Radical-Dose Image Guided Radiation Therapy in Treating Patients with Stage I-IV Non-small Cell Lung Cancer Undergoing Immunotherapy

Inclusion Criteria

• Has stage IV non-small cell lung cancer, or initially stage I-III disease with distant metastatic recurrence
• Has been receiving anti-PD-1 or anti-PD-L1 immunotherapy for at least four weeks
• Has had restaging imaging after initiation of immunotherapy, at least 4 weeks after pre-immunotherapy baseline imaging; computed tomography (CT) or positron emission tomography (PET)/CT of at least chest/upper abdomen must be performed within 4 weeks prior to registration; for patients with history of brain metastases, brain magnetic resonance imaging (MRI) or CT is required within 4 weeks of registration; for other patients brain MRI or CT is required within 12 weeks of registration; diagnostic PET/CT performed as part of radiation simulation can be used as the restaging imaging
• Most recent imaging shows measurable disease as defined by RECIST 1.1
• Evaluation by a Stanford medical oncologist must show: * The patient is expected to continue on immunotherapy for at least three more months * Imaging must show response, stable disease, or modest progression * If there is modest progression, the patient must be clinically stable in terms of performance status and overall disease-related symptoms
• Has at least one extracranial tumor safely treatable with radical-dose radiation therapy and that has not been previously treated with radiation
• Eastern Cooperative Oncology Group (ECOG) performance status 0-2
• Has the ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria

• Untreated brain metastases, if not planned to be treated in this course of radiation therapy
• Pregnancy or women of childbearing potential not willing/able to use contraception during protocol treatment