoscopic procedures such as argon plasma coagulation, laser, cryo, and mechanical resection were successful in achieving airway patency. Laser application was found to significantly improve survival (p=0.015). Acute complication rate was 8.4% and mortality rate was 0%. Conclusion In patients with tracheobronchial lesions due to secondary pulmonary malignancies, interventional bronchoscopic procedures, regardless of the stage of the disease, provide rapid palliation in life-threatening symptoms such as dyspnea and hemoptysis due to airway obstruction, prolonging patient"s survival and gain time for additional treatments to take effect for primary disease.

Impact of radiation techniques on lung toxicity in patients with mediastinal Hodgkin\u2019s lymphoma

PurposeMediastinal radiotherapy (RT), especially when combined with bleomycin, may result in substantial pulmonary morbidity and mortality. The use of modern RT techniques like intensity-modulated radiotherapy (IMRT) is gaining interest to spare organs at risk.MethodsWe evaluated 27 patients who underwent RT for Hodgkin’s lymphoma between 2009 and 2013 at our institution. For each patient, three different treatment plans for a 30-Gy involved-field RT (IFRT) were created (anterior-posterior-posterior-anterior setup [APPA], 5‑field IMRT, and 7‑field IMRT) and analyzed concerning their inherent “normal tissue complication probability” (NTCP) for pneumonitis and secondary pulmonary malignancy.ResultsThe comparison of different radiation techniques showed a significant difference in favor of standard APPA (p < 0.01). The risk of lung toxicity was significantly higher in plans using 7‑field IMRT than in plans using 5‑field IMRT. The absolute juxtaposition showed an increase in risk for radiation pneumonitis of 1% for plans using 5‑field IMRT over APPA according to QUANTEC (Quantitative Analyses of Normal Tissue Effects in the Clinic) parameters (Burman: 0.15%) and 2.6% when using 7‑field IMRT over APPA (Burman: 0.7%) as well as 1.6% when using 7‑field IMRT over 5‑field IMRT (Burman: 0.6%). Further analysis showed an increase in risk for secondary pulmonary malignancies to be statistically significant (p < 0.01); mean induction probability for pulmonary malignoma was 0.1% higher in plans using 5‑field IMRT than APPA and 0.19% higher in plans using 7‑field IMRT than APPA as well as 0.09% higher in plans using 7‑field IMRT than 5‑field IMRT. During a median follow-up period of 65 months (95% confidence interval: 53.8–76.2 months), only one patient developed radiation-induced pneumonitis. No secondary pulmonary malignancies have been detected to date.ConclusionRadiation-induced lung toxicity is rare after treatment for Hodgkin lymphoma but may be influenced significantly by the RT technique used. In this study, APPA RT plans demonstrated a decrease in potential radiation pneumonitis and pulmonary malignancies. Biological planning using NTCP may have the potential to define personalized RT strategies

Electromagnetic Navigation-Guided Preoperative Localization of Small Malignant Pulmonary Tumors

Thoracoscopic resection of small pulmonary nodules can be challenging, which highlights the importance of preoperative localization. We report our experience with electromagnetic navigation-guided localization. The clinical, radiographic, surgical, and pathologic data of patients who underwent electromagnetic navigation-guided preoperative localization for pulmonary tumors smaller than 2 cm were reviewed. Successful localization was defined as successful identification of target lesions during the thoracoscopic procedure without palpation. Included were 30 patients with 35 nodules. There were 31 transthoracic and 5 transbronchial approaches performed. One patient received both approaches for the same tumor, and 3 received both approaches for localization of multiple targets. The median nodule size was 1.0 cm (interquartile range [IQR], 0.8-1.2 cm), and the median distance from the pleural surface was 1.1 cm (IQR, 0.6-2.0 cm). The most commonly used marker for localization was dye (n= 18), followed by microcoils (n=15). In nodules located with microcoils, the median distance between the microcoil and nodule was 1 mm (IQR, 0-3 mm). There were no complications related to the localization procedure. Successful localization was achieved in 27 of 30 patients (90.0%) and in 32 of 35 nodules (91.4%). The pathologic diagnosis was primary pulmonary malignancy in 29 nodules and secondary pulmonary malignancy in6. Our experience with electromagnetic navigation-guided transbronchial and transthoracic preoperative localization of small, malignant pulmonary tumors shows this technique is feasible and appears to be a viable option for preoperative localization of pulmonary nodules that may be difficult to locate thoracoscopically.

Lung Ablation: Indications and Techniques.

Lung ablation is ever more recognized since its initial report and use almost two decades ago. With technological advancements in thermal modalities, particularly microwave ablation and cryoablation, better identification of the cohort of patients who best benefit from ablation, and understanding the role of imaging after ablation, image-guided thermal ablation for primary and secondary pulmonary malignancies is increasingly recognized and accepted as a cogent form of local therapy.

The Role of Percutaneous Image-Guided Thermal Ablation for the Treatment of Pulmonary Malignancies.

Image-guided thermal ablation is a minimally invasive treatment option for patients with primary and secondary pulmonary malignancies. Modalities include radiofrequency ablation, microwave ablation, and cryoablation. Although no large randomized studies exist comparing ablation to surgery or radiotherapy, numerous studies have reported safety and efficacy for the treatment of both primary and metastatic disease in select patients. Future studies will refine patient selection, procedural technique, and assessment for local recurrence and will evaluate long-term survival.

Salvage lung resections is associated with reasonable survival in well-selected patients with primary and secondary pulmonary lesions

Background: The experience with salvage lung resections for primary and secondary pulmonary malignancies is to date limited and patient selection criteria are not yet defined. We report our experience in this area and present a review of the published evidence.

Feasibility of assessing pulmonary blood volume using C-arm CT during transpulmonary chemoperfusion and chemoembolization in primary and secondary lung tumours.

Assessment of parenchymal blood volume (PBV) of primary and secondary pulmonary malignancies by using a C-arm CT, regarding its role in detecting early functional response to transpulmonary chemoembolization (TPCE) and clinical practicability. 21 patients with a mean age of 56.77 years, who were assigned to TPCE during their palliative treatment, were included. PBV and the diameter of tumours were analyzed. PBV maps were calculated from three-dimensional CT-angiographic (3D-CTA) data sets. Imaging was performed on a flat detector, C-arm CT. Groups of response were classified according to the criteria of the response evaluation criteria in solid tumours. Statistically significant differences were determined and Pearson's regression analysis correlated PBV and diameter as parameters of response to treatment. During 4.91 sessions, median diameter increased 18.18% (p > 0.05) and PBV reduced 39.62% (p > 0.05). Functional and imaging response per tumour was statistical significantly different (p ≤ 0.05). Correlation coefficient was r = 0.058. 2/41 tumours showed partial response; 31/41 tumours showed stable disease; and 8/41 tumours showed progressive disease. The highest pre-treatment PBV values were measured in decreasing tumours (206.93 ml l(-1)), and the lowest values were measured in increasing tumours (60.17 ml l(-1); p > 0.05). The lowest values were also measured in lung cancer (53.02 ml l(-1)) that was significantly different to uterine leiomyosarcoma (103.31 ml l(-1)) and renal cell cancer (113.14 ml l(-1); p ≤ 0.05). Assessment of PBV maps by using 3D-CTA image data is feasible in the clinical routine. PBV shows a stronger response to TPCE treatment than measurement in diameter and should be considered as a response parameter for early detection. Assessment of PBV using C-arm CT during TPCE is a feasible technique. Assessment of PBV might be useful in assessing response to treatment.

Current Readings: Percutaneous Ablation for Pulmonary Metastatic Disease

Percutaneous image-guided ablation is a technique for maintaining local control of metastatic lung lesions that may, in selected patients, confer a survival benefit over no treatment or systemic therapy alone. Although the currently accepted treatment for oligometastatic pulmonary disease is surgical resection, the existing body of literature, including the recent investigations reviewed within this article, supports a role for percutaneous ablation as an important and relatively safe therapeutic option for nonsurgical and in carefully selected surgical patients, conferring survival benefits competitive with surgical metastasectomy. Continued clinical investigations are needed to further understand the nuances of thermal technologies and applications to treat lung primary and secondary pulmonary malignancy, directly compare available therapeutic options and further define the role of percutaneous image-guided ablation in the treatment of pulmonary metastatic disease.

Optimal management of pulmonary metastases from colorectal cancer

The incidence of colorectal cancers is rising worldwide and pulmonary metastases were seen in approximately 10–15% of all patients. Surgical metastasectomy is a widely accepted procedure in selected patients and is considered as the only curative option in patients with secondary pulmonary malignancy. But surgical resection remains controversial due to the lack of randomized trials, comparing pulmonary metastasectomy to control, either medical therapy, or observation. This article will discuss the differentiated therapeutic strategies for patients with pulmonary metastases of colorectal cancer, focusing on surgical resection, patient evaluation, prognostic factors, interdisciplinary therapeutic approaches and current trials.

Interventionell-radiologische Therapien in der pneumologischen Onkologie

Interventional radiological procedures for the treatment of primary and secondary pulmonary malignancies have become increasingly important. In addition to thermally ablative treatment, selective chemoembolisation by a vascular access allows localised therapy. These treatments are considered to be palliative for patients in a reduced general condition which does not allow systemic chemotherapy. In functionally inoperable patients especially the ablative procedures are potentially curative alternatives to surgery. This article provides an overview of the currently used interventional radiological procedures in lung oncology and assesses their importance. Further studies are needed to show whether interventional radiological procedures, which are promising due to their favourable risk-benefit ratio, may represent an alternative to radiotherapy or be effective in multimodal approaches.

Lymphoproliferative disorders in patients with primary immuno-deficiencies

Primary lung tumours in children are rare and metastatic lung disease is uncommon. The majority of children who present with a primary or secondary pulmonary malignancy will present co-incidentally while seeking attention for another medical problem, or with non-specific abnormalities such as cough with collapse or consolidation on the chest radiograph. With improved techniques of medical imaging for diagnostic and therapeutic purposes and improved outcomes of childhood malignancies, the role of the respiratory paediatrician in the ongoing care of oncology patients is likely to increase.

Resection of secondary pulmonary malignancies in head and neck cancer patients

This study aimed to evaluate a single institute's experience with resection of metachronous pulmonary malignancy in patients treated for squamous cell carcinoma of the head and neck. Sixty-three consecutive patients treated curatively for head and neck squamous cell carcinoma underwent surgical resection of malignant lung lesions. Survival was estimated and potential prognostic factors investigated. The median overall survival for the total group was 22.2 months. Fifty-one patients (81 per cent) had one lung lesion, while the remainder had multiple lesions (range, two to seven). In the 63 patients, 35 lobectomies, 4 pneumonectomies and 24 wedge resections were performed. For patients with pulmonary squamous cell carcinoma (n = 52), the three-year survival rate was 35 per cent (95 per cent confidence interval, 22-48); for patients with resected adenocarcinoma (n = 10), it was 50 per cent (95 per cent confidence interval, 18-75). The overall five-year survival rate was 30 per cent (95 per cent confidence interval, 19-42). In patients treated curatively for head and neck squamous cell carcinoma, resection of secondary pulmonary cancer is associated with favourable long term overall survival, especially for patients with adenocarcinoma lesions.

Extended Resection: Is It Feasible for Pulmonary Metastases?

Extended resections may be necessary to achieve tumor-free borders for secondary pulmonary malignancies. This study was performed to analyze the outcomes that result from extended resections of pulmonary metastases. Between February 1991 and December 2008, a total of 25 extended pulmonary resections (resection of the chest wall and diaphragm, vascular procedures, sleeve resections, pneumonectomies, atrial resections, and completion pneumonectomies) were performed on 250 patients undergoing 319 metastasectomy procedures. The extended resection group was analyzed in terms of disease-free interval, type of resection, operative morbidity, mortality, and survival and was then compared with patients who underwent lobar or sublobar resections. The extended resection group consisted of 14 male and 11 female patients. The mean disease-free interval was 36.02 (minimum 6, maximum 132) months. The extended resection rate was 10%. After 30 days, all patients were alive. For all extended metastasectomy groups, actuarial 5-year survival rates from the time of the extended metastasectomy were 16.3%. Mean survival times of patients who underwent extended resection and lobar or sublobar resection were 40 months (SD = 11) (95% confidence interval, 19-61) and 20 months (SD = 3) (95% confidence interval, 14-26), respectively. This difference was not statistically significant (P = 0.09) (Fig. 2). In the subgroup analysis, survival in the extended resections and lobar or sublobar resections groups was not statistically significant (osteosarcoma, P = 0.758; epithelial tumor, P = 0.11). Extended resections, which can be performed during pulmonary metastasectomies of patients with tumor-free surgical borders, may establish curative benefits, with low rates of mortality and morbidity.

Video‐Assisted Thoracic Surgery (VATS) Compares Favorably with Thoracotomy for the Treatment of Lung Cancer: A Five‐Year Outcome Comparison

Although video-assisted thoracic surgery (VATS) lobectomy has been demonstrated to be safe and technically feasible, it is infrequently performed in most Chinese hospitals and few thoracic surgeons have performed the operation. We have therefore reviewed our experience with all VATS lobectomies, attempting to define long- and short-term outcomes of these surgeries. We retrospectively analyzed the results in patients who underwent VATS lobectomy and open lobectomy between March 1996 and August 2003. The VATS surgery was performed with the endoscopic hilar dissection technique. Perioperative data were collected and long-term outcomes were assessed by 5-year census. We successfully performed VATS procedures in 113 of 120 patients. The median operative time was 152 min and the median hospitalization was 8.6 days. The median operative blood loss was 130 ml and the median drainage time was 3.5 days. The operative and perioperative (30-day) mortality rates were 0% and 0.9%, respectively; the postoperative complications rate was 10.6%. The 5-year overall survival rates for stage I, stage II, and stage III or greater non-small cell lung cancer (NSCLC), secondary pulmonary malignancy, and benign disease were 79.1%, 45.5%, 22.2%, 33.3%, and 88.6%, respectively. Video-assisted lobectomy is a safe and feasible surgical procedure, and it gives the same long-term results as conventional open lobectomy. The VATS approach to lobectomy is a beneficial alternative to standard thoracotomy for selected cases of pulmonary lesions.

Acute Lower Extremity Ischemia Secondary to Salivary Gland Tumor Embolus

Malignant arterial tumor emboli of sufficient size that is capable of causing organ infarction or ischemia are exceedingly rare. The majority of these emboli are associated with either primary or secondary pulmonary malignancies and commonly occur perioperatively or immediately postoperatively. This study describes an unusual case of acute lower extremity ischemia secondary to a malignant parotid tumor embolus with evidence of left ventricular involvement.

Complications of Thoracoscopic Pulmonary Resection

Thoracoscopic strategies are becoming increasingly utilized in the management of patients with thoracic disease processes, including primary pulmonary malignancy, secondary pulmonary malignancy, granulomatous lung disease, and pleural processes. Although minimally invasive approaches have been demonstrated to improve outcomes and reduce complications, as compared to the conventional approach, the prevention, early recognition, and effective management of complications after thoracoscopic pulmonary resection are still critical factors in optimizing outcomes.

Thoracoscopic Lobectomy Is a Safe and Versatile Procedure

Advantages of thoracoscopic lobectomy for early stage non-small cell lung cancer (NSCLC), as compared with lobectomy by conventional thoracotomy, include less postoperative pain and shorter length of hospitalization. The outcomes after thoracoscopic lobectomy in patients with more complex pulmonary conditions are analyzed to determine safety, efficacy, and versatility. A prospective database of 500 consecutive patients who underwent thoracoscopic lobectomy between June 1999 and January 2006 was queried. Demographic, histopathologic, perioperative, and outcome variables were assessed using standard descriptive statistics and Kaplan-Meier survival analyses. Thoracoscopic lobectomy was successfully performed in 492 patients (conversion rate, 1.6%). Pathologic analysis included primary NSCLC in 416 patients (83.2%), centrally located secondary pulmonary malignancy in 37 patients (7.4%), and a variety of benign conditions in 45 patients (9%). Among the 416 patients with NSCLC, pathologic analysis demonstrated stage I in 330 patients (55.3%), stage II in 40 patients (9.6%), and stage III or greater NSCLC in 44 patients (10.6%). The operative and perioperative (30-day) mortality was 0% and 1%, respectively. The overall 2-year survival rate for the entire cohort was 80%, and the 2-year overall survival rates for stage I NSCLC, stage II or greater NSCLC, secondary pulmonary malignancy, and granulomatous disease patients were 85%, 77%, 73%, and 89%, respectively. Thoracoscopic lobectomy is applicable to a spectrum of malignant and benign pulmonary disease and is associated with a low perioperative morbidity and mortality rate. Survival rates are comparable to those for lobectomy with thoracotomy.

Lung tumours in children

Primary lung tumours in children are rare and metastatic lung disease is uncommon. The majority of children who present with a primary or secondary pulmonary malignancy will present co-incidentally while seeking attention for another medical problem, or with non-specific abnormalities such as cough with collapse or consolidation on the chest radiograph. With improved techniques of medical imaging for diagnostic and therapeutic purposes and improved outcomes of childhood malignancies, the role of the respiratory paediatrician in the ongoing care of oncology patients is likely to increase.

Pulmonary hemorrhage during percutaneous radiofrequency ablation: a more frequent complication than assumed?

To alert clinicians of the underreported complication of intraparenchymal lung hemorrhage during percutaneous radiofrequency ablation (RFA) of primary and secondary pulmonary malignancies. Of 101 RF ablations performed in 46 patients, 81 were retrospectively assessed for periprocedural intrapulmonary bleeding. The data was compared with the literature for this minimally invasive interventional treatment as well as with the reported frequency of lung hemorrhage during diagnostic lung biopsies. Our incidence of hemorrhage during percutaneous lung RFA was 5.9%. The reported frequency in the scarce literature available is less than 1%. Data in the literature for percutaneous biopsy-related intraparenchymal hemorrhage ranges from 1.4% for fine-needle aspirations to 29% for core biopsies. Intraparenchymal lung hemorrhage during percutaneous RFA of primary and secondary pulmonary malignancies is similar to reported lung hemorrhage for diagnostic core biopsies. We believe this complication to be underreported in the literature.