Lung cancer is by far the leading cause of cancer deaths in the U.S. Most patients have non-small cell lung cancer (NSCLC), and between 25% and 50% of them are diagnosed with “oligometastatic” lung cancer, meaning that they have stage IV disease but that their cancer hasn’t metastasized widely. Traditionally, these patients have not been considered candidates for surgical resection (removal of part or all of the affected lung) since their disease was considered too advanced to be helped by surgery. With advances in systemic therapy for patients, this treatment strategy may need to be revised. Now, findings from a new study by researchers at the National Cancer Institute-designated Montefiore Einstein Comprehensive Cancer Center (MECCC) indicate that surgery could be considered as a treatment option for these patients.

The team, led by Brendon Stiles, M.D., and Jorge Humberto Rodriguez-Quintero, M.D., used data from the National Cancer Database to identify more than 12,000 treated patients with oligometastatic NSCLC tumors that had only spread to a single metastatic site. As expected, most of the patients 97.1%) received chemotherapy or immunotherapy without surgery, while only a small minority (2.9%) underwent surgical resection in addition to receiving chemotherapy or immunotherapy. Comparing survival for the two groups, the researchers found that patients who received both surgery and systemic therapy lived significantly longer: an average survival of 36.8 months vs. 20.8 months for patients with chemotherapy or immunotherapy and no surgery. Although the patients were not randomized, the researchers concluded that surgical resection of the primary tumor may be underutilized for patients with single-site oligometastatic NSCLC and that surgery may improve overall survival for carefully selected patients with this diagnosis. Their paper was published online on February 9 in the Journal of the American College of Surgeons.

Dr. Stiles is professor of cardiothoracic & vascular surgery, of oncology, of medicine, and is associate director of surgical oncology at the MECCC. Dr. Rodriguez-Quintero is a surgical resident and thoracic surgery research fellow at Einstein and Montefiore Health System.