Pulmonary metastases
ICD-10 C87.0 · ICD-11 2D70

Pulmonary Oligometastatic Disease (Up to Five Lesions) When Surgery Is Not an Option

This protocol addresses patients with pulmonary oligometastatic disease — up to five lung lesions — in whom the primary tumour is controlled, but who are either medically unfit for surgical resection or who decline it.

Clinical scenario

Who this applies to

Up to five pulmonary metastatic lesions with a controlled primary tumour. Surgery — ordinarily a standard option in oligometastatic disease — is not pursued here, whether due to the patient's medical condition or patient preference. A non-surgical, ablative local treatment strategy is therefore required.

For patients unfit for surgery or who refuse it, stereotactic ablative radiotherapy (SABR) is a good option for oligometastases management, particularly for single lung metastases.

Treatment approach

Approach (partial overview)

Management in this setting centres on precise, high-dose ablative therapy directed at each pulmonary metastasis. Stereotactic ablative radiotherapy (SABR) is a key modality, with the approach varying by fractionation. Interventional ablative alternatives are also recognised options in appropriate cases.

The complete protocol — including fractionation strategy, dose thresholds, and selection between available modalities — is detailed in the full structured regimen.

Instant Access to Structured Evidence-Based Regimens

References

  1. For patients unfit for surgery or who refuse it, stereotactic ablative radiotherapy (SABR) is a good option for oligometastases management, particularly for single lung metastases.
  2. SABR is a method of external radiotherapy focusing a high dose of radiation to an extracranial target lesion in one [defined as stereotactic radiosurgery (SRS)] or few fractions of treatment [defined as stereotactic body radiotherapy (SBRT)], sparing normal tissues.
  3. The ablative effect of stereotactic radiotherapy is achieved at more than 90% of cases with effective biological dose (BED) greater than 100 Gy, irrespective of fractionation approaches.
  4. These data support the role of RFA as a feasible alternative to surgery or SBRT.

DOI: 10.21037/asj-21-81

View source ↗