Surgical indications for resection in pulmonary metastasis of choriocarcinoma.

One hundred and twenty-two patients with choriocarcinoma were treated from 1965-1977. Pulmonary metastasis was noted in 82 of the 122 patients. In 21 cases, open thoracotomy and lobectomy were performed in conjunction with chemotherapy. Fifteen patients achieved complete remission and six patients died. It became evident that the factors with the greatest effect on the outcome of the surgical treatment are the preoperative hCG values and the extent of pulmonary metastasis. The following are the authors established criteria for the operative intervention of pulmonary metastasis of choriocarcinoma (modifying Thomford's principles): (1) The patient must be a good risk for surgical intervention. (2) That the primary malignancy is controlled, (the uterus has already been resected, or no angiographical evidence of tumor in pelvic cavity). (3) There is no evidence of metastatic disease elsewhere in the body. (4) Roentgenologic evidence of pulmonary metastasis is limited to one lung. (5) The urinary hCG value is below 1000 mIU/ml.