Lung metastases from colorectal cancer: a multidisciplinary approach and role of local treatment: a narrative review

Objective: To review current available options of local treatment for colorectal lung metastases. Background: Colorectal cancer is one of the leading malignancies worldwide. Despite advances in screening policy and early surgical treatment, a significant number of patients are suffering from colorectal metastatic disease, including the lung. Local treatment for pulmonary metastatic colorectal cancer has made significant progress in the last few decades. Survival benefit and procedure related morbidity are widely studied. Methods: PubMed database is searched for articles related to local treatment of colorectal lung metastases including pulmonary metastasectomy, radiofrequency ablation, radiotherapy, isolated lung perfusion. Conclusion: Local treatment for colorectal lung metastases is widely prescribed for purported survival benefit, although evidence is based on retrospective studies only. With advances in technique and technology, approaches such as minimally invasive thoracoscopic surgery and percutaneous radiofrequency ablation can minimize trauma and procedure related morbidity. New modalities of radiotherapy like stereotactic body radiation therapy (SBRT) can reduce radiation related toxicity to surrounding structures. Isolated lung perfusion can maximize the dose of chemotherapeutic agents that can be safely delivered to the lung parenchyma; however, this is at the expense of significant associated morbidity. The role of local treatment to colorectal lung metastases needs further randomized controlled trials to define the survival benefit. Multidisciplinary meetings, involving oncologists, thoracic surgeons and interventional radiologists, are advisable before offering local treatment to patients with colorectal lung metastases.