Primary Multicentricity of Lung Cancer Compatibility with the SLN Concept

In lung cancer treatment, in the clinical and radio-diagnostic investigations synchronous multicentricity and back-metastasis to the lungs must be distinguished. It is essential that this is done before mediastinoscopy and/or SLN labeling is started. In this context it must also be emphasized that primary multicentricity does not contraindi-

cate surgical treatment, which can sometimes be curative.

With regard to this point, it must be emphasized that, at least in cases with ipsilateral multi-centricity, the surgical treatment is basically not different from lobectomy or pneumectomy procedures in cases with unifocal lung cancers. In cases with bilateral cancer foci, in addition to lobectomy or pneumectomy on the side with more intensive cancer involvement, laser and irradiation therapy of smaller foci on the contralateral side are considered and performed, as well as lymphadenectomy. Because some of these multifocal cancer types have low degrees of malignancy, the 78.3% 5-year survival rate published by Kawashima (2002) is not too astonishing.

Kawashima et al. collected 33 cases of multicentric carcinomas. The results are listed briefly in Table 3.

Table 3. Data recorded in 33 cases with synchronous multicentricity treated by Kawashima et al. (2002)

No. of patients



Mean age/ range


Bilateral involvement


Adeno-and other types

Overall 5 year survival

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