Surgical and nonresectional therapies for pulmonary metastasis

Resection of pulmonary metastases is reasonable and is commonly performed for patients whose primary disease is controlled and for whom the metastatic burden in the chest is such that all disease can be resected safely. The use of video- assisted thoracic surgery rather than an open approach in metastasectomy, however, is still being debated. In addition, nonresectional therapies such as radiofrequency ablation and stereotactic body radiation therapy are being used in centers for patients with oligometastases to the lungs. This article reviews the indications and approaches for surgical resection, as well as these other nonresectional therapies. At present, it is difficult to directly compare these approaches because of the heterogeneous nature of metastasectomy series. Moreover, the stereotactic body radiation therapy and radiofrequency ablation studies have involved smaller numbers of patients and shorter follow-up than the surgical studies. The preliminary data for these nonresectional therapies, however, are encouraging and certainly should be considered in the decision tree when treating patients with pulmonary metastases.