According to a recent article published in The Journal of Thoracic and Cardiovascular Surgery, the surgical removal of cancer spread to the lungs from colorectal cancer may provide improved long-term survival in some patients.
The colon and rectum are both parts of the large intestine. Colorectal cancer is a common malignancy in the United States and when caught prior to spread from its site of origin, has a high cure rate. However, once colorectal cancer has spread to distant sites in the body (metastasized), cure rates fall dramatically and long-term survival is rare. A common site in the body for advanced colorectal cancer to spread is the lung, referred to as pulmonary metastasis. Physicians often treat patients with advanced colorectal cancer and pulmonary metastases with chemotherapy, as their cancer is considered too advanced for the surgical removal of the metastases. However, results from some clinical trials have suggested that if possible, the surgical removal of pulmonary metastases may improve survival in patients with advanced colorectal cancer.
Researchers from Germany recently conducted a clinical trial to evaluate the safety and effectiveness of the surgical removal of pulmonary metastases in patients with advanced colorectal cancer. This trial included 167 patients with colorectal cancer that could be surgically removed at the site of origin as well as in the lungs. The cancer had not spread to any other organs besides the lungs. Approximately 5 years following therapy, overall survival was 32.4%. The researchers noted that various factors had an affect on survival. First, patients with a single pulmonary metastasis had an improved survival (45%) compared with those who had more than one metastasis (20%). In addition, pre-surgical levels of a protein marker in the blood referred to as carcinoembryonic antigen (CEA) serum levels also affected survival outcomes. Patients with a CEA level in the normal range had a 5-year survival rate of nearly 50%, compared with only 23% for those with a CEA level exceeding 5 ng/mL. Patients with cancer spread to nearby pulmonary lymph nodes also had a poorer survival rate than those without spread to those lymph nodes. The surgical procedure was well tolerated.
The researchers concluded that the surgical removal of pulmonary metastases from colorectal cancer appears to provide long-term survival, particularly in patients with a single metastasis without spread to pulmonary lymph nodes and normal CEA levels. Patients with advanced colorectal cancer that have been diagnosed with pulmonary metastasis may wish to speak with their physician about the risks and benefits of surgery or the participation in a clinical trial evaluating other novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.cancerconsultants.com. Personalized clinical trials are also offered on behalf of patients by cancerconsultants.com.
Reference: Pfannschmidt J, Muley T, Hoffman H, Dienemann H. Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: Experiences in 167 patients.
The Journal of Thoracic and Cardiovascular Surgery. 2003;126:732-739.
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