How are you incorporating abscopal radiation into your practice for metastatic NSCLC?

There is not enough evidence to guide our daily clinical practice about radiation abscopal effect off protocol. However, in stage IV NSCLC, we can use RT to:

1. Eliminate/control chemo or target therapy resistant or persistent primary and oligo-metastases

2. Concurrent SABR with targeted therapy for NSCLC with or without specific mutation

3. Maximal tumor debulking of the primary site as part of multi-modality therapy

4. Combined immunotherapy and RT: The sequence is not quite clear yet. Preliminary data indicated that it is reasonably safe to treat concurrently. Lesions in the lung and/or liver tolerate the combination well and clinical data is emerging.