Lung Cancer and Isolated Adrenal Metastases: Different Disease? - Lung Cancer and Isolated Adrenal Metastases: Different Disease? - Open Access Pub

Distant metastases generally indicate disseminated disease and the standard treatment for these patients is palliative chemotherapy. Retrospective series showed that selected patients with metastatic lung cancer and a solitary extrathoracic disease could be effectively treated with curative intention by resection of both primary tumor and the single site of metastatic disease. According to current data, adrenalectomy might be considered as an alternative option for patients with isolated adrenal metastases. Significant morbidity and mortality may be happened by these procedures, and a cautious analysis of pros and cons should be discussed with the patient. We present a review of the literature and updated recommendations focusing lung cancer with solitary adrenal metastasis. DOI10.14302/issn.2642-9241.jrd-18-2499 Isolated adrenal metastasis are reported in 1,6 -3,5% of patients with primary non-small cell lung cancer (NSCLC), presenting with resectable tumors, and it increases up to 40% as the disease progresses1,2. The setting of distant metastasis generally indicates disseminated disease and the standard treatment for these patients is palliative chemotherapy. Retrospective series suggest that some stage IV non-small-cell-lung cancer (NSCLC) patients with a solitary synchronous/metachronous extrathoracic metastatic disease (“micrometastatic disease”) might be cured by resection of both primary tumor and isolated metastases2,3. Since 1982, when Twomey et al4 reported on prolonged survival after adrenalectomy, introducing the concept of curative management of patients with lung cancer and isolated adrenal metastases, many reports have addressed this topic and confirmed the feasibility of such approach. We adopted a comprehensive assessment of the literature where studies published in English were included. Studies on adrenal metastases and NSCLC were identified using Pubmed, (until December 2017) and the Cochrane Library (until December 2017). The search words were: adrenal metastases, adrenal metastasectomy, adrenal metastases resection, surgery for adrenal metastases, non-small cell lung cancer adrenal metastases To be considered to enter in this review, studies consisted of reviews and case series. Entry criteria for studies included: operative morbidity and mortality, type of resection, systemic therapy, primary tumor characteristics, disease free-interval, and adrenal nodules/ masses aspects. The surgical approach included unilateral or bilateral adrenalectomy. The authors attempted to view adrenal metastasectomy as a surgical option for patients