Irradiation of Large Lung Tumors or Two or More Lung Metastases Simultaneously

Inclusion Criteria

• Inclusion Criteria for group A and B: - Weight loss < 10% in the last three months. - WHO-performance status ≤ 2 - Medical inoperable patients or patients refusing surgery. - Chemotherapy is allowed in neoadjuvant and adjuvant setting, with exclusion of the period 4 weeks pre-SBRT and 6 weeks post-SBRT. - Before patient registration, written informed consent must be given according to ICH/GCP, national and local regulations. Risk group A specification: - NSCLC (Cytological or histological proven) patients with peripheral tumors >5 cm with tumor staging cT2bN0M0 or cT3N0M0 (chest wall infiltration is no exclusion criteria, as long as the tumor diameter is > 5 cm). - Single peripheral lung metastasis in inoperable patients with a diameter of > 5 cm. In case of first presentation of metastatic disease, cytological or histological proof is obligated. - In patients without cytological or histological confirmation of NSCLC, a growing FDG-PET positive lesion (SUV >5) is accepted if a contra-indication for invasive diagnostic examination (or refusal) is present. Risk group B specification: - Patients with ≥ 2 simultaneous peripheral lung metastases ≤ 5 cm of any origin at any location in the lung. - In case of first presentation of metastatic disease, cytological or histological proof is obligated. This is not necessary in case of a history of an already proven disseminated disease. - Patients having ≥ 2 peripheral lung metastases without unacceptable dose overlap. Exclusion Criteria: - Patients with central tumors - Pancoast tumors - Prior radiotherapy treatment to the thorax - Patients receiving any systemic treatment during SBRT - Pregnant patients - Patients previously treated with adriamycin agents in case of heart involvement within the treatment field.