F-075 SURVEILLANCE OF THE REMAINING NODULES AFTER RESECTION OF THE DOMINANT LESION IN MULTIFOCAL LUNG ADENOCARCINOMA IS AN APPROPRIATE FOLLOW-UP STRATEGY

Publication Title

Interactive Cardiovascular & Thoracic Surgery

Document Type

Conference Proceeding

Publication Date

6-2014

Keywords

washington; swedish; swedish thoracic surgery

Abstract

  • Abstract: Objectives: Lung adenocarcinoma presenting as multifocal disease creates a challenge when there is a dominant lesion with additional nodules. Recent data supports resection of the dominant lesion but management of the remaining lesions is controversial. Some advocate resection of the remaining nodules that show growth or morphologic changes; whereas, others advocate surveillance owing to the slow doubling time exhibited in these lesions. We assessed the nodules remaining after resection of the dominant lesion to determine a reasonable strategy of management for these nodules.Methods: We retrospectively evaluated patients with multifocal lung adenocarcinoma from 2000 to 2013 after a dominant lesion was resected. A modified Schwartz formula was used to measure volume doubling time (VDT) of the overall size of lung lesions.Results: Eighty-one patients underwent resection of 82 dominant lesions (Group 1) concurrently with 45 non-dominant lesions (Group 2) while 134 non-dominant lesions were radiologically surveyed (Group 3). Only 8/134 (6%) of the unresected lesions showed growth in size. Two of these also appeared denser. One lesion was confirmed cancer on biopsy and treated with radiation. The remaining 7 nodules are under surveillance and have changed minimally at a mean follow-up of 5.8 years.Conclusions: These data support surveillance of the remaining nodules in patients with multifocal lung adenocarcinoma who have undergone resection of the dominant lesion. The strategy of resection of the dominant lesion followed by surveillance is reasonable with selective resection of lesions larger than 1 cm, PET avid, of mixed morphology and with shorter VDT.Disclosure: No significant relationships.
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Clinical Institute

Cancer

Specialty

Oncology

Specialty

Pulmonary Medicine

Specialty

Surgery

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