Excision of the primary in stage IV non-small cell lung cancer (NSCLC): A feasibility study

Background/Introduction

Benefit from resection of the primary tumour in stage IV renal and breast cancer has been demonstrated. This has never been shown in patients with stage IV lung cancer.

Aims/Objectives

To establish the feasibility of a trial in NSCLC we assessed the proportion of stage IV patients in whom video-assisted thoracoscopic (VAT) wedge resection of the primary lesion would be possible.

Method

A prospective lung cancer database was analysed to identify patients with stage IV lung cancer. Inclusion criteria included: WHO performance status of 0-2 and histologically confirmed NSCLC. Patients with cerebral metastases were excluded. The images of these patients were independently reviewed by two surgeons to determine the suitability for a VATS wedge resection of the primary lesion. Areas of discrepancy were resolved by a third senior reviewer.

Results

Over a 14-month period, 893 patients with stage IV lung cancer were identified. A sample of 300 consecutive patients (34%) with a performance status of 0-2 were analysed of which 30 were excluded as they did not fulfil the primary criteria. Thirty-six (16%) of the remaining 230 had histological confirmation and no cerebral metastases. A further 23 patients were excluded due to the size or location of the primary. Thirteen patients (5.6%): median age 70 years (IQR: 64-76 years) were found to be suitable for a VATS wedge resection and the most common cell type was adenocarcinoma (46%).

Discussion/Conclusion

A proposed trial of resecting the primary in stage IV NSCLC would be challenging as a busy unit would only have one candidate per month. This data will guide the design of a future multicentre trial.