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      Endobronchial Metastases from Colorectal Adenocarcinomas: Clinical and Endoscopic Characteristics and Patient Prognosis

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          Abstract

          Background: Endobronchial metastases (EBM) secondary to extrapulmonary solid malignant tumours are rare but may occur. The most common extrathoracic malignancies associated with EBM are breast, renal and colorectal carcinomas. This study aimed to evaluate the clinical and bronchoscopic aspects of EBM from colorectal carcinomas and the prognosis of the patients. Methods: EBM were diagnosed in 7 patients with colorectal carcinomas between 2004 and 2005. All patients underwent colorectal resection at the time of primary tumour diagnosis. Bronchial involvement was proved by bronchoscopy, and the metastatic nature of the lesions was confirmed histopathologically in all patients. EBM patients were compared with a control group of 7 patients with pulmonary metastases from colorectal cancer. Results: Median age at time of colorectal carcinoma was 55 years in EBM patients and 57 years in controls. Distressing airway symptoms caused by EBM were relieved by use of newer intrabronchial therapies: radiotherapy, brachytherapy and cryotherapy. One patient underwent metastasis resection. The median survival after diagnosis of EBM was 18.9 months. All patients had pulmonary metastases. The median survival after diagnosis of pulmonary metastasis from colorectal carcinoma was 55.7 months in EBM patients and 12.7 months in controls (p < 0.005). Discussion: EBM are generally underdiagnosed in patients with colorectal carcinoma. Bronchoscopy is not part of the standard evaluation of these patients. Physicians must be more attentive to pulmonary symptoms, even when patients’ pulmonary metastases are known. Various management options are available for localized endobronchial tumours. Conclusion: On average, EBM are diagnosed about 5 years after the diagnosis of the primary tumour, which is a relatively long lead time. Although this metastatic location usually implies a very negative prognosis regarding life expectancy, it did not seem to significantly reduce survival in our patients. Local treatments allow substantial improvement of pulmonary symptoms.

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          Most cited references18

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          Endobronchial metastasis.

          An attempt was made to define the incidence of tumor metastasis to central bronchi that could clinically mimic primary bronchogenic carcinoma. In a retrospective review of 1,359 consecutive autopsies at Walter Reed General Hospital, metastatic involvement of a major airway was present in only 2% of patients who died with solid tumors. The most common extrathoracic tumors associated with metastatic involvement of a central airway are renal and colorectal carcinomas. The clinical and roentogenographic features of endobronchial metastasis and bronchogenic carcinoma were found to be indistinguishable. However, in the majority of cases the primary tumor site is clinically apparent before symptoms of endobronchial metastasis. In most cases of endobronchial metastasis, the histologic appearance of the bronchoscopic biopsy suggests the correct diagnosis. A central bronchogenic carcinoma should rarely be confused with a metastasis to a major airway from an extrathoracic source.
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            Breast cancer and thoracic metastases: review of 119 patients.

            Review of the case notes of 660 patients with a diagnosis of breast cancer during a five-year period showed that in 119 cases there had been thoracic metastases. These were recorded as pleural or extrapleural metastases (79 patients), mediastinal tumour (46 patients), lymphangitic carcinoma (41 patients), pulmonary nodules (34 patients), and solitary pulmonary nodule (nine patients). Endobronchial metastases were present in seven patients and multiple pulmonary tumour emboli in two. The thorax was often the initial site of tumour recurrence. Most of these recurrences were present in several locations (intrathoracic or both intrathoracic and extrathoracic) simultaneously, facilitating the clinical diagnosis of metastatic breast cancer. Histopathological confirmation of metastasis was mandatory for the 10 patients who had a solitary intrathoracic abnormality without evidence of disease elsewhere. The median survival after diagnosis and treatment of a solitary thoracic metastasis was 42+ months and three of 10 patients are currently in remission (at 44, 87, and 121 months). The small tumour burden and early diagnosis giving lead time may explain the long survival in this group of patients.
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              Endobronchial metastatic disease: analysis of 32 cases.

              Endobronchial metastasis (EM) from nonpulmonary tumors is uncommon. A 9-year retrospective study at the University Hospital Vall d'Hebron (Barcelona, Spain) identified 32 patients with EM. All but four cases were diagnosed by fiberoptic bronchoscopy with bronchial biopsy. Primary tumors included the following types: breast cancer (20), colorectal cancer (3), melanoma (2), gastric cancer (1), neuroblastoma of the olfactory nerve (1), abdominal leiomyosarcoma (1), hypernephroma (1), endometrial carcinoma (1), papillary thyroid cancer (1), and hepatocarcinoma (1). Median age at diagnosis of EM was 58.7 years and median interval from the diagnosis of the primary tumor to the diagnosis of EM was 50.4 months. Seventeen patients (53%) had evidence of other metastatic sites at endobronchial relapse. The more common clinical manifestations included cough (37.5%), haemoptysis (28%), dyspnea (18.7%), and recurrent pulmonary infections (6.2%). Eight patients (25%) had no symptoms. There appears to be a predilection for metastatic involvement of the right and left upper lobe bronchus. Treatment was instituted in 20 patients, and their median survival was 11 months, in comparison with the 3 months found in 12 patients who received only palliative therapy because of advanced disseminated disease. Breast cancer is the most common tumor causing EM. The prognosis of patients with EM depends on the type of the primary tumor and the presence of other metastatic sites. Treatment must be individualized.
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                Author and article information

                Journal
                OCL
                Oncology
                10.1159/issn.0030-2414
                Oncology
                S. Karger AG
                0030-2414
                1423-0232
                2007
                June 2008
                02 June 2008
                : 73
                : 5-6
                : 395-400
                Affiliations
                Oncology Department, Centre Léon Bérard, Lyon, France
                Article
                136794 Oncology 2007;73:395–400
                10.1159/000136794
                18515979
                7a932606-fc9e-4d6a-9bb4-c4e0d7bf2665
                © 2008 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 30 May 2007
                : 16 October 2007
                Page count
                Figures: 4, Tables: 2, References: 20, Pages: 6
                Categories
                Clinical Study

                Oncology & Radiotherapy,Pathology,Surgery,Obstetrics & Gynecology,Pharmacology & Pharmaceutical medicine,Hematology
                Endobronchial metastases,Endoscopy,Colorectal cancer

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