Additive local radical therapy in synchronous oligometastatic non–small cell lung cancer without oncogenic drivers: a monocentric retrospective cohort study

Synchronous oligometastatic disease (sOMD) in non-small cell lung cancer (NSCLC) is considered a potentially curable intermediate state between localized and widely metastatic disease. Whether adding local radical therapy (LCT after initial systemic therapy (S) or upfront) as surgery and/or radiotherapy to all visible sites improves outcomes in non-oncogene-addicted sOMD remains uncertain. We conducted a retrospective, single-center cohort study. Patients diagnosed with histologically confirmed NSCLC (2018-2023) in stage T1–T3, N0–N2 and M1a (excluding pleural/pericardial carcinomatosis), M1b or M1c with≤3 metastases in≤2 organs were eligible. Driver-mutated tumors were excluded. Patients received either S alone (control group) or S plus LCT to primary and all metastases (intervention group). Primary endpoints were a modified objective response rate (mORR), PFS and OS. Secondary endpoints were hospitalization-requiring adverse events (CTCAE≥3). Inverse-probability-of-treatment weighting (IPTW) was used to adjust for baseline imbalances. Time-to-event outcomes were analyzed with weighted Cox models and Kaplan-Meier estimates; binary outcomes with logistic regression. Among 47 eligible patients, 24 were in the control group and 23 in the intervention group. Baseline characteristics were largely balanced with exceptions for N stage and ECOG performance status, favoring the intervention group. Median PFS was 7.0 months in the control group and 7.4 months in the intervention group (hazard ratio (HR) 1.19); median OS was 19.3 vs 22.9 months (HR 0.65); neither difference was statistically significant. mORR did not differ significantly between groups. CTCAE≥3 hospitalizations were less frequent in the intervention than in the control group. In an exploratory analysis within the intervention group, a consolidative sequence (systemic therapy first, then LCT) showed a trend toward longer OS, while upfront local radical therapy before systemic therapy numerically prolonged PFS. In this real-world, non-oncogene-addicted sOMD NSCLC cohort, adding local radical therapy to systemic treatment yielded no statistically significant improvement in PFS or OS. Numerical trends favored the intervention for OS and fewer severe hospitalizations. Publication History Article published online: 04 March 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany