Therapeutic approaches to pulmonary metastases in colorectal cancer

Pulmonary metastases of colorectal cancer (CRC) represent a significant clinical problem that requires a multidisciplinary approach in determining treatment tactics. To date, there are no prognostic scales and algorithms that make it possible to stratify patients with metastatic lung damage and give preference to surgical treatment, systemic or radiotherapy.
Purpose of the study. To systematize data on treatment methods for pulmonary metastases of CRC and to evaluate the influence of prognostic factors on survival rates in this cohort of patients.
Materials and methods. The analysis of publications for 2000–2025 in the PubMed and Google Scholar databases was carried out using the keywords: "colorectal cancer", "pulmonary metastases", "thoracoscopic surgery", "stereotactic radiation therapy", "circulating tumor DNA". Studies that do not correspond to the topic, duplicate data, and work on metastatic lung damage in other nosologies are excluded.
Results. The results of treatment in the group of patients with pulmonary metastases of CRC are significantly influenced by many characteristics of the tumor. These include the number of metastatic foci, the presence or absence of affected mediastinal lymph nodes, and the level of cancer-­ embryonic antigen (CEA). A prognostically unfavorable factor is a history of metastatic liver damage and KRAS/BRAF mutations. The localization of the primary tumor among patients with oligometastatic CRC is also significant: the left-sided localization of the primary tumor is characterized by better overall survival rates than with the right-­sided lesion.
Conclusion. Surgical resection for pulmonary metastases is the standard of treatment in the group of patients with oligometastatic CRC. Therapeutic tactics for each individual case should be determined by a multidisciplinary team, considering the biological and genetic characteristics of the tumor. In the presence of negative prognosis factors, adjuvant systemic therapy can improve long-term treatment outcomes. Modern treatment approaches for pulmonary metastases are based on data from retrospective studies, which highlights the need for prospective randomized trials and the importance of developing standardized algorithms.

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