Surgical management of non–small cell lung cancer with limited metastatic disease involving only the brain

Objective The optimal primary site treatment modality for non–small cell lung cancer with brain oligometastases is not well established. This study sought to evaluate the long-term survival of patients with non–small cell lung cancer with isolated brain metastases undergoing multimodal therapy with or without thoracic surgery. Methods Patients with cT1-3, N0-1, M1b-c non–small cell lung cancer with synchronous limited metastatic disease involving only the brain treated with brain stereotactic radiosurgery or neurosurgical resection in the National Cancer Database (2010-2017) were included. Long-term overall survival of patients who underwent multimodal therapy including thoracic surgery (“Thoracic Surgery”) versus systemic therapy with or without radiation to the lung (“No Thoracic Surgery”) was evaluated using Kaplan–Meier analysis, Cox proportional hazards modeling, and propensity score matching. Results Of the 1240 patients with non–small cell lung cancer with brain-only metastases who received brain stereotactic radiosurgery or neurosurgery and met study inclusion criteria, 270 (21.8%) received primary site resection. The Thoracic Surgery group had improved overall survival compared with the No Thoracic Surgery group in Kaplan–Meier analysis (P < .001) and after multivariable-adjusted Cox proportional hazards modeling (P < .001). In a propensity score–matched analysis of 175 patients each in the Thoracic Surgery and No Thoracic Surgery groups, matching on 13 common prognostic variables, thoracic surgery was associated with better survival (P = .012). Conclusions In this national analysis, patients with cT1-3, N0-1, M1b-c non–small cell lung cancer with isolated limited brain metastases had better overall survival after multimodal therapy including thoracic surgery compared with systemic therapy without surgery. Multimodal thoracic treatment including surgery can be considered for carefully selected patients with non–small cell lung cancer and limited brain metastases.