Special treatment issues

Frank C. Detterbeck, David R. Jones, Kemp H. Kernstine, Keith S. Naunheim

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

This chapter of the Lung Cancer Guidelines addresses patients with particular forms of non-small cell lung cancer that require special considerations. This includes patients with Pancoast tumors, T4N0,1M0 tumors, satellite nodules in the same lobe, synchronous and metachronous multiple primary lung cancers (MPLC), and solitary metastases. For patients with a Pancoast tumor, a multimodality approach, involving chemoradiotherapy and surgical resection, appears optimal provided appropriate staging has been carried out. Patients with central T4 tumors that do not have mediastinal node involvement are uncommon. When carefully staged and selected, however, such patients appear to benefit from resection as part of the treatment as opposed to chemoradiotherapy alone. Patients with a satellite lesion in the same lobe as the primary tumor have a good prognosis and require no modification of the approach to evaluation and treatment from what would be dictated by the primary tumor alone. On the other hand, it is difficult to know how best to treat patients with a focus of the same type of cancer in a different lobe. Although MPLC do occur, the survival results after resection for either a synchronous presentation or a metachronous presentation with an interval of < 4 years between tumors are variable and generally poor, suggesting that many of these patients may have had a pulmonary metastasis rather than a second primary lung cancer. A thorough and careful evaluation of these patients is warranted to try to differentiate between patients with a metastasis and those with a second primary lung cancer, although criteria to distinguish them have not been defined. Finally, some patients with a solitary focus of metastatic disease in the brain or adrenal gland appear to benefit substantially from resection.

Original languageEnglish (US)
JournalChest
Volume123
Issue number1 SUPPL.
StatePublished - 2003

Fingerprint

Lung Neoplasms
Pancoast Syndrome
Therapeutics
Neoplasms
Second Primary Neoplasms
Chemoradiotherapy
Neoplasm Metastasis
Brain Diseases
Adrenal Glands
Non-Small Cell Lung Carcinoma
Guidelines
Lung
Survival

Keywords

  • Adrenal metastasis
  • Brain metastasis
  • Carina
  • Metachronous primary lung cancers
  • Multiple primary lung cancer
  • Pancoast tumor
  • Satellite nodules
  • Superior sulcus tumor
  • Superior vena cava
  • Synchronous primary lung cancers
  • T4N0,1M0 tumor

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Detterbeck, F. C., Jones, D. R., Kernstine, K. H., & Naunheim, K. S. (2003). Special treatment issues. Chest, 123(1 SUPPL.).

Special treatment issues. / Detterbeck, Frank C.; Jones, David R.; Kernstine, Kemp H.; Naunheim, Keith S.

In: Chest, Vol. 123, No. 1 SUPPL., 2003.

Research output: Contribution to journalArticle

Detterbeck, FC, Jones, DR, Kernstine, KH & Naunheim, KS 2003, 'Special treatment issues', Chest, vol. 123, no. 1 SUPPL..
Detterbeck FC, Jones DR, Kernstine KH, Naunheim KS. Special treatment issues. Chest. 2003;123(1 SUPPL.).
Detterbeck, Frank C. ; Jones, David R. ; Kernstine, Kemp H. ; Naunheim, Keith S. / Special treatment issues. In: Chest. 2003 ; Vol. 123, No. 1 SUPPL.
@article{87341af922d244e8b64875a1be210ac0,
title = "Special treatment issues",
abstract = "This chapter of the Lung Cancer Guidelines addresses patients with particular forms of non-small cell lung cancer that require special considerations. This includes patients with Pancoast tumors, T4N0,1M0 tumors, satellite nodules in the same lobe, synchronous and metachronous multiple primary lung cancers (MPLC), and solitary metastases. For patients with a Pancoast tumor, a multimodality approach, involving chemoradiotherapy and surgical resection, appears optimal provided appropriate staging has been carried out. Patients with central T4 tumors that do not have mediastinal node involvement are uncommon. When carefully staged and selected, however, such patients appear to benefit from resection as part of the treatment as opposed to chemoradiotherapy alone. Patients with a satellite lesion in the same lobe as the primary tumor have a good prognosis and require no modification of the approach to evaluation and treatment from what would be dictated by the primary tumor alone. On the other hand, it is difficult to know how best to treat patients with a focus of the same type of cancer in a different lobe. Although MPLC do occur, the survival results after resection for either a synchronous presentation or a metachronous presentation with an interval of < 4 years between tumors are variable and generally poor, suggesting that many of these patients may have had a pulmonary metastasis rather than a second primary lung cancer. A thorough and careful evaluation of these patients is warranted to try to differentiate between patients with a metastasis and those with a second primary lung cancer, although criteria to distinguish them have not been defined. Finally, some patients with a solitary focus of metastatic disease in the brain or adrenal gland appear to benefit substantially from resection.",
keywords = "Adrenal metastasis, Brain metastasis, Carina, Metachronous primary lung cancers, Multiple primary lung cancer, Pancoast tumor, Satellite nodules, Superior sulcus tumor, Superior vena cava, Synchronous primary lung cancers, T4N0,1M0 tumor",
author = "Detterbeck, {Frank C.} and Jones, {David R.} and Kernstine, {Kemp H.} and Naunheim, {Keith S.}",
year = "2003",
language = "English (US)",
volume = "123",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "1 SUPPL.",

}

TY - JOUR

T1 - Special treatment issues

AU - Detterbeck, Frank C.

AU - Jones, David R.

AU - Kernstine, Kemp H.

AU - Naunheim, Keith S.

PY - 2003

Y1 - 2003

N2 - This chapter of the Lung Cancer Guidelines addresses patients with particular forms of non-small cell lung cancer that require special considerations. This includes patients with Pancoast tumors, T4N0,1M0 tumors, satellite nodules in the same lobe, synchronous and metachronous multiple primary lung cancers (MPLC), and solitary metastases. For patients with a Pancoast tumor, a multimodality approach, involving chemoradiotherapy and surgical resection, appears optimal provided appropriate staging has been carried out. Patients with central T4 tumors that do not have mediastinal node involvement are uncommon. When carefully staged and selected, however, such patients appear to benefit from resection as part of the treatment as opposed to chemoradiotherapy alone. Patients with a satellite lesion in the same lobe as the primary tumor have a good prognosis and require no modification of the approach to evaluation and treatment from what would be dictated by the primary tumor alone. On the other hand, it is difficult to know how best to treat patients with a focus of the same type of cancer in a different lobe. Although MPLC do occur, the survival results after resection for either a synchronous presentation or a metachronous presentation with an interval of < 4 years between tumors are variable and generally poor, suggesting that many of these patients may have had a pulmonary metastasis rather than a second primary lung cancer. A thorough and careful evaluation of these patients is warranted to try to differentiate between patients with a metastasis and those with a second primary lung cancer, although criteria to distinguish them have not been defined. Finally, some patients with a solitary focus of metastatic disease in the brain or adrenal gland appear to benefit substantially from resection.

AB - This chapter of the Lung Cancer Guidelines addresses patients with particular forms of non-small cell lung cancer that require special considerations. This includes patients with Pancoast tumors, T4N0,1M0 tumors, satellite nodules in the same lobe, synchronous and metachronous multiple primary lung cancers (MPLC), and solitary metastases. For patients with a Pancoast tumor, a multimodality approach, involving chemoradiotherapy and surgical resection, appears optimal provided appropriate staging has been carried out. Patients with central T4 tumors that do not have mediastinal node involvement are uncommon. When carefully staged and selected, however, such patients appear to benefit from resection as part of the treatment as opposed to chemoradiotherapy alone. Patients with a satellite lesion in the same lobe as the primary tumor have a good prognosis and require no modification of the approach to evaluation and treatment from what would be dictated by the primary tumor alone. On the other hand, it is difficult to know how best to treat patients with a focus of the same type of cancer in a different lobe. Although MPLC do occur, the survival results after resection for either a synchronous presentation or a metachronous presentation with an interval of < 4 years between tumors are variable and generally poor, suggesting that many of these patients may have had a pulmonary metastasis rather than a second primary lung cancer. A thorough and careful evaluation of these patients is warranted to try to differentiate between patients with a metastasis and those with a second primary lung cancer, although criteria to distinguish them have not been defined. Finally, some patients with a solitary focus of metastatic disease in the brain or adrenal gland appear to benefit substantially from resection.

KW - Adrenal metastasis

KW - Brain metastasis

KW - Carina

KW - Metachronous primary lung cancers

KW - Multiple primary lung cancer

KW - Pancoast tumor

KW - Satellite nodules

KW - Superior sulcus tumor

KW - Superior vena cava

KW - Synchronous primary lung cancers

KW - T4N0,1M0 tumor

UR - http://www.scopus.com/inward/record.url?scp=0037250148&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037250148&partnerID=8YFLogxK

M3 - Article

VL - 123

JO - Chest

JF - Chest

SN - 0012-3692

IS - 1 SUPPL.

ER -