CC is a public health problem in developing countries. Dissemination is typically lymphogenous but can develop hematogenous metastases. Chemotherapy alone is associated with a median SV of 13 months on metastatic disease. In selected cases with Isolated lung metastases (LM), PM is associated with prolonged SV.
Observational, retrospective cohort. Patients (ptes) with CC who underwent PM at the National Cancer Institute (INCan) Mexico from January 2005 to December 2017. Primary end-points were Overall Survival (OS) and Disease-Free Survival (DFS) Secondary end-points were morbidity and mortality of PM.
A total of 29 ptes were identified. Squamous carcinoma was primary histology in 21 (72.4%). Most presented with advanced tumors at initial diagnosis, 11 (37.9%) stage II, 5 (17.2%) stage III and 7 (24.1%) stage IV. Unilateral nodules were seen in 27 (93.1%) and a single nodule was present in 24 (82.4%). Nodules were diagnosed as metachronous (after 6 months of diagnosis) in 21 (72.4%). Surgery was the initial treatment in 25 (86.2%) and only 4 (13.8%) received pre-operative chemotherapy. A wedge resection was performed in 16 (55.2%), interestingly, a lobectomy was needed in 12 cases (41.4%) and 1 case required a pneumonectomy. One case developed hemothorax requiring exploration for a 90-day morbity of 3.4% and 90-day mortality was 0%. An R0 resection was achieved in 26 (89.7%) On pathological analysis, only in 20 ptes (69%) LM were confirmed, in the other ptes a benign condition was diagnosed. Postoperative chemotherapy was indicated in 12 cases. Median follow up was 101.5 months (6 – 260). For SV analysis only ptes with proved LM were included. Median OS has not been reached, 5-year OS 35%. Median DFS 100 months (6.4 -193.5) Only R2 resection (p 0.05), no postoperative chemotherapy (p 0.025) and disease relapse (p 0.007) were statistically significantly associated with a worst SV.
In our cohort, PM is associated with better OS than chemotherapy alone. Although some ptes required a lobectomy, a very low morbidity and zero mortality in our cases is very encouraging. PM should be considered as fundamental part of multi-disciplinary treatment in cases of CC with isolated LM.
Clinical trial identification
Legal entity responsible for the study
Jose Francisco Corona-Cruz.
Has not received any funding.
All authors have declared no conflicts of interest.