328 Ch 327. Pulmonary Metastases and Paraneoplastic Pulmonary Syndromes

Pulmonary metastases 是 lung 最常見 cancer presentation（多於 primary lung cancer）；routes：(1) hematogenous (most)；(2) lymphatic；(3) bronchogenic；(4) direct extension；patterns：multiple peripheral nodules > solitary > miliary > lymphangitic carcinomatosis > endobronchial > pleural；common primary tumors with lung mets：breast、colon、kidney、testicular、head/neck、melanoma、sarcoma；diagnosis：tissue biopsy (CT-guided)、IHC + molecular profile to identify primary；treatment：systemic therapy (depends on primary)、surgical resection (metastasectomy) for selected (limited mets, controlled primary, technically feasible, sufficient lung function)；colorectal mets：surgery + chemo improves survival；sarcoma mets：surgery + chemo；germ cell mets：chemo-sensitive；SABR (stereotactic ablative radiotherapy) + RFA alternative for non-surgical；oligometastatic disease concept evolving — aggressive local therapy may improve OS。Paraneoplastic pulmonary syndromes = lymphangitic carcinomatosis、tumor embolism、paraneoplastic ILD、HP-like、cryptogenic organizing pneumonia + DIC + Trousseau。