Recommendation ID

What is the cost effectiveness and safety of non-surgical ablation and stereotactic body radiotherapy compared to resection for people with metastatic colorectal cancer in the lung amenable to local treatment?

Any explanatory notes
(if applicable)

Why the committee made the recommendations
As there was limited evidence, the committee made recommendations based on their clinical knowledge. There was not enough evidence to recommend one treatment over another even though the current first choice is to perform surgery over stereotactic body radiation therapy or ablation. Referring people to multidisciplinary teams that specialise in primary lung disease may not be appropriate as they do not specialise in the management of lung metastases from colorectal cancer. Therefore, the committee agreed that the multidisciplinary team should include a thoracic surgeon and a specialist in non-surgical ablation to ensure that the appropriate specialist knowledge is available.
Based on their clinical knowledge, the committee recommended that biopsies should be considered for patients with a single lung lesion to rule out primary lung cancer and guide treatment options even if surgical excision is not planned.
Because of the lack of clinical evidence, a randomised trial comparing surgical to non-surgical treatment is needed to provide more high quality, comparative data, so the committee made a research recommendation on this topic.

How the recommendations might affect practice
The recommendations are expected to increase the involvement of thoracic surgeons in the management of metastatic colorectal cancer, however this additional expertise would result in expensive treatments being more appropriately targeted. While assessing fitness for surgery is common practice, the advice to also discuss factors including disease-free interval, carcinoembryonic antigen (CEA) level, number, size and site of metastases and other sites of disease should improve best practice across the NHS.
Full details of the evidence, the committee's discussion and the recommended approach to research are in evidence review D3: treatment for metastatic colorectal cancer in the lung amenable to local treatment.

Source guidance details

Comes from guidance
Colorectal cancer
Date issued
January 2020

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 30/11/2019