Background: Resection of liver mts has been repeatedly shown to prolong survival of pts with metastatic colorectal cancer (mCRC). While in some published data resection of lung mts (RLM) seems to be equally advantageous, a comparison between outcomes of resected vs non resected pts has never appeared. Methods: We collected data from 706 mCRC pts treated in 2 different institutions from 1994 to 2007. We selected data from 214 pts (30.3%) with lung mts at first diagnosis of mCRC which were grouped as follows: G1) 148 pts with lung and extra-lung mts; G2) 29 pts with lung as unique site of mts not submitted to RML; G3) 28 pts submitted to RML and subsequent adjuvant chemotherapy; G4) 9 pts submitted to neoadjuvant chemotherapy prior to surgery. Results: Patients’ characteristics were: median age (range) yrs: 63.3 (31.1–80.6); male/female 133/81; stage at diagnosis (A/B/C/D/UNKN) 13/22/73/102/4; site of primitive: rectum/left colon/right colon 75/91/48; site of mts: liver/lung/other: 128/214/114. Chemotherapy administered were: 1 pts Triplet, 168 pts Doublets (LOHP-based 144, CPT11-based 24); 45 pts 5FU or oral fluoropyrimidines only. Response rates were: overall 80/214 (37.4%); G1 50/148 (33.8%); G2 14/29 (48.3%); G3 not applicable; G4 7/9 (77.8%). Surgery was performed in 37/214 pts (17.3%). No surgery mortality was recorded. Time to progressions (TTP) were (mos): 13.5, 11.6, 13.1, 20.4, 27.9 Overall, G1, G2, G3, and G4, respectively (p<0.0001). Considering only pts with lung as unique site of mts (G2 non resected vs G3+4 resected), TTPs were 13.1 vs 24.1 mos (p<0.001). Overall survivals (OS) were (mos): 29.6, 23.8, 31.2, 67.2, 59.5+ for Overall, G1, G2, G3, and G4, respectively (p<0.00001). Considering only pts with unresected lung mts (G2) vs resected lung mts (G3+G4), OSs were 31.2 vs 71.2 mos (p<0.0001). Conclusions: Although in the presence of pts selection bias typical of retrospective studies, our comparative data showed that: 1) resection of lung mts is safe, confirming previous reports; 2) resected patients presented a longer TTP and OS than non resected ones; 3) chemotherapy administration before or after surgery did not seem to be different in terms of OS, even though neoadjuvant therapy might help clinicians to select those pts with a more indolent form of the disease.
Survival of lung surgery patients with pulmonary metastases from colonic neoplasms
TAMPELLINI, MARCO;ALABISO, Oscar;DOGLIOTTI, Luigi
2008-01-01
Abstract
Background: Resection of liver mts has been repeatedly shown to prolong survival of pts with metastatic colorectal cancer (mCRC). While in some published data resection of lung mts (RLM) seems to be equally advantageous, a comparison between outcomes of resected vs non resected pts has never appeared. Methods: We collected data from 706 mCRC pts treated in 2 different institutions from 1994 to 2007. We selected data from 214 pts (30.3%) with lung mts at first diagnosis of mCRC which were grouped as follows: G1) 148 pts with lung and extra-lung mts; G2) 29 pts with lung as unique site of mts not submitted to RML; G3) 28 pts submitted to RML and subsequent adjuvant chemotherapy; G4) 9 pts submitted to neoadjuvant chemotherapy prior to surgery. Results: Patients’ characteristics were: median age (range) yrs: 63.3 (31.1–80.6); male/female 133/81; stage at diagnosis (A/B/C/D/UNKN) 13/22/73/102/4; site of primitive: rectum/left colon/right colon 75/91/48; site of mts: liver/lung/other: 128/214/114. Chemotherapy administered were: 1 pts Triplet, 168 pts Doublets (LOHP-based 144, CPT11-based 24); 45 pts 5FU or oral fluoropyrimidines only. Response rates were: overall 80/214 (37.4%); G1 50/148 (33.8%); G2 14/29 (48.3%); G3 not applicable; G4 7/9 (77.8%). Surgery was performed in 37/214 pts (17.3%). No surgery mortality was recorded. Time to progressions (TTP) were (mos): 13.5, 11.6, 13.1, 20.4, 27.9 Overall, G1, G2, G3, and G4, respectively (p<0.0001). Considering only pts with lung as unique site of mts (G2 non resected vs G3+4 resected), TTPs were 13.1 vs 24.1 mos (p<0.001). Overall survivals (OS) were (mos): 29.6, 23.8, 31.2, 67.2, 59.5+ for Overall, G1, G2, G3, and G4, respectively (p<0.00001). Considering only pts with unresected lung mts (G2) vs resected lung mts (G3+G4), OSs were 31.2 vs 71.2 mos (p<0.0001). Conclusions: Although in the presence of pts selection bias typical of retrospective studies, our comparative data showed that: 1) resection of lung mts is safe, confirming previous reports; 2) resected patients presented a longer TTP and OS than non resected ones; 3) chemotherapy administration before or after surgery did not seem to be different in terms of OS, even though neoadjuvant therapy might help clinicians to select those pts with a more indolent form of the disease.
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