Secondary lung tumors, or pulmonary metastases, are common and usually asymptomatic. CT scans are the gold standard for detection and can identify nodules as small as 3mm. Tissue diagnosis via bronchoscopy, biopsy, or video-assisted thoracoscopic surgery is often pursued. Surgical resection of metastases according to the Alexander and Haight criteria can improve 5-year survival rates by 25-40% for select patients by completely removing all detectable tumors. Options besides surgery include radiofrequency ablation for small, few lesions or isolated lung perfusion with high-dose chemotherapy for advanced cases.

1. MANAGEMENT OF
SECONDARY LUNG TUMOR
Tummarat Ruangpratyakul, M.D.

2. Introduction
• Secondary malignancy tumor of lung = pulmonary
metastasis
• Lung is second most common site of metastasis
• 20-54% patient who die with cancer also have
pulmonary metastasis
• Breast, colon, kidney, oropharynx, soft tissue
sarcoma are most common primary

4. Clinical Features
• 75-90% are asymptomatic
• Discovered by routine or follow-up radiologic exam
• Rare: dyspnea, cough, hemoptysis or pain

5. Radiographic evaluation
• CT is gold standard
• HRCT can detect nodule small as 3 mm
• PET overall sensitivity of 67.5%

8. Tissue Diagnosis
• Bronchoscopy
• Fine needle aspiration
• VATS (sen&spec approaching 100%)

9. Surgical Therapy
• Alexander and Haight criteria for resection of
secondary pulmonary malignancy
1. Primary tumor is controlled (or is controllable)
2. Any extrapulmonary disease is controlled (or is
controllable)
3. Patient must be fit for surgical resection (patient's
pulmonary reserve will tolerate pulmonary
resection)

10. Surgical Therapy
• Open or Thoracoscopy no significant differences
outcome
• Open: sufficient manual palpation
• Thoracoscopy: decrease post-op pain, ICD duration,
hospital LOS, faster recovery, inflammation response

11. Surgical Therapy
• Wedge resection to include negative margin is the
standard therapy
• Peripheral: wedge resection
• More central: segmentectomy, lobectomy, rarely
pulmonectomy
• Lymph node dissection was no routinely performed

12. Outcomes
• Metastectomy is improve survival 25-40%
• Most important predictor is completeness of
resection
• Other prognostic factors: longer DFI, tumor
doubling time, No. of nodule
• Recurrence of disease is most common cause of
death

14. Outcomes
• Best surgical outcomes: nonseminomatous germ cell
tumor, colon cancer, renal cell carcinoma and
sarcoma
• Worse: oral cavity and oropharynx, melanoma
• Breast is moderate outcome

15. Alternative Treatment
• Radiofrequency ablation: thermal energy, 90-100C
to produce coaglulation necrosis
• lesion<5cm, <4 lesion in both lungs, abut
mediastinal structure
• Reserved of inoperable or refuse surgery

16. Alternative Treatment
• Isolated lung suffusion: injected high-dose CMT
into pulmonary system
• Injected to pulmonary artery, clamped at proximal
to injection site and clamped pulmonary veins
• Reduce of systemic toxicities

17. Summary
• Metastectomy is the treatment of choice in select
patients with lung metastasis
• Metastectomy improve 5-year survival as 40-50%

18. THANK YOU