better prognosis for those with <4 lung metastases with metastectectomy
 

ie, surgical removal of those metastases

This goes along with an article I posted years ago by Dr. Hortobagyi et all of MD Anderson that those with solitary or very few bone mets had a much better prognosis

These articles are both reasons for oncologists to chuck their nihilistic attitude that those with Stage IV live on average 2 years no matter what they do.

The first thing to change that was the discovery of herceptin. The second thing would hopefully be a trial where they followed patients more closely for recurrence, perhaps with radioimagiing that could detect minimal residual disease(like iron nanoparticles fused to herceptin for her2+s), treat it promptly upon discovery and see if the natural history of the disease could be susbstantially improved upon and/or cures noted.

Cancer. 2010 Jun 15;116(12):2890-901.
Prognostic factors for recurrent breast cancer patients with an isolated, limited number of lung metastases and implications for pulmonary metastasectomy.
Yhim HY, Han SW, Oh DY, Han W, Im SA, Kim TY, Kim YT, Noh DY, Chie EK, Ha SW, Park IA, Bang YJ.

Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Abstract
BACKGROUND:: The aim of this study was to evaluate the clinical treatment outcomes of recurrent breast cancer with a limited number of isolated lung metastases, and to evaluate the role of pulmonary metastasectomy. METHODS:: The authors consecutively enrolled 140 recurrent breast cancer patients with isolated lung metastasis from 1997 to 2007 in Seoul National University Hospital and retrospectively analyzed 45 patients who had <4 metastatic lesions. RESULTS:: Fifteen patients had pulmonary metastasectomy followed by systemic treatment (pulmonary metastasectomy group), and 30 received systemic treatment alone (nonpulmonary metastasectomy group). The 3-year progression-free survival (PFS) and 4-year overall survival (OS) was significantly longer in the pulmonary metastasectomy group than in the nonpulmonary metastasectomy group (3-year PFS, 55.0% vs 4.5%, P < .001; 4-year OS, 82.1% vs 31.6%, P = .001). In multivariate analysis, a disease-free interval (DFI) of <24 months (hazard ratio [HR], 4.53; 95% CI, 1.72-11.90), no pulmonary metastasectomy (HR, 9.52; 95% CI, 3.34-27.18) and biologic subtypes such as human epithelial growth factor receptor-2 positive (HR, 3.00; 95% CI, 1.04-8.64) and triple negative (HR, 3.92; 95% CI, 1.32-11.59) were independent prognostic factors for shorter PFS. CONCLUSIONS:: The authors' results demonstrated that DFI and biologic subtypes of tumor are firm, independent, prognostic factors for survival, and pulmonary metastasectomy can be a reasonable treatment option in this population. Further prospective studies are warranted to evaluate the role of pulmonary metastasectomy. Cancer 2010. (c) 2010 American Cancer Society.

PMID: 20564396 [

Re: better prognosis for those with <4 lung metastases with metastectectomy
 

PS Most small pulmonary nodules do not end up being cancer--so if you had some, do NOT assume the doctors ignored you erroneously, that you should have had surgery and your prognosis is poor.

Rather look at this as...if any of those nodules ever proved to be cancer,or I develop lung mets subsequently, if found early when there are only a few, this might be a good opportunity to improve my prognosis

Hope I kept some needless worry at bay!

Re: better prognosis for those with <4 lung metastases with metastectectomy
 

Lani,

Thanks for this post.

I like your preface about medical oncs not giving much attention to local treatments, such as surgery in the case of lung mets. And this study shows that such treatment can offer benefit.

In my case, the small, single pulmonary nodule (and the only met) removed by minimally invasive surgery recurred a year later. I treated the recurrence with radiofrequency ablation. Unfortunately, the procedure created a cavity that allowed a fungus to grow which lead to another lung resection 11 months later. However, up until that point, the cancer had not recurred, as the path report noted only the fungus.

I really regret the fungus growing, not only for the obvious outcome (coughing up blood which lead to another lung surgery), but also because I was tremendously curious how the lung RFA would have worked out beyond a year.

Joan