Oligometastatic non-small cell lung cancer (NSCLC) refers to a stage with limited metastatic spread, representing an intermediate disease state between localized and widely metastatic NSCLC. Patients in this category often exhibit a less aggressive disease course compared to those with widespread metastasis. While systemic therapy is commonly used, it may miss the opportunity to enhance survival through local consolidative therapy (LCT). Defining this subgroup precisely and determining the most effective treatment strategies remain key challenges in clinical management.
Pulmonary resection as an LCT option is increasingly recognized for appropriately selected oligometastatic NSCLC patients, with growing evidence supporting its potential survival benefits. However, significant variations exist in institutional and regional practices, and comprehensive, evidence-based guidelines are still lacking. To address this, the Society of Thoracic Surgeons (STS) convened a panel of experts to evaluate existing evidence, identify critical clinical questions, and conduct a thorough literature review, ultimately developing best practice recommendations to guide treatment decisions.
- Pulmonary resection as a local consolidative therapy significantly improves overall survival (OS) and progression-free survival (PFS) compared to the best supportive care or maintenance systemic therapy. Therefore, it should be considered a treatment option for patients with oligometastatic NSCLC. (COR: I, LOE: B-R)
- There is currently a lack of sufficient evidence to justify routine systematic lymphadenectomy during pulmonary resection for oligometastatic lung cancer. However, it may offer prognostic value, and the potential benefits should be carefully balanced against associated risks. (COR: IIb, LOE: B-NR)
- The choice between lobectomy and parenchymal-sparing sublobar resection for oligometastatic lung cancer remains inconclusive due to insufficient supporting evidence. (COR: IIb, LOE: B-NR)
- The advantages of local consolidative therapy are likely to extend beyond cases with three metastases, and surgical intervention should be considered for carefully selected patients. (COR: IIa, LOE: B-R)
- Surgery can be an option for patients with oligoprogressive disease if all disease sites can be managed through local consolidative therapy or show responsiveness to systemic treatment. (COR: IIb, LOE: B-R)
- No conclusive evidence currently favors one surgical technique over another for pulmonary resection as a local consolidative therapy in oligometastatic lung cancer. (COR: IIb, LOE: C-LD)
- Patients with oligometastatic NSCLC who exhibit disease stability should undergo a multidisciplinary evaluation, including a surgical consultation. (COR: I, LOE: B-NR)
Abbreviations: COR, Class of Recommendation; LOE, Level of Evidence; NSCLC, Non-Small Cell Lung Cancer; OS, Overall Survival; PFS, Progression-Free Survival.
Strong evidence supports the use of surgical resection of the primary lung tumor as a local consolidative therapy in stage IV lung cancer. These evidence-based recommendations aim to assist multidisciplinary teams in treatment planning and provide direction for future research needs.