Changing equipoise in the landscape of radiation for oligometastatic lung cancer

For both men and women, metastatic non-small cell lung cancer (NSCLC) represents the greatest contributor to cancer related mortality (1). Despite advances in screening, nearly half of newly diagnosed NSCLC will be metastatic at presentation (2). Furthermore, approximately half of patients with locally advanced NSCLC will progress distantly despite aggressive treatment with definitive chemoradiation or neo-adjuvant chemoradiation followed by surgery (3,4). Recently, incorporation of adjuvant durvalumab after definitive chemoradiation for locally advanced NSCLC was found to decrease the incidence of new site progression to 22.5% compared to 33.8% in the control arm (5). Thus, even with contemporary treatment approaches, many patients who initially present with localized disease will ultimately progress