DOI: https://doi.org/10.36347/sasjm.2026.v12i07.006

Pages: 734-742

Introduction: Pulmonary metastases occur in 10% to 15% of patients with colorectal cancer and represent a frequent site of recurrence for rectal cancer. In the context of oligometastatic disease, local ablative treatment via surgery or stereotactic body radiotherapy (SBRT) is central to the therapeutic strategy. While surgical metastasectomy remains the historical gold standard, SBRT is emerging as an effective, non-invasive alternative, particularly for central lesions or patients at high surgical risk. This study reports our experience in managing pulmonary metastases of rectal origin and defines criteria for selecting between these two modalities. Materials and Methods: We conducted a retrospective study over a 4-year period, including six patients with histologically confirmed rectal adenocarcinoma whose cases were discussed during a multidisciplinary tumor board (MTB). Data collected included primary tumor characteristics, neoadjuvant and systemic treatments received, and the profile of the metastatic disease (number and location of lesions). Selection criteria between surgical resection and SBRT were based on anatomical (central or peripheral location), functional (respiratory reserve), and oncological parameters. Primary endpoints were local control, progression-free survival, and toxicity. Results: At initial diagnosis, disease was locally advanced in 83% of patients (T3N1, n=5) and T2N1 in 17% (n=1). The majority (83%) received short-course neoadjuvant radiotherapy (5×5 Gy) followed by primary tumor excision and systemic chemotherapy (XELOX/FOLFOX). At the metastatic stage, disease involved the lungs (50%, n=3) or liver (50%, n=3), with 1 to 3 lesions per patient. Three patients were treated with surgery (peripheral lesions) and three with SBRT (central lesions or surgical contraindication). The local control rate with SBRT was 100%, documented by morphological imaging and PET-CT, with doses ranging from 30 to 54 Gy in 4 to 6 fractions. No grade ≥3 toxicit