Does perioperative chemotherapy improve survival in patients with resectable lung metastases of colorectal cancer?

A best evidence topic was constructed according to a structured protocol. The question addressed was whether the administration of perioperative chemotherapy (CT) is effective in improving survival in patients with resectable lung metastases of colorectal cancer (CRC). Of the 44 papers found using a report search, 6 investigated the effect of perioperative CT (adjuvant-CT, preoperative-CT or both) on outcomes in patients undergoing lung metastasectomy for CRC. These 6 studies presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. Overall, none of the studies were successful in demonstrating that CT had an independent effect on overall survival in patients undergoing lung resection surgery for CRC metastasis. Indeed, beneficial outcomes have been shown in particular sub-groups of patients: multiple metastases, metachronous lung metastasis, low-risk patients, particular molecular marker expression and oxaliplatin-based regimen. All the studies indicated a benefit in disease-free survival or progression-free survival. Administration of tailored perioperative CT might be effective after an accurate patient selection. We conclude that the current evidence does not support the administration of unselective perioperative CT in patients with resectable lung metastases of colorectal cancer.