Objective: 

To assess the effect of local ablative therapy (LAT) on overall survival in patients with lung metastases from colorectal cancer (CRC) compared with patients treated with systemic therapy.

Summary background Data: 

CRC affects approximately 1.4 million individuals worldwide every year. The lungs are commonly affected by CRC, and there is no treatment standard for a secondary lung metastasis from CRC.

Methods: 

This longitudinal, retrospective cohort study (2010–2018) quantified the pulmonary and extrapulmonary tumor burden of 1143 patients by retrospectively reviewing computed tomography images captured at diagnosis. A comprehensive multidisciplinary approach informed how and when surgery and/or stereotactic body radiotherapy was administered.

Results: 

Among 1143 patients, 473 patients (41%) received LAT, with surgery first (n = 421) or stereotactic ablative radiation therapy first (n = 52) either at the time of diagnosis (n = 288), within 1 year (n = 132), or after 1 year (n = 53). LAT was repeated in 158 patients (33.4%, 384 total sessions) when new lung metastases were detected. The 5- and 10-year survival rates for patients treated with LAT (71.2% and 64.0%, respectively) were significantly higher than those of patients treated with systemic therapy alone (14.2% and 10.0%, respectively; P <0.001). The overall survival of patients who received LAT intervention increased as the total tumor burden decreased.

Conclusions: 

A high long-term survival rate was achievable in a significant portion of patients with lung metastasis from CRC by the timely administrations of LAT to standard systemic therapy. The tumor burden and LAT feasibility should be included in a discussion during the follow-up period.

中文翻译：

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结直肠癌患者肺转移局部消融治疗的重要性

客观的： 

与接受全身治疗的患者相比，评估局部消融治疗 (LAT) 对结直肠癌 (CRC) 肺转移患者总生存期的影响。

摘要背景数据： 

CRC 每年影响全球约 140 万人。结直肠癌通常累及肺部，对于结直肠癌继发性肺转移尚无治疗标准。

方法： 

这项纵向、回顾性队列研究（2010-2018）通过回顾性审查诊断时捕获的计算机断层扫描图像，量化了 1143 名患者的肺部和肺外肿瘤负荷。综合的多学科方法告知如何以及何时进行手术和/或立体定向放射治疗。

结果： 

在 1143 名患者中，473 名患者 (41%) 接受了 LAT，在诊断时 (n = 288) 在 1 年内首先进行手术 (n = 421) 或立体定向消融放射治疗(n = 52) (n = 132），或一年后（n = 53）。当检测到新的肺转移时，158 名患者（33.4%，总共 384 次）重复了 LAT。LAT治疗患者的5年和10年生存率（分别为71.2％和64.0％）显着高于仅接受全身治疗的患者（分别为14.2％和10.0％；P <0.001 ）。随着总肿瘤负荷的降低，接受 LAT 干预的患者的总生存期有所增加。

结论： 

通过及时给予 LAT 和标准全身治疗，很大一部分 CRC 肺转移患者可以获得较高的长期生存率。肿瘤负荷和 LAT 可行性应纳入随访期间的讨论中。