title: Systemic Versus Local Therapies for Colorectal Cancer Pulmonary Metastasis: What to Choose and When?
abstract: BACKGROUND
  Lung is the second most common site of colorectal cancer metastasis. Treatment is based mainly on systemic therapy which has largely evolved lately, but outcome remains relatively poor. The place of locoregional therapies as curative strategies is still debated.
  
  
  METHODS
  A systematic literature review was performed by the authors for systemic therapy, surgery, radiofrequency ablation (RFA), and stereotactic body radiation therapy (SBRT). The highest level of evidence for each strategy was presented. Major findings were addressed in a summarized and clinically relevant manner.
  
  
  RESULTS
  All reported studies were descriptive non comparative reports except for one retrospective study comparing surgery to SBRT. The highest level of evidence for each therapeutic strategy are presented as follows: three large meta-analyses for surgery as well as seven and three prospective trials for RFA and SBRT, respectively.
  
  
  CONCLUSIONS
  Surgery has the highest level of evidence for cure followed by RFA and SBRT. However, careful patient selection and complete resection of all metastasis are the main principles behind the efficacy of local therapies in the curative setting. Despite encouraging results, randomized trials are still needed.
authors.affiliation: Hematology-Oncology Department, Faculty of Medicine-Saint Joseph University, Medical Sciences Campus, Alfred Naccach street, Ashrafie, Beirut, Lebanon. ibrahim_toni@hotmail.com.
authors.forename: Tony
authors.initials: T
authors.lastname: Ibrahim
authors.affiliation: Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France.
authors.forename: Lambros
authors.initials: L
authors.lastname: Tselikas
authors.affiliation: Gastroenterology-Hepatology Department, Faculty of Medicine-Holy Spirit Kaslik University, Kaslik, Lebanon.
authors.forename: Charbel
authors.initials: C
authors.lastname: Yazbeck
authors.affiliation: Hematology-Oncology Department, Faculty of Medicine-Saint Joseph University, Beirut, Lebanon.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kattan
mesh_terms: D017115:Catheter Ablation / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D016634:Radiosurgery / Q000379:methods*
keywords: Chemotherapy; Colorectal cancer; Metastasectomy; Pulmonary metastasis; Radiofrequency ablation; Stereotactic body radiation therapy