Today, pulmonary metastasectomy is the treatment of choice for many patients with lung metastases from various solid tumors. Prognostic factors for a better survival are patients with germ cell tumors, long disease-free intervals and single metastases. Nevertheless, 5-year survival after surgical resection is low due to relative insensitivity to currently available chemotherapy. Isolated lung perfusion as a regional therapy proved to be a technique that can deliver a higher drug level within the tumor mass without apparent systemic toxicity. In addition, isolated lung perfusion in animal models proved to be more effective compared to intravenous therapy. In this way, isolated lung perfusion seems very promising although optimal regimens in patients are still unknown.