Lung resection as part of multi-modality treatment for stage IV lung cancer

Background: Some observational studies have demonstrated reasonable survival outcomes for selected patients with stage IV lung cancer undergoing lung resection as part of multi-modality treatment. We review our experience of stage IV lung cancer patients undergoing therapeutic lung resection. Methods: A single-centre retrospective review of 19 patients with stage IV lung cancer undergoing therapeutic surgical resection as part of multi-modality treatment between 2012 and 2018 was undertaken. Reported outcomes included adherence to planned treatment regimens, adherence to local policy of treatment sequencing and 1-, 2- and 3-year survival. Results: Three patients with cranial metastases underwent initial radiotherapy to the brain. Of the remaining 16 patients, nine were treated with systemic therapy initially and 77.8% (n=7/9) completed all planned treatment modalities. Seven patients didn’t receive systemic therapy first and only 28.6% (n=2/7) of these patients completed all planned treatment modalities. Observed 1-, 2- and 3-year survival rates were 73.7% (n=14), 52.6% (n=10) and 47.4% (n=9), respectively. Conclusions: Multi-modality treatment in selected patients with stage IV lung cancer can be considered in selected patients with good mid-term results. A policy of systemic therapy first to ensure disease stability prior to local treatments may improve adherence to planned treatment strategy.