Management of single pulmonary metastases from colorectal cancer: State of the art

Abstract

Colorectal cancer (CRC) is one of the most common causes of death from cancer. Lung seeding occurs in approximately 10% of patients surgically treated for primary CRC with radical intent: the lung is the most common site of metastases after the liver. While surgical treatment of liver metastases is widely accepted to affect long-term outcomes, more controversial and not standardized is the therapy for CRC patients developing lung metastases. Experience suggests the potential curative role of pulmonary metastasectomy, especially in oligometastatic disease. However, the optimal strategy of care and the definition of prognostic factors after treatment still need to be defined. This review focused on the uncommon scenario of single pulmonary metastases from CRC. We explored pertinent literature and provide an overview of the epidemiology, clinical characteristics and imaging of single pulmonary metastases from CRC. Additionally, we identified the best available evidence for overall management. In particular, we analyzed the role and results of locoregional approaches (surgery, radiotherapy or ablative procedures) and their integration with systemic therapy.

Keywords: Colorectal cancer; Pulmonary metastases; Oligometastases; Chemotherapy; Surgery; Radiotherapy

Core Tip: Single pulmonary metastasis from colorectal cancer is an uncommon scenario in which diagnostic pitfalls should be considered. Locoregional approaches (surgery more than radiotherapy or ablative procedures) might have a potential curative role with rewarding long-term results. However, since recurrences are common, the best long-term results might be expected by integrating loco-regional with systemic treatment. Moreover, despite limited evidence, different factors seem to influence prognosis in this subset of patients and should be considered when planning a tailored care strategy.