ASO Author Reflections: Long-Term Outcomes of Pulmonary Metastasectomy for Uterine Malignancies: A Multi-institutional S
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Long-Term Outcomes of Pulmonary Metastasectomy for Uterine Malignancies: A Multi-institutional Study in the Current Era Ryu Kanzaki, MD, PhD Osaka University Graduate School of Medicine, Suita, Japan
PAST Information on pulmonary metastasectomy (PM) for uterine malignancies is limited due to the relatively low incidence of isolated pulmonary metastasis. The use of fluorine-18 2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT) in general clinical practice in Japan became widespread in 2006, and since then, there has been a remarkable improvement in the diagnosis of recurrent uterine malignancies using medical imaging. These improvements may influence the outcomes of recurrent uterine malignancies; however, little information is available regarding the performance of PM for uterine malignancies in the current era. PRESENT This paper describes long-term outcomes following PM for uterine malignancies in the current era (2006–2015) in a multiinstitutional setting.1 Fifty-seven patients underwent PM for uterine malignancies. Forty patients (70%) received FDG-PET/CT before PM. Complete resection was achieved in 52 patients (91%); the 5-year relapse-free survival and 5-year overall survival (OS) rates for these 52 patients were 40.7% and 68.8%, respectively. The 5-year OS rates of patients with cervical non-squamous cell carcinoma, cervical squamous cell carcinoma, corpus endometrial carcinoma, and corpus sarcoma were 85.7%, 83.1%, 72.6%, and 16.7%, respectively. Univariate
Ó Society of Surgical Oncology 2020 First Received: 22 March 2020 R. Kanzaki, MD, PhD e-mail: [email protected]
analysis revealed that a disease-free interval B 24 months was significantly associated with poorer OS. According to this study, the long-term outcome of PM for cervical cancer seems to have improved in comparison with reports before 2005. FUTURE Recently, medical treatments for uterine malignancies have shown remarkable development. For uterine leiomyosarcoma, molecular targeted drugs, such as olaratumab and pazopanib, and immune checkpoint inhibitors, such as nivolumab and pembrolizumab, have been used in clinical trials.2 For cervical cancer, the addition of bevacizumab to combination chemotherapy for recurrent disease has been associated with prolonged survival.3 Moreover, patients with cervical cancer can be treated using immune checkpoint inhibitors.4 In addition to these, stereotactic body radiation therapy has been widely performed for patients with pulmonary metastases and has shown favorable local control rates.5 In this clinical context, the indication and timing of PM for uterine malignancies may be changing. Investigating the outcomes of PM associated with these therapies compared with other therapies is our future task. REFERENCES 1. Kanzaki R, Susaki Y, Takami K, et al. Long-term outcomes of pulmonary metastasectomy for uterine malignancies: a multiinstitutional study in the current era. Ann Surg Oncol. 2020. https://doi.org/10.1
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