Stereotactic Radiosurgery in Treating Patients with Oligo-Recurrent Disease

Inclusion Criteria

• Pathologically (histologically or cytologically) proven diagnosis of solid malignancy * NOTE: fludeoxyglucose F 18 (FDG)-positron emission tomography (PET) scans are required for full staging of metastatic disease prior to enrollment; if subject has had an FDG-PET/computed tomography (CT) scan within the last 8 weeks, it will not need to be repeated * NOTE: pathological confirmation is not required for all disease sites as long as the sites of metastatic disease are radiographically and clinically consistent with metastatic disease from a known (biopsy proven) primary * NOTE: biopsy does not have to be performed at the time of enrollment for patients with recurrent disease as long as biopsy was performed at time of initial diagnosis
• Eligible disease sites include the following * Breast * Prostate * Gastrointestinal (GI) (including colorectal, anal, esophagus, pancreas, gastric with the exception of patients with colon cancer and liver-only metastatic disease) * Head and neck * Skin (melanoma and squamous cell carcinoma) * Lung (both small cell and non-small cell) * Sarcoma (both soft tissue and bone) * Gynecologic (endometrial, cervical, ovarian, vaginal, vulvar)
• Patients are stage IV (M1) or recurrent with any combination of T and N with oligometastatic disease as defined by 5 or fewer total sites of metastatic disease * NOTE: number of metastatic sites based on most recent imaging studies in order to determine number of oligometastatic sites; for example, if patient initially had 10 sites of metastatic disease, was treated with chemotherapy resulting in complete response of 5 lesions and stable disease of 5 lesions, and no new lesions based on repeat imaging, the patient would be eligible for treatment on protocol
• Can have recurrent disease from the primary disease (this is definition of oligorecurrent disease) but cannot have any other primary cancer diagnosed or treated within the last 3 years other than cutaneous skin cancer
• Prior systemic chemotherapy is allowable
• Zubrod performance status 0-1
• Absolute neutrophil count (ANC) >= 1,800 cells/mm^3
• Platelets >= 100,000 cells/mm^3
• Hemoglobin >= 8.0 g/dl (Note: the use of transfusion or other intervention to achieve hemoglobin [Hgb] >= 8.0 g/dl is acceptable)
• Women of childbearing potential and male participants must practice adequate contraception
• Patient must provide study specific informed consent prior to study entry

Exclusion Criteria

• Ineligible disease sites include the following * Lymphoma * Leukemia * Multiple myeloma * Primary central nervous system (CNS) * Peritoneal carcinomatosis * Colon cancer with liver-only metastatic disease that is treatable with surgical resection
• Other * Diffuse metastatic spread confined to one organ system is ineligible; examples of this include leptomeningeal spread in the CNS and peritoneal carcinomatosis. * Metastatic disease sites must be treatable with stereotactic radiosurgery (at discretion of treating physician); patients with oligometastatic sites not amenable to SRS treatment, either through size or locations, are ineligible for this trial
• Severe, active co-morbidity, defined as follows: * Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months * Transmural myocardial infarction within the last 6 months * Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration * Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects; note, however, that laboratory tests for liver function and coagulation parameters are not required for entry into this protocol
• Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception
• Patients unable to have an FDG-PET scan, either through insurance coverage, patient decision or other reason are not eligible for this study
• Oligometastatic disease sites not eligible based on concern for toxicity: * Trachea involvement (direct invasion, tumors close to or abutting trachea are eligible) * Heart (direct invasion or involvement, pericardial lymph nodes can be treated)
• Patients unable to have SRS/SBRT through insurance coverage or ability to pay for SRS/SBRT