Lung Metastasectomy for Pulmonary Metastatic Breast Carcinoma

Abstract

Breast carcinoma with pulmonary metastasis can be treated locally or systemically. Following primary tumour resection patients with isolated, completely resectable pulmonary nodules and definite functional operability can be offered lung metastasis resection. Following metastasectomy a median survival of 32 to 96.6 months can be achieved with corresponding five-year survival rates between 30.8 and 54.4%. The procedure is associated with a mortality rate of 0 to 3%. The most important independent prognostic factor for long-term survival is complete resection of all lung lesions. The configuration and pattern of metastasis as well as disease-free interval, hormone and HER2/neu receptor status also appear to influence prognosis, but are of lesser importance. Intrapulmonary recurrence of metastases may, after careful selection on a case-by-case basis, also be treated operatively. In some cases this is associated with a favourable long-term prognosis. Pulmonary metastasectomy should be the treatment of choice for selected patients with metastatic breast carcinoma.

Key words

breast carcinoma - breast cancer - lung metastases - metastasectomy - R₀ resection

• References/Literatur

• 1 Zentrum für Krebsregisterdaten im Robert Koch-Institut. Hrsg. Bericht zum Krebsgeschehen in Deutschland 2016. Berlin: 2016
• 2 Friedel G, Pastorino U, Ginsberg RJ. Results of lung metastasectomy from breast cancer: prognostic criteria on the basis of 467 cases of the International Registry of Lung Metastases. Eur J Cardiothorac Surg 2002; 22: 335-344
• 3 Ludwig C, Stoelben E, Hasse J. Disease-free survival after resection of lung metastases in patients with breast cancer. Eur J Surg Oncol 2003; 29: 532-535
• 4 Planchard D, Soria JC, Michiels S. et al. Uncertain benefit from surgery in patients with lung metastases from breast carcinoma. Cancer 2004; 100: 28-35
• 5 Tanaka F, Li M, Hanaoka N. et al. Surgery for pulmonary nodules in breast cancer patients. Ann Thorac Surg 2005; 79: 1711-1714 discussion 1714–1715
• 6 Rena O, Papalia E, Ruffini E. et al. The role of surgery in the management of solitary pulmonary nodule in breast cancer patients. Eur J Surg Oncol 2007; 33: 546-550
• 7 Chen F, Fujinaga T, Sato K. et al. Clinical features of surgical resection for pulmonary metastasis from breast cancer. Eur J Surg Oncol 2009; 35: 393-397
• 8 Welter S, Jacobs J, Krbek T. et al. Pulmonary metastases of breast cancer. When is resection indicated?. Eur J Cardiothorac Surg 2008; 34: 1228-1234
• 9 Yoshimoto M, Tada K, Nishimura S. et al. Favourable long-term results after surgical removal of lung metastases of breast cancer. Breast Cancer Res Treat 2008; 110: 485-491
• 10 Kycler W, Laski P. Surgical approach to pulmonary metastases from breast cancer. Breast J 2012; 18: 52-57
• 11 Meimarakis G, Ruttinger D, Stemmler J. et al. Prolonged overall survival after pulmonary metastasectomy in patients with breast cancer. Ann Thorac Surg 2013; 95: 1170-1180
• 12 Fan J, Chen D, Du H. et al. Prognostic factors for resection of isolated pulmonary metastases in breast cancer patients: a systematic review and meta-analysis. J Thorac Dis 2015; 7: 1441-1451
• 13 Oxford University. Centre for evidence-based medicine – levels of evidence. Online: http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/ Stand: 23.01.2017
• 14 Macherey S, Doerr F, Heldwein M. et al. Is manual palpation of the lung necessary in patients undergoing pulmonary metastasectomy?. Interact Cardiovasc Thorac Surg 2016; 22: 351-359
• 15 Carlsson J, Nordgren H, Sjostrom J. et al. HER2 expression in breast cancer primary tumours and corresponding metastases. Original data and literature review. Br J Cancer 2004; 90: 2344-2348
• 16 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). Interdisziplinäre Leitlinie der Qualität S3 zur Diagnostik, Therapie und Nachsorge des Mammakarzinoms, Kurzversion 3.0, 2012 AWMF Registernummer: 032/045OL. Online: http://leitlinienprogrammonkologie.de/Leitlinien.7.0.html Stand: 15.02.2017
• 17 AGO Breast Committee. Diagnosis and treatment of patients with primary and metastatic breast cancer. Recommendations 2017 Online: http://www.ago-online.de/fileadmin/downloads/leitlinien/mamma/2017-03/AGO_deutsch/PDF_Einzeldateien_deutsch/2017D%252022_Besondere%2520Situationen%2520und%2520Lokalisationen%2520in%2520der%2520metastasierten%2520Situation.pdf Stand: 22.03.2017