Surgery and chemotherapy for pulmonary metastases: long-term results from a combined modality approach

Eighty-three patients underwent pulmonary metastatectomy as part of a combined modality approach between 1. 1. 1972 and 31. 12. 1988 and 80 were followed up until 1. 1. 1990 or until death, with an average follow-up of 110 months. The estimated 5-, 10-, and 15-year survival rate was 38%, 32%, and 22% respectively. Recurrent pulmonary metastases were observed in 60% of the patients during follow-up with an estimated 24 months relapse-free survival rate of 50%. An additional 20% of the patients developed extrapulmonary recurrent tumor manifestation without evidence of pulmonary disease. One of five patients remained tumor free up to 207 months (an average of 87 months) after the initial pulmonary metastatectomy. A multivariate analysis identified completeness of tumor removal, the type of primary tumor, and a difference in histology between primary and metastatic neoplasm as three independent prognostic factors with significant impact on overall survival, the completeness of tumor removal being the most important one. Disease-free long-term survival for patients with pulmonary metastases treated by surgery and chemotherapy is related to completeness of tumor removal and the type of primary tumor.