title: Isolated pulmonary metastases define a favorable subgroup in metastatic pancreatic cancer.
abstract: OBJECTIVE
  Liver metastasis represents the first site of dissemination in >80% of metastatic pancreatic cancer (PC) patients. Pulmonary metastasis as first site of dissemination in PC is a rare event and might define a biologically distinct subgroup in metastatic PC.
  
  
  METHODS
  Consecutive PC patients who were diagnosed or treated with isolated pulmonary metastases at our high-volume comprehensive cancer center were included in a prospectively maintained database between 2002 and 2015. Medical records and correlating computed tomography findings (CT) were retrospectively analyzed.
  
  
  RESULTS
  A total of 40 PC patients with isolated pulmonary metastases were identified. Pulmonary metastases represented disease recurrence after initial resection of PC in 22 patients and disease progression of locally advanced pancreatic cancer in 5 patients. 14 out of 27 PC patients (56%) had received chemoradiotherapy for localized disease prior to pulmonary metastasis. Data on 1st-line treatment for pulmonary metastases was available for 38 patients: most patients (71%) received a gemcitabine-based chemotherapy regimen, 5 patients (13%) received best supportive care. After a median follow-up of 37.3 months, median survival after diagnosis of pulmonary metastasis was estimated with 25.5 months (95% CI 19.1-31.8); a significantly improved survival after diagnosis of pulmonary metastasis was observed for patients with less than 10 lung metastases (31.3 vs 18.7 months, p = 0.003) and for an unilateral localization of lung involvement (31.3 vs 21.8 months, p = 0.03).
  
  
  CONCLUSIONS
  Our results suggest a favorable outcome of PC patients with isolated pulmonary metastases. Further research is warranted to elucidate the specific molecular characteristics of this rare subgroup.
authors.affiliation: Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Kruger
authors.affiliation: Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Haas
authors.affiliation: Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany.
authors.forename: Philipp Johannes
authors.initials: PJ
authors.lastname: Burger
authors.affiliation: Institute of Pathology, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Ormanns
authors.affiliation: Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany.
authors.forename: Dominik Paul
authors.initials: DP
authors.lastname: Modest
authors.affiliation: Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany.
authors.forename: Christoph Benedikt
authors.initials: CB
authors.lastname: Westphalen
authors.affiliation: Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany.
authors.forename: Marlies
authors.initials: M
authors.lastname: Michl
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Kleespies
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany.
authors.forename: Martin Kurt
authors.initials: MK
authors.lastname: Angele
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Hartwig
authors.affiliation: Department of General, Abdominal and Vascular Surgery, Otto-von-Guericke-University, D-39120 Magdeburg, Germany.
authors.forename: Christiane Josephine
authors.initials: CJ
authors.lastname: Bruns
authors.affiliation: Department of Radiation Oncology, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Niyazi
authors.affiliation: Department of Radiation Oncology, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany; Department of Molecular Radiation Oncology, Deutsches Krebsforschungszentrum (DKFZ), D-69120 Heidelberg, Germany.
authors.forename: Falk
authors.initials: F
authors.lastname: Roeder
authors.affiliation: Institute of Pathology, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kirchner
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.affiliation: Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Heinemann
authors.affiliation: Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, D-81377 Munich, Germany. Electronic address: stefan.boeck@med.uni-muenchen.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Boeck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D016208:Databases, Factual; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine
keywords: Ductal adenocarcinoma; Isolated; Lung; Lung recurrence; Pancreatic cancer; Pulmonary metastases