The use of local consolidative therapy is advancing rapidly to improve survival outcomes in patients with oligometastatic non-small cell lung cancer (NSCLC), an intermediate stage between localized and widely spread disease. However, despite these advancements, there is still a significant need for greater consistency in the surgical management of these patients.
Recently, a panel of thoracic surgical oncologists assembled by the STS Workforce on Evidence Based Surgery developed clinical practice guidelines for the surgical management of oligometastatic NSCLC. The guidelines aim to establish the role of pulmonary resection as a local therapeutic approach based on the best available evidence and clinical practice.
“Our goal is to provide clear and actionable recommendations to guide clinicians in making informed decisions about the optimal treatment for patients with oligometastatic NSCLC,” said Mara Antonoff, MD, of MD Anderson Cancer Center in Houston, who chaired the workforce that produced the guidelines. “While the use of radiation in this patient population has been more widely acknowledged, guidelines were in need to ensure that surgical resection will be considered and offered to appropriate patients.”
Methodology
The writing committee members identified seven clinically significant research questions related to the care of patients using the PICO (Patients/Population, Intervention, Comparison/Control, and Outcome) Framework. After conducting a literature search for each question, practice guidelines were developed using a modified Delphi method. These guidelines included a “recommendation” classification and evidence level, graded according to the Class of Recommendations (COR) and Level of Evidence (LOE) based on the American College of Cardiology/American Heart Association (ACC/AHA) Recommendation System. A modified Delphi consensus process, along with anonymous electronic voting, was used to approve the final recommendations.
Key Focus Areas
In summary, the guidelines strongly recommend pulmonary resection as a valuable treatment option for patients with oligometastatic NSCLC, advocating for a multidisciplinary evaluation for all patients with limited spread of disease. The authors highlight the potential differences between surgical caveats of curative-intent surgery in early-stage disease versus those relevant to stage IV NSCLC. In addition, they also summarized areas in which further research is needed to refine surgical techniques and optimize patient outcomes.
“Overall, there is substantial evidence supporting the role of surgical therapy in patients with stage IV lung cancer,” emphasized Dr. Antonoff. “However, the specifics of surgical procedures — such as the nuances of nodal dissection and the extent of resection — remain uncertain due to insufficient evidence.”