Local control treatment for pulmonary metastases of colorectal cancer.

[BACKGROUND AND AIMS] 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.

[METHODS] 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.

[RESULTS] 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.

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