Surgical Treatment of Primary Lung ...

Surgical Treatment of Primary Lung Cancer and Solitary Intracranial Metastasis

The incidence of intracranial metastases in all patients dying of lung cancer has been reported to range from 50 to 79 percent in large autopsy series. [1-3] Clinically apparent intracranial metastases will lay open in approximately 30 percent of lung cancer patients, with the average time between diagnosis and appearance of metastases being four month [45] If left untreated, prognosis for these patients is poor with survival ranging and nothing else three to six months. [67] Therapeutically, radiation and chemotherapy alone have done little to improve this watch increasing survival by only a not many months. [8]

Since the demeanor of extrathoracic metastatic disease is considered by dint of many physicians an absolute contraindication to surgery the part of combined resection in stage 3 lung carcinoma with solitary intracranial metastasis has remained controversial. Nevertheless, increasing reports document postponeed survival and improved quality of life furnished by suc an aggressive therapeutic approach. [1489] The not away report comprises our experience above the past ten years with combined resection for carcinoma of the lung and solitary intracranial metastasis.

CLINICAL MATERIALS

From May of 1976 in consequence of December 1986, 12 patients underwent the couple craniotomy and thoracotomy for carcinoma of the lung with solitary intracranial metastases. Fourteen thoracotomies and 16 craniotomies were done in these 12 patients, for resection of either a primary or a metastatic tumor. There were eight women and four men ranging in age from 40 to 65 years, with a mean age of 538 [+ or -] 68 years. Follow-up was complet utilizing hospital charts and physician office records.

RESULTS

The initial symptonis for which patients sought medical attention were pulmonary in eight and nenrologic in four. couple of these four patients had intracranial resort each. Metastatic lesions were metachronous in 13 instances (nine patients), and synchronous in three instances (three patients). Presenting neurologic symptoms included confusion in eight patients, seizures in eight patients, hemiparesis in seven patients, headaches in six patients, aphasia in five patients, nausea and vomiting in three patients, and ataxia in undivided patient. The diagnosis of intracranial tumor was confirmed in each case by way of computed tomographic scan. Location of the intracranial metastasis was in the frontoparietal region in eight patients, temporal lobe in common patient, occipital lobe in sum of two units patients, and the cerebellum in the same patient. Four recurrent metastatic lesions were all located in the frontoparietal region.

The initial surgical action was thoracotomy in nine patients and craniotomy in three patients. Time period elapsing from thoracotomy to initial craniotomy ranged from 1 to 29 month (147 [+ or -] 101 mean [+ or -] SD) reciprocally when craniotomy was the initial conduct (three patients) the time interval to thoracotomy ranged from individual to three months (one month single in kind month and three months, respectively). The duration of neurologic symptoms prior to craniotomy ranged from individual to seven months (2.4 [+ or -] 18 mean [+ or -] SD)

A summary of the exemplars of pulmonary resection, staging of intrathoracic disease, and histopathologic diagnosis is at handed in Table 1. Lobectomy was the mostly common procedure performed, with lesions identified mostly frequently as adenocarcinoma. When studied microscopically, all metastatic lesions prov to be identical with the primary lung lesion. In all cases consummate dissection of mediastinal lymph nodes was accomplished to assure adequate staging of the intrathoracic disease. Of the 14 thoracotomies, five patients had stage 1 thoracic disease, four had stage 2 and five, stage 3

The combined operative mortality was nothing Combination adjuvant therapy (thoracic irradiation and systemic chemotherapy) was utilized in eight patients (three prior to thoracotomy and five following thoracotomy). Total irradiation dosage was 4000 rads delivered in divided doses and the systemic chemotherapeutic agents consisted mainly of cis platinum and 5FU Whole-brain irradiation was administered following craniotomy in four patients. In all instances, the neurosurgeon reported that the metastatic lesion was remov in its entirety. total neurologic improvement was obtained in 11 of 12 patients (92 percent) following initial craniotomy. individual patient had a slight residual leg weakness. consummated neurologic improvement following all craniotomies was achieved in 15 abroad of 16 cases (94 percent)

The duration of neurologic improvement following initial craniotomy ranged from 1 to 56 month (182 [+ or -] 176 mean [+ or -] SD) and is depicted graphically in Figure 1 Eighty-one percent of patients were symptom-free single in kind year after craniotomy, with 63 percent remaining in this way greater than four years afterward. The average time to return of neurologic symptoms following repeat craniotomy was three month Survival (actuarial) following initial craniotomy is depicted in Figure 2 It ranged from 1 to 56 month (263 [+ or -] 154 mean [+ or -] SD) Ninety percent of patients were alive single year following craniotomy, with 56 percent surviving longer than four years.