Surgical Resection of Pulmonary Metastases From Colorectal Cancer: A Systematic Review of Published Series

Pfannschmidt, Joachim; Dienemann, Hendrik; Hoffmann, Hans

doi:10.1016/j.athoracsur.2007.02.093

Cited by 515 publications

(497 citation statements)

References 70 publications

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“…Although lung metastasis is less common than liver involvement, similar long-term survival has been observed after complete resection with a 5-year survival rate of 48% in a recent systematic review of 20 surgical retrospective series (Pfannschmidt et al, 2007). However, similar to liver resection, it would be difficult to conduct a randomised trial against no resection nowadays.…”

Section: What Are the Current Controversies With Resection Of Colorecmentioning

confidence: 95%

Treatment in advanced colorectal cancer: what, when and how?

Chau

Cunningham

2009

Br J Cancer

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Treatment of advanced colorectal cancer (CRC) increasingly requires a multidisciplinary approach and multiple treatment options add to the complexity of clinical decision-making. Recently novel targeted therapy against angiogenesis and epidermal growth factor receptor completed a plethora of phase III studies. The addition of bevacizumab to chemotherapy improved the efficacy over chemotherapy alone in both first and second line settings, although the magnitude of benefit may not be as great when a more optimal chemotherapy platform is used. Studies performed thus far did not address conclusively whether bevacizumab should be continued in subsequent lines of treatment. Anti-angiogenesis tyrosine kinase inhibitors have not shown any additional benefit over chemotherapy alone so far. Although some benefits were seen with cetuximab in all settings of treating advanced CRC, K-ras mutation status provides an important determinant of who would not benefit from such a treatment. Caution should be exercised in combining anti-angiogenesis with anti-EGFR strategy until further randomised data become available. In this review, we have focused on the implications of these trial results on the everyday management decisions of treating advanced CRC.

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Section: What Are the Current Controversies With Resection Of Colorecmentioning

confidence: 95%

Treatment in advanced colorectal cancer: what, when and how?

Chau

Cunningham

2009

Br J Cancer

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“…The 5-year survival outcome of 30% in the current study iterates the safety and efficacy of this treatment that compares favorably with the 5-year survival of 48% that was reported in a systematic review of published results on surgical resection for colorectal pulmonary metastases that comprised of 1684 patients from 17 different studies where the mortality rate ranged from 0 to 2.5%. 15 In conclusion, the use of RFA to treat colorectal pulmonary metastases is a step toward a nonsurgical option that combines systemic and local treatment for metastatic disease. Our institution's experience in the use of this ablative technique for pulmonary metastases has led to a decline in the incidence of postprocedural complications and an improved patient selection process through identification of appropriate lesion characteristics for this treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The practice of pulmonary metastasectomy is evolving with a large number of published series reporting the results of surgical resection of pulmonary metastases from colorectal cancer with a median 5-year survival of 48%. 15 Despite these encouraging survival results, there remains no consensus within the thoracic surgical community regarding pulmonary metastasectomy for colorectal cancer, with concerns for treatment-related morbidity, post-treatment effect of loss of lung volume on quality of life, and the optimal approach to resecting pulmonary metastases. 16 These issues are likely to be resolved only through planned randomized trials in the future.…”

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confidence: 99%

Radiofrequency ablation as an adjunct to systemic chemotherapy for colorectal pulmonary metastases

Chua

Thornbury

Saxena

et al. 2010

Cancer

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BACKGROUND: Radiofrequency ablation (RFA) is an alternative to local treatment for pulmonary metastases in patients who are nonsurgical candidates. Based on previously documented efficacy of this treatment, the authors retrospectively studied the prognostic factors for long-term survival. METHODS: One hundred patients with unresectable colorectal pulmonary metastases underwent percutaneous RFA. Clinical and treatment variables were collected and evaluated using univariate and multivariate analyses with overall survival as the primary endpoint. RESULTS: At a median follow-up period of 23 (range, 1 to 96) months from the time of RFA treatment, 49 patients have died. The median overall survival after RFA treatment was 36 months and 5-year overall survival rates of 30%. Univariate analyses demonstrated that histopathological grade (p < .001), time to RFA treatment (p ¼ .017), response to treatment (p < .001), repeat RFA treatments (p ¼ .001), presence of extrapulmonary metastases (p < .001), presence of mediastinal lymphadenopathy (p ¼ .007), and adjunct systemic chemotherapy (p < .001) were associated with overall survival. Multivariate analyses demonstrated that response to RFA treatment (p < .001), repeat RFA treatment (p ¼ .002), presence of extrapulmonary metastases (p ¼ .008), and use of adjunct systemic chemotherapy (p ¼ .05) were independent predictors for survival. CONCLUSIONS: Radiofrequency ablation for colorectal pulmonary metastases represents a step forward towards a nonsurgical option of combining systemic and local treatment for metastatic disease and is a safe treatment with a low risk profile.

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“…Die Studie fand keinen signifikanten Unterschied Tab. 9 5-Jahres-Gesamtüberle-ben nach R0-Resektion pulmonaler Metastasen (exemplarisch nach Pfannschmidt et al [833] im Überleben im PET-Arm, jedoch eine signifikante Verringerung der Zahl "überflüssiger Laparotomien" im PET-Arm. Bei Patienten, die eine 5-FU/Folinsäure-basierte Therapie erhielten, konnten als günstige prognostische Faktoren ECOG Performance Status (0 -1), Leukozytenzahl (< 10 × 10 9 /L), alkalische Phosphatase (< 300 U/l) und der Nachweis nur einer Metastasenlokalisation identifiziert werden [887].…”

Section: Hintergrundunclassified