Is there evidence supporting the role of SBRT in the management of oligometastatic stage IV NSCLC?

Yes. I would look at a great trial from Wake Forest, looking at consolidative radiotherapy after 3-6 cycles of platinum-based chemotherapy, followed by observation, so chemotherapy, then radiotherapy, then observation (no maintenance chemotherapy). The trial occurred from 2010 to 2015. This single-arm trial had a median progression-free survival of 11.2 months with a median OS of 28.4 months. They provided a nice summary of their dose constraints and other granular details.

MD Anderson published a multicenter trial on this same topic in 2016 and subsequently provided a long-term update in 2019--with a median follow-up of 38.4 months. Local consolidation therapy (LCT) (either surgery or radiotherapy) provided a PFS benefit of 23.1 months vs 4...

To define a population undergoing active treatment with effective systemic agents that might benefit from LCT requires a nuanced approach, given that tumor response may operate in a time-dependent manner depending on the systemic agent used. The definition of oligometastasis: site, volume, and number (e.g., two adjacent vertebral bodies or multiple mediastinal nodes counted as a solitary site) of metastases, distribution of biomarkers, circulating tumor DNA, duration of exposure to systemic therapy (typically set at 3 months--perhaps it should be much longer?), radiomics, etc.

So, the question may be, in the setting of ICI, which subgroup of patients benefits from LCT?

One approach that makes sense is to assess patients with oligoresidual (ol...