Surgery for oligometastatic non-small cell lung cancer

Local consolidative therapy (LCT) has emerged as a promising approach for the treatment of oligometastatic non-small cell lung cancer (NSCLC). While stage IV NSCLC was traditionally considered incurable, advances in systemic agents, including the expansion of targeted therapies and introduction of immune checkpoint inhibitors, have led to improved disease control and overall survival. LCT, which includes surgical resection and/or radiotherapy to the primary tumor and limited sites of metastasis (≤3), has shown significantly improved long-term outcomes for patients with limited burden of metastatic disease. The evidence supporting LCT for metastatic lung cancer has grown rapidly in recent years. Randomized trials and retrospective studies have demonstrated the efficacy of LCT in improving progression-free survival (PFS) and overall survival (OS), with more pronounced benefits in certain subgroups. Investigators have explored the roles of surgery and radiation in combination with systemic therapies, including traditional chemotherapy, immunotherapy, and targeted agents. The outcomes have shown favorable results, with impressive PFS and OS rates. Comprehensive LCT, targeting all sites of disease, has been associated with greatest survival benefits, and the selection of the most suitable modality (surgery or radiation) depends on individual patient factors and disease characteristics. Current evidence supports the use of LCT in combination with systemic therapies, with surgery playing a significant role in selected patients. Further research and ongoing clinical trials are needed to refine patient selection criteria, optimize treatment regimens, and determine the long-term benefits and potential side effects of LCT in varying subsets of patients with stage IV NSCLC.