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Table 4 Treatment strategy for lung metastases with liver metastasis only

From: Expert consensus on multidisciplinary therapy of colorectal cancer with lung metastases (2019 edition)

Clinical situation

Alternative strategies

Lung metastases

Liver metastases

Curable

Curable

Radical local treatment of the primary tumor, lung metastases, and liver metastases1 in stages. Administer 6 months of perioperative treatment before and after local treatment2

Curable

Incurable

Systemic treatment3

Incurable

Curable

Elective radical local treatment4 for liver metastases can be conducted on the basis of effective systemic treatment3

Incurable

Incurable

Systemic treatment3

  1. 1It is recommended that the local treatment sequence and method be decided after MDT team discussion. It is currently believed that the type of resection for lung metastases has mild effects on the patient prognosis. If both liver metastases and lung metastases are technically resectable lesions, simultaneous or sequential resection of the lesions can be conducted. It is recommended that metastatic lesions with the highest difficulty be resected first. However, considering that reduced pulmonary function after resection of lung metastasis may affect surgical anesthesia, it is usually recommended that liver metastases be resected first when there are no differences of surgical difficulties between lung metastases and liver metastases [55]. SBRT or radiofrequency ablation is also effective for local treatment of lung metastases. This is particularly so for non-technically unresectable lung metastases, in which the use of SBRT or ablation therapy is highly recommended [56,57,58,59]
  2. 2Perioperative treatment includes neoadjuvant therapy and adjuvant therapy. Neoadjuvant chemotherapy can reduce the preoperative tumor volume and reduce the formation of micrometastases and increase radical resection rate of surgery. In order to limit the occurrence of drug-induced liver injury, the duration of neoadjuvant chemotherapy is usually limited to 2–3 months. In addition, the patient’s physical condition, RAS and BRAF gene status, and tumor burden should be considered to decide whether chemotherapy should be combined with targeted therapy
  3. 3It is necessary to consider the patient’s physical status, location of primary tumor, molecular biology characteristics, and prognostic status before determining the systemic treatment regimen
  4. 4For patients with lung metastases that are unable to undergo technical radical resection, resection of liver metastases may provide survival benefits [60]. However, the selection of these patients should be based on MDT team discussion