Most people can now get on board with definitive stereotactic body radiation (SBRT) for small primary non-small cell lung cancer (NSCLC). But what about multiple small NSCLCs? This retrospective look at 60 patients treated with SBRT for 126 synchronous NSCLC tumors demonstrates a solid median overall survival time of 46 months. At a median follow-up of 47 months, 25 patients (42%) had experienced disease progression at a median of 36 months: 9 (15%) local, 4 (7%) regional, and 11 (18%) distant. Even more than any of that, 13 (21%) developed new primaries. At the same time, only 2 patients (3%) experienced a grade 3+ toxicity (pneumonitis and hemoptysis). In other words, being extremely safe and effective when respecting total lung dosimetric constraints, SBRT is a good definitive treatment option for 2+ NSCLC synchronous tumors —and then probably serially as needed for metachronous ones, as well.  | Raju, Pract Radiat Oncol 2021


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