A registry-based randomized screening phase II trial. A total of 68 patients with metastatic non small cell lung cancer on systemic therapy with oligoprogression to 1-5 extracranial lesions will be randomized using a 1:1 ratio to standard of care (begin next-line systemic therapy, best supportive care, continue current systemic line, based on treating physician decision) vs. receive stereotactic ablative radiotherapy to all oligoprogressive lesions while continuing their current systemic therapy.
Age ≥18 years
Metastatic NSCLC enrolled in our CRCHUM Lung Cancer Registry and co-enrolled to the PERa registry
Ability to provide written informed consent
Eastern Cooperative Oncology Group (ECOG) performance status 0-3
Any lesion beyond 5 cm
Pregnancy or breastfeeding
Any medical condition that could, in the opinion of the investigator, preclude radiotherapy or prevent follow-up after radiotherapy.
Presence of spinal cord compression Metastatic disease that invades the GI tract (including esophagus, stomach, small or large bowel)
Parallel
SABR
RadiationSABR to all oligoprogressive lesions + continuation of current systemic therapy
Standard of care
Other interventionPatients on the standard arm will be treated as per standard of care in our institution. Treatment options could include switching to next systemic therapy line, best supportive care or continuing on current systemic therapy.
PFS
PFS defined from randomization to disease progression at any site or death
OS
OS defined as time from randomization to time of death from any cause.
Quality of life Measured using the FACT-G tool, lung cancer-related patient reported outcome- CTCAE (PRO-CTCAE)
Measured using the FACT-G tool, lung cancer-related patient reported outcome- CTCAE (PRO-CTCAE)
Quality of life 5-level EQ-5D (EQ-5D-5L)
questionnaire
Grade ≥ 3 toxicity
Measured using the Common Terminology Criteria for Adverse Events (CTCAE v5.0)
Local control
Defined as time from the end of SABR treatment to date of local failure and will be measured only in the experimental arm
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