Removal or ablation of asymptomatic lung metastases should be reconsidered

The lungs are the commonest site of systemic cancer metastases. Surgical resection has been used for over 50 years,1 and since 1995, when the term oligometastases was proposed (box 1), it is increasingly justified by framing it as an “opportunity” for curative local treatment in patients with “oligometastasis.”23 Less invasive treatments—ablation by stereotactic ablative radiotherapy (SABR) or image guided thermal ablation—with the same objective are also being more widely used in Europe and North America. NHS England commissioned ablative radiotherapy for metastases in 2021,4 and in 2023 three international professional societies published clinical practice guidelines on the removal or ablation of lung metastases.56Box 1OligometastasesIn 1995 the concept of an intermediate oligometastatic state was proposed for patients with a “few” metastases. It was suggested that cure might be achieved by surgical removal.2 Recently techniques for ablation by radiation, heat, or freezing have been developed and become popular because they are less…
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