Very rare & very Interesting.........................! Never met a surgeon ready to do that!

Yes, there is some thought now in the Oncology world that some patients with oligometastatic disease have long term survivals after resection. This is well established in cases of colon cancer with mets to the liver. MD Anderson had a small series about 5-10 years ago and I used this to justify resection of brain mets and one thoracic met in a patient with lung cancer.  He was alive without recurrence last I heard, about 5 years after mets resected.  I've seen this in the literature and personal experience also for melanoma and limited mets in breast cancer. 

Thank you so much, colleagues!

Dear all, this never ever shows any good prognosis, From a biological point of view this is nearly M1b!! However if this is the only cancer site and your patient is in good performance status go for operation , especially in squamous cell cancer.  I totally agree with L.P. Burke - and for instance there is new literature about CUP-syndrom resected totally with triple OS in comparison to non-resectable CUP of the same extent.

Dear Rita, your question is really interesting as the real oligometastatic state is a rarely encountered clinical scenario in metastatic carcinomas including NSCLC. The biology of metastasis may be different and although the disease metastasized to a distant site it may still be confined and can be treated with curative intent with surgical resection. we conducted a systematic review assessing prognosis following resection of oligometastatic disease to solitary sites including some patients with solitary LN metastasis from NSCLC to sites other than the brain and adrenal gland (see the link below). The data showed that if the mediastinal LN are not involved and the intra-thoracic stage is not stage 3, then there is an excellent chance for long- term survival following resection of the solitary metastatic site and definitive therapy of the primary NSCLC. PET scan and Mediastinoscopy is indicated in such case to exclude mediastinal LN involvement and other metastatic sites. If mediastinal LN are not involved then surgical resection of the solitary LN metastasis is indicated in my opinion.

Ref: Salah S, Tanvetyanon T, Abbasi S. Metastatectomy for extra-cranial extra-adrenal non-small cell lung cancer solitary metastases: systematic review and analysis of reported cases. Lung Cancer. 2012 Jan;75(1):9-14. 

http://www.ncbi.nlm.nih.gov/pubmed/?term=Metastatectomy+for+extra-cranial+extra-adrenal+non-small+cell+lung+cancer+solitary+metastases%3A+Systematic+review+and+analysis+of+reported+cases

Thank you, Jose Gross. Yes, I completely agree with you, we need a wider, more detailed database...Talking back about my patients, of course, before keeping my scalpel in hand, I performed a contrast CT scan - PET, and a neck and supraclavicular US. I bet there's something we're missing in such patients; I really would like to invite you all to collect data about single cervical or supraclavicular metastases from lung cancer...We may organize a common database...Thank you, I appreciated very much your suggestions about a research on this topic...

....pretty interesting... Have a nice day!

I have two more questions:

1- Did you perform "adjuvant" radiotherapy / chemotherapy after surgical resection, that could explain the good outcome?

2- Did you consider the posibility to be a second neoplasm, such as a hidden cancer of the head and neck (unknown origin) which is known to have a better prognostic? In practice sometimes is hard to distinguish a squamous cell lung cancer from a head-neck one, as first or second event or viceversa. Is not rare to observe patients multiple neoplasia (lung and head-neck cancers) as both tumors share similar risk factors.

Have a nice day.

Daer doctor David Aguiar Bujanda, answering your questions: none of the partients underwent any adjuvant treatment; one of them refused chemotherapy, the others didn't need adjuvant therapies because of their pathological stage. We considered indeed the possibilityof second neoplasms; therefore we performed a complete re-staging (contrast TC-PET total body, nerck and sopraclavicular regions US, with head and neck NMR, laryngoscopy and bronchoscopy) before the radical lynphadenectomy.

Nearly half of our NSCLC patients have lifetime relapse. This is not really considered when talking about some classical approaches with radiotherapy. From my point of view possible treatments coming from the IO side like chemoablation or chemoperfusion + physical ablation has to be considered more frequently.

To read:

Drucker A et al..Curr Oncol. 2008 June; 15(3): 136–142.

We identified seven gene signatures, and combined them with the clinical parameters age and stage, we could differentiate patients into three risk groups and predict patient survival probabilities at 10 and 15 years post-surgical resection, which were extensively verified using 6 other datasets from five different countries.

This breaking new study published in the first issue of EBioMedicine which is a high quality peer review journal under editorial leadership of Cell Press and The Lancet.

Please read the whole paper. Here is the linker:http://www.sciencedirect.com/science/article/pii/S2352396414000140

http://www.sciencedirect.com/science/article/pii/S2352396414000140

MARVELOUS paper!!! Congratulations! Are you planning to to analyze these genes by a chip-array?

Best regards,

W. H.-Schmidt

Dear Dr. Wolfgang H.-S:

Sorry for late replying your question and thanks for your praising. We are going to apply phase III clinical trail using those genes chip-array next year in USA and China. If you can cooperate with us to do phase III clinical trail in Germany, we would be very appreciated.

Best,

Tiehua