What dose-fractionation do you use when treating primary NSCLC with oligometastatic disease?

The approach to the lung primary in a patient with a single brain metastasis is dependent in our experience on clearly defining the extent of disease in the chest. Thus, the unusual presentation of a single brain lesion with an isolated primary (i.e.,. no regional nodal or distant disease) in the chest is usually treated definitively in good performance patients in our institution, driven mainly by retrospective experiences such as Hu et al.'s publication in Cancer in 2006 which suggested these patients have a favorable natural history. For example, the single brain metastasis might be resected and get whole brain adjuvant therapy and then after PET and mediastinoscopy or EBUS had established an "early" node negative primary, the patient wo...

There are a couple of series that suggest that for patients with oligometastatic disease with Stage III disease in the chest, that these patients can achieve significant long-term survival outcomes with definitive thoracic chemoRT (for example Khan A et al and Jabbour SK et al). Our approach is to treat the brain metastasis first and then treat with chemotherapy. If after chemotherapy, the disease is still localized, we then incorporate definitive thoracic chemoradiation.