The optimal primary site treatment modality for non-small-cell lung cancer (NSCLC) with brain oligometastases is not well-established. This study sought to evaluate long-term survival of patients with NSCLC with isolated brain metastases undergoing multimodal therapy with or without thoracic surgery.
Patients with cT1-3, N0-1, M1b-c NSCLC with synchronous limited metastatic disease involving only the brain treated with brain stereotactic radiosurgery (SRS) 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.
Of the 1,240 patients with NSCLC with brain-only metastases who received brain SRS or neurosurgery and met study inclusion criteria, 270 (21.8%) received primary site resection. The Thoracic Surgery group had improved overall survival compared to the No Thoracic Surgery group in Kaplan-Meier analysis (p<0.001) and after multivariable-adjusted Cox proportional hazards modeling (p<0.001). 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=0.012).
In this national analysis, patients with cT1-3, N0-1, M1b-c NSCLC with isolated limited brain metastases had better overall survival after multimodal therapy including thoracic surgery compared to systemic therapy without surgery. Multimodal thoracic treatment including surgery can be considered for carefully selected patients with NSCLC and limited brain metastases.

Copyright © 2023. Published by Elsevier Inc.