Objective To summarize the recent progress in the research on the mechanism and treatment of lung metastasis of hepatocellular carcinoma, in order to provide reference for clinical workers to systematically treat patients with lung metastasis of hepatocellular carcinoma, guarantee their survival and improve their quality of life. Method The literatures about mechanism and clinical treatment of lung metastasis of hepatocellular carcinoma in recent years were reviewed. Results At home and abroad, there was no unified treatment standard for patients with lung metastasis of hepatocellular carcinoma. For patients with early metastasis, some scholars proposed resection of the metastasis, or ablation, radiotherapy and other methods for the metastatic site. For patients with advanced lung metastasis, systematic therapy was used. Conclusions The treatment effect is not ideal due to the limitations of few clinical studies, low level of evidence and complex disease mechanism, and there is no unified treatment standard. Therefore, in view of the differences between patients and the specific reality in clinical treatment, personalized treatment is implemented.
Abstract： Pulmonary metastasectomy is an option for patients with metastatic tumor of lung. Numerous retrospectivestudies have demonstrated that complete control of primary tumor and complete resection of metastases limited to thelungs may be associated with prolonged survival. Speci?c issues require consideration when planning pulmonary metastasectomy. Regardless of histological type of primary tumor, complete resection is the most important prognostic factor. The other two important prognostic factors are long disease interval and limited number of metastatic tumor of lung. Hand-assisted thoracoscopic surgery for bilateral lung metastasectomy through sternocostal triangle access is recommended. Pulmonary hilar and mediastinal lymph node metastases are some relative contraindications for this surgery. Nowdays preoperative imaging examinations still have limitations in detecting all the lung metastases. Some data emphasize the importance of considering patients for extended resection in metastatic tumor of lung. Repeat resection after previous metastasectomies can be of benefit under certain circumstances so we should remove as little healthy lung tissue as possible. In this review, we discuss about some disputed issues in order to establish a useful criterion for consideration of pulmonary metastasectomy.
Objective To investigate the diagnosis, indications for surgery, operative methods and prognostic factors of surgical resection for pulmonary metastases, and improve the survival rate of patients with pulmonary metastases . Methods A total of 125 patients with pulmonary metastases underwent 138 metastasectomies,116 patients had metastasectomy once while 5 patients underwent a second metastasectomy and 4 patients a third metastasectomy. There were 66 wedge resections,2 segmentectomies, 53 lobectomies,2 en bloc resections of chest wall plus lobectomy,3 pneumonectomies and 12 precision resections. Surgical approaches included 130 thoracotomies and 8 videoassisted thoracic surgery. Results The primary tumor sites were epithelial in 94 patients ,sarcoma in 26 and others in 5. There was no perioperative mortality. A total of 122 patients were followed up , followup time was 1-10 years. The 1-, 3-, and 5-year survival rates were 90.4%, 53.3%, and 34.8% respectively. Better prognoses were found in patients with colorectal cancer, renal cancer and soft tissue sarcoma, the 5-year survival rates were 43.8%, 37.5%, and 33.3% respectively. For the 105 patients whose pulmonary metastases were resected completely, the 5-year survival rate was 38.9%. The 5-year survival rate was only 16.7% for 20 patients with incomplete resection, however. Systematiclymph node dissection had been performed in 89 patients but metastases were identified only in 12 patients. The 5-year survival rates were 14.3% for node positive patients and 41.5% for node negative patients. Conclusion Surgical resection for pulmonary metastases should be performed in properly selected patients and successful outcomes can be achieved. Posterolateral minithoracotomy is the most common surgical approach. The completeness of resection and the status of mediastinal lymph nodes may be important prognostic factors.
Objective To analyze and summarize clinical characteristics, diagnostic method, choice of treatment, and prognosis of metastatic lung cancer to thyroid gland. Method The clinical materials of the 15 patients presenting with secondary thyroid cancer were analyzed retrospectively. Results There were 10 females and 5 males in the 15 patients, with the female to male ratio of 2 : 1. The age ranged from 36 to 79 years old with an average 59 years old. The diagnoses of 12 cases were made by the surgery or the fine needle aspiration biopsy (FNAB), 3 cases by the clinic. The interval from the diagnosis of the primary tumor to the thyroid metastasis varied from 0 month to 21 months with an average 4 months. Three patients received the thyroidectomy, 5 patients received the chemotherapy or chemoradiotherapy, and 7 patients gave up the treatment. The average survival time was 10 months. Conclusions Metastatic lung cancer to thyroid gland is rare, and FNAB is a useful tool for diagnosis. Thyroidectomy may not be recommended because of poor prognosis.
ObjectiveTo investigate clinical outcomes and prognostic factors of surgical resection of pulmonary metastases after esophagectomy. MethodsClinical data of 15 patients who underwent surgical resection of pulmonary metastases after esophagectomy from March 1994 to May 2008 were retrospectively analyzed. There were 10 males and 5 females with their age of 43-72 (65.0±8.8) years. Surgical procedures included partial lung resection, pulmonary wedge resection, segmental resection and lobectomy. Follow-up duration was 60 months after surgical resection of pulmonary metastases. The influence of number and size of pulmonary metastases, TNM staging of primary esophageal cancer, and disease-free interval (DFI) after esophagectomy on postoperative survival rate after pulmonary metastasectomy was analyzed. ResultsTwelve, 24 and 60 months survival rates after pulmonary metastasectomy were 80.0%, 66.7% and 6.7%, respec-tively. Median DFI was 30 months. Survival rate after pulmonary metastasectomy of patients whose DFI was longer than 24 months was significantly longer than that of patients whose DFI was shorter than 24 months (χ2=5.144, P=0.023). Survival rate after pulmonary metastasectomy of patients with solitary pulmonary metastasis was significantly longer than that of patients with multiple pulmonary metastases (χ2=3.990, P=0.046).The size of pulmonary metastases and TNM staging of primary esophageal cancer didn't have significant impact on survival rate after pulmonary metastasectomy (P > 0.05). Cox proportional hazards model showed that DFI after esophagectomy was the main factor affecting survival rate after pulmonary metastasectomy (P=0.026). ConclusionSurgical resection is a therapeutic strategy for the treatment of pulmonary metas-tases after esophagectomy, and may achieve good clinical outcomes for patients with solitary pulmonary metastasis and patients whose DFI is longer than 24 months.
ObjectiveTo investigate the value of integrin αvβ3 targeted microPET/CT imaging with 68Ga-NODAGA-RGD2 as radiotracer for the detection of osteosarcoma and theranostics of osteosarcoma lung metastasis.MethodsThe 68Ga-NODAGA-RGD2 and 177Lu-NODAGA-RGD2 were prepared via one-step method and their stability and integrin αvβ3 binding specificity were investigated in vitro. Forty-one nude mice were injected with human MG63 osteosarcoma to established the animal model bearing subcutaneous osteosarcoma (n=21), osteosarcoma in tibia (n=5), and osteosarcoma pulmonary metastatic (n=15). The microPET-CT imaging was carried out in 3 animal models at 1 hour after tail vein injection of 68Ga-NODAGA-RGD2. Biodistribution study of 68Ga-NODAGA-RGD2 was performed in animal model bearing subcutaneous osteosarcoma at 10, 60, and 120 minutes. The animal model bearing pulmonary metastatic osteosarcoma was injected with 177Lu-NODAGA-RGD2 at 7 weeks after model establishment to observe the therapeutic effect of pulmonary metastatic osteosarcoma. Histological and immunohistochemistry examinations were also done to confirm the establishment of animal model and integrin β3 expression in animal models bearing subcutaneous osteosarcoma and bearing pulmonary metastatic osteosarcoma.Results68Ga-NODAGA-RGD2 and 177Lu-NODAGA-RGD2 had good stability in vitro with the 50% inhibitory concentration value of (5.0±1.1) and (6.5±0.8) nmol/L, respectively. The radiochemical purity of 68Ga-NODAGA-RGD2 at 1, 4, and 8 hours was 98.5%±0.3%, 98.3%±0.5%, and 97.9%±0.4%; while the radiochemical purity of 177Lu-NODAGA-RGD2 at 1, 7, and 14 days was 99.3%±0.7%, 98.7%±1.2%, and 96.0%±2.8%. 68Ga-NODAGA-RGD2 microPET-CT showed that the accumulation of 68Ga-NODAGA-RGD2 in animal models bearing subcutaneous osteosarcoma and osteosarcoma in tibia and in lung metastasis as small as 1-2 mm in diameter of animal model bearing pulmonary metastatic osteosarcoma. Biodistribution study of 68Ga-NODAGA-RGD2 in animal model bearing subcutaneous osteosarcoma revealed rapid clearance from blood with tumor peak uptake of (3.85±0.84) %ID/g at 120 minutes. The distribution of 177Lu-NODAGA-RGD2 in lung metastasis was similar with 68Ga-NODAGA-RGD2. The number and size of osteosarcoma metastasis decreased at 2 weeks after 177Lu-NODAGA-RGD2 administration and integrin targeting specificity was confirmed by pathology examination.Conclusion68Ga-NODAGA-RGD2 was potential for positive imaging and early detection of osteosarcoma and metastasis. Targeted radiotherapy with 177Lu-NODAGA-RGD2 was one potential alternative for osteosarcoma lung metastasis.
As the most common primary malignant bone tumor in children and adolescents, osteosarcoma has the characteristics of high malignancy, easy metastasis and poor prognosis. The recurrence, metastasis and multi-drug resistance of osteosarcoma are the main problems that limit the therapeutic effect and survival rate of osteosarcoma. Among them, lung metastasis is often the main target organ for distant metastasis of osteosarcoma. In recent years, people have paid attention to the signaling pathway of the occurrence and development of osteosarcoma and made in-depth studies on its mechanism. A variety of relevant signaling pathways have been constantly clarified. At present, there is still a lack of systematic and multi-directional exploration and summary on the signaling pathway related to the pulmonary metastasis of osteosarcoma. This paper explores the new direction of targeted therapy for osteosarcoma by elucidating the relationship between the signaling pathway associated with osteosarcoma and the pulmonary metastasis of osteosarcoma.