Overview and epidemiology of lung metastases in colorectal cancer
Diagnosis and differential diagnosis of lung metastases in CRC
Imaging diagnosis
Risk factors supporting lung metastases diagnosis
Lymphangitic carcinomatosis
Differential diagnosis
Pathological diagnosis
General guidelines for multidisciplinary therapy of lung metastases in CRC
Management of synchronous lung metastases
Management of isolated and resectable lung metastases
Principles of surgical resection
Factors resulting in poor prognosis | Description |
---|---|
Multiple metastatic lesions | |
Hilar/mediastinal lymph node metastases present | |
High preoperative CEA levels | |
Large tumor diameter | The larger the tumor, the poorer the survival [34] |
Short disease-free interval (DFI) | Poor survival if DFI < 24 months [26] |
Older age | Poor survival if > 70 years [29] |
Advanced primary tumor stage | Advanced stage of primary tumor results in poor prognosis [36] |
Primary tumor located at the rectum | Rectal cancer has a poorer survival than colon cancer [25] |
R1 or R2 resection | |
Pulmonary lobectomy | Pulmonary lobectomy has poorer survival than wedge resection or segmental resection of the lung [40] |
Perioperative treatment
Clinical situation | Alternative strategies |
---|---|
Middle and lower rectal cancer: T3–4 or N+ | 1. Preoperative systemic drug treatment/rectal neoadjuvant radiotherapy, resection of primary lesion/lung metastases, adjuvant chemotherapy |
2. Preoperative systemic drug treatment/rectal neoadjuvant radiotherapy, resection of primary lesion, systemic drug treatment, resection of lung metastases, adjuvant chemotherapy | |
Middle and lower rectal cancer: T1-2N0; Upper rectal cancer and colon cancer: T1–4N0–2 | 1. Preoperative systemic drug, resection of primary lesion, resection of lung metastases, adjuvant chemotherapy |
2. Resection of primary lesion, systemic drug treatment, resection of lung metastases, adjuvant chemotherapy | |
3. Resection of primary lesion, resection of lung metastases, adjuvant chemotherapy |
Management of isolated and potentially resectable lung metastases
Clinical situation | Alternative strategies |
---|---|
Patients who have initial potentially resectable lung metastases1 | 1. Conversion therapy, resection of primary tumor, resection of lung metastases, postoperative adjuvant therapy |
2. Resection of primary tumor, conversion therapy, resection of lung metastases, postoperative adjuvant chemotherapy2 |
Management of isolated and unresectable lung metastases
Management of lung metastases with extrapulmonary metastases at any other sites
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 |
Clinical situation | Alternative strategies | |
---|---|---|
Lung metastases | Extrapulmonary metastases | |
Curable | Curable | Mainly systemic therapy1. This suitable patients for surgical resection of lung metastases and other metastatic lesions should be carefully selected2 |
Curable | Incurable | Systemic therapy1 |
Incurable | Curable | Systemic therapy1 |
Incurable | Incurable | Systemic therapy1 |
Tumor lesion | Assessment methods |
---|---|
Primary tumor | 1. Colonoscopy should be conducted to determine the location of the primary tumor, tumor size, the proportion of the intestinal lumen that the tumor occupies, and biopsy should be used to confirm the pathology of the tumor (including molecular biology tests, RAS/BRAF gene status, microsatellite instability status, and HER2 status) |
2. Enhanced CT of the entire abdomen | |
Lung metastases | 1. High-resolution chest CT scan1 |
2. Enhanced chest CT scan (when mediastinal lymph node metastases are present) | |
3. Evaluation of lung function | |
Liver metastases | Contrast-enhanced MRI of the liver1 |
Other metastases | 1. Contrast-enhanced MRI of the pelvis (when pelvic implantation metastases are present) |
2. Bone ECT (when symptoms associated with bone metastases are present) | |
3. PET-CT2 |