For patients with NSCLC with large primary tumors (ie T4) but no mediastinal nodal involvement who are found to have isolated oligometastatic disease in the brain, do you still consider definitive management of the primary lung tumor?   

Interesting question! Particularly since T4N0M1 NSCLC is a relatively rare clinical scenario.   First, what is the appropriate management of T4N0M0 lesions? Historically, these patients were considered unresectable and were classified as stage IIIB. Even with improvement in surgical techniques...