A Randomized Phase III Trial of Stereotactic Ablative Radiotherapy for Patients With Up to 10 Oligometastases and a Synchronous Primary Tumor.

Exclusion Criteria

• •Serious medical comorbidities precluding radiotherapy. These include ILD in patients requiring thoracic radiation, Crohn's disease in patients where the gastrointestinal (GI) tract will receive radiotherapy, or ulcerative colitis where the bowel will receive radiotherapy and connective tissue disorders such as lupus or scleroderma.
• •For patients with liver metastases, moderate/severe liver dysfunction (Child Pugh B or C); please see the Child-Pugh score calculator.
• •Substantial overlap with a previously treated radiation volume. Prior radiotherapy in general is allowed, as long as the composite plan meets dose constraints herein. For patients treated with radiation previously, biological effective dose calculations should be used to equate previous doses to the tolerance doses listed in Appendix 1. All such cases must be discussed with a member of the study steering committee.
• •Malignant pleural effusion
• •Inability to treat all sites of disease
• •Brain metastasis \> 3 cm in size or a total volume of brain metastases greater than 30 cc.
• •Metastasis in the brainstem
• •Clinical or radiologic evidence of spinal cord compression
• •Metastatic disease that invades any of the following: GI tract (including esophagus, stomach, small or large bowel), or skin
• •Pregnant or lactating women