The standard treatment for patients with stage IV non-small cell lung cancer (NSCLC) is chemotherapy. Retrospective series suggest, however, that some patients with stage IV lung cancer with a solitary synchronous site of extrathoracic metastatic (M1) disease are effectively treated by resection of both the primary tumor and the meststasis. Although these patients represent a small minority of those with stage IV lung cancer, it appears reasonable to consider highly selected patients with a solitary resectable metastasis from NSCLC for surgical resection of all evident disease or for chemotherapy without surgery. Because of the results of the current author's trial, however, it is difficult to recommend the regimen of combined medical and surgical therapies used in the current protocol in the management of solitary M1 disease. Future trials could be designed to include newer, less toxic chemotherapeutic regimens.