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No formal statistical comparison of toxicities or complications was performed due to small numbers of events. All analyses were performed using SPSS version 18. Results Fifty one eligible patients underwent 72 curative resec tions for pulmonary metastases. Table 1 shows the base line characteristics of eligible patients. Of 51 patients in our selleck chem cohort, 38 received neoadjuvant and or adju vant chemotherapy relating to their pulmonary resection. In those with no metastatic disease at diagnosis, the me dian DFI was 24. 1 months for the whole cohort 20. 5 months in the peri operative chemotherapy group and 27. 5 months in the surgery alone group. How ever, 11 38 patients in the CS group presented with synchronous metastases at the time of diagnosis.

Forty five patients had CEA levels performed pre thoracotomy, with an elevated result in only 9 patients. 18FDG PET was performed in 45 patients with only 8 PET scans demonstrating no FDG avidity in the lung lesions. The timing of the PET scan did not affect FDG avidity, even in those undergoing neoadjuvant chemotherapy. Table 2 shows the comparisons among CT, PET and sub sequent histology. Concordance with number of con firmed pulmonary metastases diagnosed histologically was higher in PET than CT for those with FDG avid lesions. The median size of the largest lesion was higher in the PET positive group compared to PET negative group. Chemotherapy Of the 38 patients who underwent peri operative systemic therapy, 36 received it with their initial T resection, while 2 patients only received chemotherapy with subsequent resections.

Table 3 shows details of peri operative chemotherapy. Nine patients received tar geted biological agents combined with neoadjuvant chemotherapy. All targeted biological treatments were administered in combination with an oxaliplatin or irinotecan based chemotherapy doublet. Post operative chemotherapy plus targeted therapy was given to all patients receiving bevacizumab and 1 patient who received neoadjuvant cetuximab. In this cohort of 38 patients, chemotherapy was delivered in a total of 49 resections. most commonly peri operatively, with neoadjuvant alone given in 17 resec tions and adjuvant alone after 10 resections. Seven patients who underwent multiple pulmonary resections received no systemic peri operative treatment for at least 1 of these resections.

The median number of chemother apy cycles administered was 4 pre operatively and 5 post operatively. Of 30 patients who received neoadjuvant chemotherapy, 8 developed treatment related complications. Post operative chemotherapy related complica tions occurred more frequently, in 14 patients undergo ing adjuvant chemotherapy. None of the CT scans performed following chemotherapy demonstrated fibrotic changes or pneumonitis suggestive of chemotherapy related lung toxicity.