Solitary sites of metastatic disease in non-small cell lung cancer |
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Authors: | Matthew J Schuchert James D Luketich |
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Institution: | (1) Division of Thoracic and Foregut Surgery, Department of Surgery, UPMC Health System, 15213 Pittsburgh, PA, USA |
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Abstract: | Opinion statement Metastatic (stage IV) non-small cell lung cancer is a lethal disease, with few patients surviving longer than 5 years. Surgery
is not an option, and adjuvant therapy regimens (platinum-based chemotherapy, radiation therapy, and supportive care) have
been structured around palliation and maximizing the quality of life for patients. However, patients with solitary foci of
metastatic disease represent a subgroup with a better prognosis. Studies have indicated that surgical resection may enhance
the survival rate of patients in this setting. Patients who have resectable primary tumors and a solitary site of metastasis,
based on a thorough metastatic work-up, benefit from surgical resection (primary tumor and solitary metastasis). The role
of adjuvant chemotherapy and radiation depends on the individual and patient setting. There have been several case series
indicating an improvement in the long-term (5-year) survival rates of patients after surgical resection of solitary metastases
of the brain, adrenal gland, and other sites. Prospective trials will be required to determine the magnitude of benefit of
surgical resection for patients and the role of multimodality therapy. The standard of care for patients with solitary metastases
in non-small cell lung cancer should include consideration of surgical resection and ablation. Favorable criteria include
control of the primary tumor, a negative metastatic survey, good performance status, and a significant metachronous interval. |
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