Surgical approach is superior to palliative treatment in oligometastatic lung cancer

The majority of patients with lung cancer are diagnosed in a metastatic state, in which prognosis is rather poor. Chemotherapy can improve median overall survival by only a few months, but a small percentage of these patients suffer only from oligometastatic diseases and may therefore be treated with curative intend. In this study, we compared two groups of patients with oligometastatic lung cancer, who received palliative treatment or multimodal treatment with a surgical approach.

We conducted a retrospective review of all patients with synchronous extrapulmonary oligometastatic disease diagnosed between 2010 and 2013. All data were extracted from the medical database of our department and further analysed.

There were 52 patients diagnosed with oligometastatic lung cancer between 2010 and 2013. A cohort of 32 patients was treated surgically in a multimodal approach, but 19 patients refused surgery. These patients were treated by palliative chemotherapy or other palliative treatments, such as radiochemotherapy etc. Median overall survival was 18 months in the surgically treated group and 6 months in the palliative group (p < 0.001). In the surgically treated group, survival was correlated to pathologic T stage (pT1 29 months, pT2 13 months and pT3 13 months median overall survival, p < 0.05) and lymph node involvement (with mediastinal lymph node involvement 13 months and without mediastinal lymph node involvement 28 months median overall survival).

We conclude that surgery may have a beneficial effect in multimodal treatment of oligometastatic lung cancer. A prospective randomized study is necessary and may be feasible.