Systemic Versus Local Therapies for Colorectal Cancer Pulmonary Metastasis: What to Choose and When?

Background: Lung is the second most common site of colorectal cancer metastasis. Treatment is based mainly on systemic therapy which has largely evolved lately, but outcome remains relatively poor. The place of locoregional therapies as curative strategies is still debated. Method: A systematic literature review was performed by the authors for systemic therapy, surgery, radiofrequency ablation (RFA), and stereotactic body radiation therapy (SBRT). The highest level of evidence for each strategy was presented. Major findings were addressed in a summarized and clinically relevant manner. Results: All reported studies were descriptive non comparative reports except for one retrospective study comparing surgery to SBRT. The highest level of evidence for each therapeutic strategy are presented as follows: three large meta-analyses for surgery as well as seven and three prospective trials for RFA and SBRT, respectively. Discussion: Surgery has the highest level of evidence for cure followed by RFA and SBRT. However, careful patient selection and complete resection of all metastasis are the main principles behind the efficacy of local therapies in the curative setting. Despite encouraging results, randomized trials are still needed.