Is a Lung Transplant an Option for Lung Cancer Treatment?

Reasons a Lung Transplant May be Used as a Lung Cancer Treatment

Doctor looking at x-ray
Can I have a lung transplant for lung cancer?. Martin Barraud/OJO Images/Getty Images

A very good question I’m sometimes asked is: “Can I have a lung transplant for lung cancer?”

While in the past lung cancer was considered an absolute ​"contraindication" for a lung transplant (an absolute contraindication means a procedure should be avoided altogether) the answer isn’t always "no." There are times, though quite rare, when a lung transplant may be used as a treatment for people with lung cancer.

In fact, the use of lung transplants for lung cancer has slowly increased in recent years. When may a lung transplant be recommended, what does the research say, and why would it not be recommended for most people living with lung cancer?

When and Why Would a Lung Transplant Be Ineffective as a Lung Cancer Treatment?

For most people with lung cancer, a lung transplant (single or double) is not an option. One reason is that lung transplants are considered a local treatment. Local treatments such as a lung transplant, lung cancer surgery, and radiation therapy for lung cancer only treat cancer cells that are confined to the lungs. Unfortunately, for the majority of people with lung cancer, the cancer has spread beyond the lungs to lymph nodes and often to distant regions of the body. When this happens, systemic treatments (treatments that work on cancer cells throughout the body) such as chemotherapy and targeted therapies are better choices.

Another major reason is the risk of lung cancer recurrence in the transplanted lung. In fact, even in those rare people for whom lung transplants may be used as a treatment, lung cancer often recurs in the transplanted (donated) lung.

When Might a Lung Transplant Be Used for Lung Cancer?

There are 3 main scenarios in which a lung transplant may be considered for someone with lung cancer.

 These include people with:

  • Bronchioloalveolar carcinoma of the lung (BAC) which is advanced and multifocal (more than one area of cancer in a lung or the lungs.) BAC - which is no longer called BAC and instead is a subtype of lung adenocarcinoma -  accounts for 5 percent of lung cancers or less, is more common in non-smokers (a third of patients have never smoked,) in women, and people of East-Asian heritage.
  • Early stage lung cancer combined with end-stage lung disease.
  • Metastatic cancer to the lungs from another region of the body, that is only metastatic to the lung, and when the primary cancer (the "original" cancer) is well controlled. This scenario is very rare.

In these settings, a lung transplant may be considered when non-surgical alternatives can't provide adequate control of the cancer. In order to be successful, doctors need to carefully select patients who may benefit from a lung transplant and make sure that the cancer is carefully staged - for example, that tests such as a PET scan and an endobronchial ultrasound do not show any evidence of cancer spread beyond the lungs.

 

What is the Goal of a Lung Transplant for Lung Cancer?

A lung transplant may be used as a curative treatment (with the intent to cure the disease) or as a palliative treatment (with the intent to prolong life but not cure the disease.)

Research on Lung Transplants for Lung Cancer

To date, lung transplant has been an uncommon treatment for lung cancer, but a review of the United Network for Organ Sharing (UNOS) database reveals the following:

From 1987 to 2010 there are fewer than 50 recorded cases (less than 0.1 percent of the lung transplant cases) of lung transplantation being used for lung cancer. Of these people, 29 patients had advanced multifocal BAC.

Without a lung transplant, and with traditional treatments, the median survival rate for people with advanced BAC is 1 year. For patients who received a lung transplant, the 5-year survival rate was around 50 percent - similar to the survival rate for people who receive lung transplants for other reasons, such as COPD, and better than survival would be with chemotherapy.

The consensus seems to be that in carefully selected people, lung transplant may result in long-term survival for some people with BAC.

Lung Transplant for Lung Cancer - A Real Life Example

When living with cancer, there is nothing like hearing about people who have "been there." Many of us in the lung cancer community have been inspired by former college football player, Jerrold Dash, who has shared his journey in receiving a bilateral lung transplant for stage 4 BAC.

In his blog, he shares about winning his lung cancer fight with a lung transplant. Here is a timeline of his transplant, and his patient's point of view on BAC and lung transplant.

Lung Diseases for Which Lung Transplants May be Considered

A lung transplant may be considered for people with end-stage lung disease, when no further treatment options are available, and when a patient is unlikely to live more than a year but is in otherwise good health. Some of these diseases include:

Do Lung Transplants Raise the Risk of Lung Cancer? 

Yes, for a number of reasons people who have received a lung transplant are at an increased risk of developing lung cancer in the future, with numbers stating risk is around 2.5 percent depending on the study.

Next Steps

The following articles show pictures of what happens with a lung transplant, as well as what happens with a lung transplant for COPD:

Sources:

Ahmad, U. et al. Outcomes for lung transplantation for lung cancer in the United Network for Organ Sharing Registry. Annals of Thoracic Surgery. 2012. 94(3):935-40.

de Perrot, M. et al. Role of lung transplantation in the treatment of bronchogenic carcinomas for patients with end-stage pulmonary disease. Journal of Clinical Oncology. 2004. 22(21):4351-6.

Garver, R. et al. Recurrence of bronchioloalveolar carcinoma in transplanted lungs. New England Journal of Medicine. 1999. 340(14):1071-4.

Machuca, T., and S. Keshavjee. Transplantation for lung cancer. Current Opinion in Organ Transplantation. 2012. 17(5):479-84.

Mathew, J., and R. Kratzke. Lung cancer and lung transplantation: a review. Journal of Thoracic Oncology. 2009. 4(6):753-60.

Raviv, Y. et al. Lung cancer in lung transplant recipients: experience of a tertiary hospital and literature review. Lung Cancer. 74(2):280-3.

Zorn, G. et al. Pulmonary transplantation for advanced bronchioloalveolar carcinoma. Journal of Thoracic and Cardiovascular Surgery. 2003. 125(1):45-8.

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