Pulonary Mets

Question 1

Malignancies with predilection for the lungs?

Answer 1

Osteosarcoma
Ewings
Wilms
Hepatoblastoma
Papillary thyroid
HCC
Malignant Rhabdoid tumour of the kidney
No rhabdo sarcomas

Question 2

Malignant features on CT?

Answer 2

Osteo- calcifications
- <5 mm near fissures are usually nodes

PET-CT - unreliable for lesions < 6 mm

Question 3

Osteosarcoma pulmonary Mets Management?

Answer 3

Complete resection of nodules if possible.
Thoracotomy preferred as many nodules are only detectable with palpation.
Bilateral exploration controversial.

Question 4

Poor prognostic factors in osteosarc mets?

Answer 4

Time to relapse
Central location
> 3 nodules
Bilateral involvement
Complete resection

Question 5

Medical treatment for pulmonary Mets in Wilms?

Answer 5

Doxorubicin
Vincrisitne
Actinomycin-D
Whole lung radiation

Question 6

When can whole lung radiation be eliminated in Wilms with pulmonary Mets?

Answer 6

Favourable histology, and no LOH for 1p or 16q.
Complete response after 6 weeks of 3 drug chemo.
Event free survival 78 % at 4 years

Question 7

What regimen is used for non-complete responders after 6 weeks of treatment for Wilms?

Answer 7

Regime M (whole lung radiation with addition of cyclophosphamide and etoposide.

Question 8

Hepatoblastoma with pulmonary Mets management?

Answer 8

“Aggressive surgical resection for persistent or recurrent pulmonary Mets following neoadjuvent chemo.”

3 yr EFS 56%

Question 9

Ewing’s sarcoma with pulmonary Mets?

Answer 9

No clear benefit to surgery, standard management is radiation.

Question 10

Non Rahbdo sarcoma pulmonary mets mgmt?

Answer 10

Complete resection is only chance for long term survival.

Perform metasectomy if good control of primary and no other disease.