Introduction. Patients with high-grade sarcoma (HGS) frequently develop metastatic disease thus limiting their long-term survival. Lung metastases (LM) have historically been treated with surgical resection (metastasectomy). A potential alternative for controlling LM could be stereotactic body radiation therapy (SBRT). We evaluated the outcomes from our institutional experience utilizing SBRT. Methods. Sixteen consecutive patients with LM from HGS were treated with SBRT between 2009 and 2011. Routine radiographic and clinical follow-up was performed. Local failure was defined as CT progression on 2 consecutive scans or growth after initial shrinkage. Radiation pneumonitis and radiation esophagitis were scored using Common Toxicity Criteria (CTC) version 3.0. Results. All 16 patients received chemotherapy, and a subset (38%) also underwent prior pulmonary metastasectomy. Median patient age was 56 (12–85), and median follow-up time was 20 months (range 3–43). A total of 25 lesions were treated and evaluable for this analysis. Most common histologies were leiomyosarcoma (28%), synovial sarcoma (20%), and osteosarcoma (16%). Median SBRT prescription dose was 54？Gy (36–54) in 3-4 fractions. At 43 months, local control was 94%. No patient experienced G2-4 radiation pneumonitis, and no patient experienced radiation esophagitis. Conclusions. Our retrospective experience suggests that SBRT for LM from HGS provides excellent local control and minimal toxicity. 1. Introduction Although sarcomas are rare, accounting for less than 1% of cancers in adults, 20–40% of all sarcoma patients ultimately develop metastatic disease in the lungs [1–4]. Of the high-grade sarcomas (HGS), 40–60% of patients will develop lung metastases (LM), of which 70–80% will have disease limited to the lungs, likely through hematogenous spread. The development of lung metastatic disease is associated with poor outcomes as few patients achieve durable disease control [5]. Many sarcomas have a unique biological predilection for the lung, often the only signs of metastatic disease, and, therefore, controlling these specific sites of progression can increase survival. Due to this predilection of HGS for the lungs, surgical resection has been a vital part of managing these patients. Reported 5-year overall survival rates following metastasectomy vary from 20 to 40% depending upon the patient selection [5–10]. Over the past two decades, many groups have published results demonstrating successful palliation and even prolongation of survival after resection of LM from HGS [11]. Nearly 80% of the
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