Local control treatment for pulmonary metastases of colorectal cancer

Colorectal cancer with lung metastases (CRC-LM) pose a significant clinical challenge. Although systemic therapy is the mainstay, local control treatments (LAT), including surgery, stereotactic body radiation therapy (SBRT), and image-guided thermal ablation (IGTA), are increasingly utilized for oligometastatic disease. Previous studies have generally reported on surgery or SBRT; there are few reports on IGTA. This review aimed to synthesize evidence on the efficacy and outcomes of different LAT modalities for CRC-LM.

A comprehensive literature review was conducted to analyze studies reporting survival outcomes and local control rates for surgical resection, SBRT, and thermal ablation. We systematically identified studies (PubMed, 2000-2025) involving patients with colorectal cancer and up to 10 lung metastases who received local therapy (surgery, radiotherapy, or ablation). Eligible studies provided follow-up data on survival and response; studies on patients with other recent malignancies, no local therapy, or insufficient data were excluded.

Local control treatments provide significant survival benefits to patients with CRC-LMs. The median overall survival (OS) was 24-82 % for patients who underwent surgical resection, whereas SBRT and thermal ablation showed a median OS of 17.8-39 months and 25-76 months, respectively. Each modality offered distinct advantages in terms of local control and safety.

Local control treatments including radical surgery, SBRT and thermal ablation play an essential role in the management of CRC-LM, especially with oligometastases.