title: The indolent nature of pulmonary metastases from ductal adenocarcinoma of the pancreas.
abstract: OBJECTIVE
  The natural history of pulmonary metastases from pancreatic ductal adenocarcinoma (PDAC) is not well studied. Limited evidence suggests patients with isolated pulmonary metastases from PDAC follow a more benign clinical course than those with other sites of metastases.
  
  
  METHODS
  We performed a retrospective review of all patients with pulmonary metastases from PDAC from 2000 to 2010 and analyzed survival utilizing the Kaplan-Meier method based upon location of first metastasis (lung first, intra-abdominal first, or synchronous intra-abdominal and lung metastases).
  
  
  RESULTS
  Median survival among subjects with lung as the only site of metastases was significantly longer than those with other metastatic patterns. In subjects that had undergone resection of their PDAC, survival in those with lung as a first site of recurrence remained significantly longer than those with abdominal first or synchronous intra-abdominal and lung recurrence. Among resected patients that developed lung only recurrence, survival was significantly prolonged (67.5 months) in those who underwent surgical resection/stereotactic radiosurgery compared to chemotherapy (33.8 months) or observation (29.9 months) for treatment of lung recurrence.
  
  
  CONCLUSIONS
  Patients with isolated pulmonary recurrence from PDAC may realize a survival benefit from surgical intervention or stereotactic radiosurgery compared to chemotherapy or observation for treatment of lung recurrence.
authors.affiliation: Divisionof Surgical Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Downs-Canner
authors.affiliation: Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Mazen
authors.initials: M
authors.lastname: Zenati
authors.affiliation: Divisionof Surgical Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Boone
authors.affiliation: Divisionof Surgical Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Varley
authors.affiliation: Divisionof Surgical Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Steve
authors.affiliation: Divisionof Surgical Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hogg
authors.affiliation: Divisionof Surgical Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Amer
authors.initials: A
authors.lastname: Zureikat
authors.affiliation: Divisionof Surgical Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.affiliation: Divisionof Surgical Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Kenneth K W
authors.initials: KK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D011013:Pneumonectomy / Q000401:mortality*; D011379:Prognosis; D016634:Radiosurgery / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate
keywords: lung metastases; pancreatic ductal adenocarcinoma; pulmonary metastases