[Synchronous primary lung cancers: due to the four cases]

Area of Science:

• Pulmonology
• Oncology
• Thoracic Surgery

Background:

• Synchronous multiple primary lung cancers (MPLC) are defined as two or more primary lung cancers diagnosed simultaneously.
• MPLC accounts for 0.1-1.6% of all lung cancer diagnoses.

Observation:

• This report details four male patients (mean age 63) diagnosed with MPLC between 1999 and 2002, all with a history of heavy smoking (mean 58 pack-years).
• Histological subtypes included squamous-adeno (2 cases), squamous-small cell lung cancer (1 case), and squamous-squamous (2 cases).
• All patients presented with bilateral lung masses, but without mediastinal or systemic spread. Crucially, one or more lesions were only detectable via computed tomography (CT) or bronchoscopy, not standard chest X-ray.

Findings:

• Diagnostic procedures involved transthoracic needle biopsy (3 lesions) and bronchoscopic biopsy (other lesions).
• Despite recommendations for separate staging and surgical treatment of MPLC, patient factors such as advanced age, presence of small cell lung cancer, and poor respiratory reserve precluded surgery.
• Consequently, patients received chemotherapy, with three of the four patients dying within a mean survival of 11 months.

Implications:

• Accurate and separate diagnostic evaluation of each lesion is critical for MPLC.
• Treatment planning must be individualized based on the specific characteristics and staging of each primary tumor.
• Improved diagnostic strategies are needed to detect all MPLC lesions, especially those not visible on initial chest radiography.