title: What to choose as radical local treatment for lung metastases from colo-rectal cancer: surgery or radiofrequency ablation?
abstract: BACKGROUND
  Long-term survival can be obtained with local treatment of lung metastases from colorectal cancer. However, it is unclear as to what the optimal local therapy is: surgery, radiofrequency ablation (RFA) or stereotactic radiotherapy (SBRT).
  
  
  METHODS
  A systematic review included 27 studies matching with the a priori selection criteria, the most important being ≥50 patients and a follow-up period of ≥24months. No SBRT studies were eligible. The review was therefore conducted on 4 RFA and 23 surgical series.
  
  
  RESULTS
  Four of the surgical studies were prospective, all others were retrospective. No randomized trial was found. The reporting of data differed between the studies, which led to difficulties in the analyses. Treatment-related mortality rates for RFA and surgery were 0% and 1.4-2.4%, respectively, whereas morbidity rates were reported inconsistently but seemed the lowest for surgery.
  
  
  CONCLUSIONS
  Due to the lack of phase III trials, no firm conclusions can be drawn, although most evidence supports surgery as the most effective treatment option. High-quality trials comparing currently used treatment modalities such as SBRT, RFA and surgery are needed to inform treatment decisions.
authors.affiliation: Maastricht University, Faculty of Health, Medicine and Life Sciences, School of Medicine, Maastricht, The Netherlands; Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: roel.schlijper@maastro.nl.
authors.forename: Roel C J
authors.initials: RC
authors.lastname: Schlijper
authors.forename: Janneke P C
authors.initials: JP
authors.lastname: Grutters
authors.forename: Ruud
authors.initials: R
authors.lastname: Houben
authors.forename: Anne-Marie C
authors.initials: AM
authors.lastname: Dingemans
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Wildberger
authors.forename: Dirk
authors.initials: D
authors.lastname: Van Raemdonck
authors.forename: Eric
authors.initials: E
authors.lastname: Van Cutsem
authors.forename: Karin
authors.initials: K
authors.lastname: Haustermans
authors.forename: Guido
authors.initials: G
authors.lastname: Lammering
authors.forename: Philippe
authors.initials: P
authors.lastname: Lambin
authors.forename: Dirk
authors.initials: D
authors.lastname: De Ruysscher
mesh_terms: D017115:Catheter Ablation; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019468:Disease Management; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cancer; Colon cancer; Keywords; Lung metastases; RFA; Rectal cancer; Surgery