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Treatment choices for single adrenal metastasis in lung cancer

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Introduction: Metastatic non-small cell lung cancer accounts for approximately half of newly diagnosed cases. Surgery is not an option as the majority has disseminated metastatic disease at diagnosis. Still, patients with solitary extra-thoracic metastasis (brain, adrenal, liver) represent a subset with slightly better prognosis than those with multiple sites of metastases. Discussion: The adrenals represent a common metastatic site in patients with lung cancer. Solitary adrenal metastases treated with adrenalectomy revealed long-term survival rates compared to chemotherapy alone. Studies found higher survival rates in the metachronous group than in patients with synchronous adrenal metastases. A disease free interval of more than 6 months from the thoracic surgery moment to the diagnosis of an adrenal metastasis is a predictor of increased survival. Comparing adrenalectomy with conservative management, there was found higher survival in the chemotherapy-plus-adrenalectomy group rather than chemotherapy alone. In patients with metachronous disease, a higher survival was found in patients who received adjuvant chemotherapy after adrenalectomy than in those with surgical resection alone.

Conclusions: Based mostly on retrospective studies, available evidence supports the idea that selected patients with solitary adrenal metastasis may benefit from complete surgical resection. Surgery should be performed only if mediastinal lymph node involvement is excluded, as survival remains poor for N2- N3 positive patients. Adrenalectomy after a disease-free interval of more than 6 months can provide long-term survival in patients that had undergone complete primary lung cancer resection. Abbreviations: NSCLC – non small cell lung cancer

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