Recent Advances in the Diagnosis and Management of Multiple Primary Lung Cancer
by
, , ,
Chi-Lu Chiang
1,2,3
,
Ping-Chung Tsai
4,
Yi-Chen Yeh
2,5,
Yuan-Hung Wu
2,6,7,
Han-Shui Hsu
2,4 and
Yuh-Min Chen
1,2,* 1
Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
2
School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
3
Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
4
Department of Surgery, Division of Thoracic Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan
5
Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
6
Department of Oncology, Division of Radiation Oncology, Taipei Veterans General Hospital, Taipei 112, Taiwan
7
Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
*
Author to whom correspondence should be addressed.
Cancers 2022, 14(1), 242; https://doi.org/10.3390/cancers14010242
Submission received: 7 December 2021
/
Revised: 31 December 2021
/
Accepted: 1 January 2022
/
Published: 4 January 2022
(This article belongs to the Collection Diagnosis and Treatment of Primary and Secondary Lung Cancers)
Simple Summary
With the wide application of computed tomography and lung cancer screening, the incidence of multiple primary lung cancer, that is, the occurrence of two or more primary malignant lung tumors in a patient, has been increasingly reported. The optimal strategy for the diagnosis and treatment of multiple primary lung cancers is controversial. Surgery remains the main treatment modality, whereas other treatment methods, including radiotherapy and local ablation, are also feasible, particularly for inoperable patients. Next-generation sequencing and novel therapies, such as targeted agents and immune-checkpoint inhibitors, have provided new insights into this topic.
Abstract
With the wide application of computed tomography in lung cancer screening, the incidence of multiple primary lung cancer (MPLC) has been increasingly reported. Despite the established criteria, the differentiation between MPLC and intrapulmonary metastasis remains challenging. Although histologic features are helpful in some circumstances, a molecular analysis is often needed. The application of next-generation sequencing could aid in distinguishing MPLCs from intrapulmonary metastasis, decreasing ambiguity. For MPLC management, surgery with lobectomy is the main operation method. Limited resection does not appear to negatively affect survival, and it is a reasonable alternative. Stereotactic ablative radiotherapy (SABR) has become a standard of care for patients refusing surgery or for those with medically inoperable early-stage lung cancer. However, the efficacy of SABR in MPLC management could only be found in retrospective series. Other local ablation techniques are an emerging alternative for the control of residual lesions. Furthermore, systemic therapies, such as targeted therapy for oncogene-addicted patients, and immunotherapy have shown promising results in MPLC management after resection. In this paper, the recent advances in the diagnosis and management of MPLC are reviewed.
