How to treat isolated metastases of non-small cell lung cancer?

  1. Isolated metastases of primary lung cancer: it should be clarified whether they are true isolated metastases or pseudo-isolated metastases; enhanced magnetic resonance imaging is recommended for intracranial lesions, and PET or PET/CT imaging is recommended for extracranial lesions.  2. For isolated metastases occurring at the same time: for non-small cell lung cancer with primary foci of T1-2N0 and completely resectable, surgery + systemic chemotherapy (chemotherapy or targeted therapy) is recommended for the primary lung foci and resectable isolated metastases; for non-small cell lung cancer with primary foci of T1-3N1 and completely resectable, local treatment (surgery or radiotherapy) is recommended for the primary lung foci and resectable isolated metastases + systemic therapy (chemotherapy or targeted therapy); for non-small cell lung cancer with N2 primary foci and resectable isolated metastases, chemotherapy-based combination therapy is recommended; if the primary lung foci are evaluated as incompletely resectable, systemic therapy should be the main treatment even if the isolated metastases are resectable.  3.For isolated metastases occurring in heterogeneous stage: for resectable isolated metastases occurring in heterogeneous stage after primary lung cancer surgery, surgical resection + systemic therapy is recommended if the tumor-free interval is >6 months; if the tumor-free interval is <6 months, conformal radiotherapy + systemic therapy is recommended.  4.Treatment of isolated brain metastases: if symptomatic isolated brain metastases occurred at the same time, such as good PS status, the recommended treatment mode is surgical resection of isolated brain metastases + whole brain radiotherapy → systemic chemotherapy → surgical resection of primary lung cancer; if asymptomatic isolated brain metastases occurred at the same time, such as good PS, the recommended treatment mode is 3-4 cycles of systemic chemotherapy → surgical resection of isolated brain metastases + whole brain radiotherapy or conformal radiotherapy of brain metastases → surgical resection of primary lung cancer.  5. Treatment of isolated adrenal metastases: If the PS status is good and the primary lung metastases are completely resected, surgical resection or conformal radiotherapy + systemic chemotherapy is recommended.  6. Treatment of isolated metastases from other sites: if the PS status is good and the primary foci of lung can be completely removed, surgical resection or moderate radiotherapy + systematic systemic chemotherapy is recommended for other isolated extracranial metastases.  7. Treatment of isolated bone metastases: if PS status is good, limited metastases of weight-bearing bone with dysfunction and pain, surgical treatment + radiotherapy followed by systemic treatment is recommended.