Stereotactic Radiosurgery in Treating Patients with Oligometastatic Disease

Inclusion Criteria

• Pathologically (histologically or cytologically) proven diagnosis of solid malignancy within 8 weeks of registration * NOTE: fludeoxyglucose F 18 (FDG)-positron emission tomography (PET)/computed tomography (CT) scans are required for full staging of metastatic disease; if subject has had an FDG-PET/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: the primary site does not have to be the site of pathological confirmation; for example, in a patient with a radiographic lung lesion with mediastinal lymphadenopathy and a liver lesion, a liver biopsy which is constant with lung primary would preclude the necessity for further pathologic diagnosis
• Eligible disease sites include the following * Breast * Prostate * Gastrointestinal (GI) (including colorectal, anal, esophagus, pancreas, gastric with the exception of colon cancer with resectable liver-only lesions) * 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) with any combination of T and N with oligometastatic disease as defined by 5 or fewer total sites of metastatic disease involving 3 or fewer organ systems * Examples of patients eligible for trial ** T3N2M1 non-small cell lung cancer (NSCLC) with 1 central nervous system (CNS) metastatic lesion, 2 liver lesions, and 1 adrenal lesion. ** T4N1M1 colorectal cancer with 1 liver lesion, 4 bone lesions ** T3N0M1 gastric cancer with 1 supraclavicular lymph node, 2 liver lesions, and 2 CNS lesions
• Metastatic disease sites must be treatable with SRS (at discretion of treating physician)
• Primary disease site must be able to be treated with curative intent
• 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 CNS * Peritoneal carcinomatosis * Colon cancer with resectable liver-only lesions
• Examples of patients ineligible for trial * T1N1M1 NSCLC with 1 CNS lesion, 1 bone lesion, 1 adrenal lesion and a cervical lymph node (4 sites of metastatic disease) * T2N1M1 Gastric cancer with 6 liver lesions (more than 5 sites of metastatic disease)
• Other * Lung cancer with pleural effusion (wet IIIB) are not eligible * Recurrent cancers are not eligible * Diffuse metastatic spread confined to one organ system is ineligible; examples of this include leptomeningeal spread in the CNS and peritoneal carcinomatosis
• Prior systemic chemotherapy for the study cancer; note that prior chemotherapy for a different cancer is allowable but cannot have any other primary cancer diagnosed or treated within the last 3 years other than cutaneous skin cancers; patient may have previous chemotherapy as treatment of this previous malignancy as long as the chemotherapy has completed more than 3 years ago
• Prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields
• 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
• Oligometastatic disease sites not eligible: * 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 an FDG-PET/CT scan, either through insurance coverage, patient decision or other reason are not eligible for this study
• Patients unable to have SRS/SBRT through insurance coverage or ability to pay for SRS/SBRT