الفهرس 
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Abstract
The purpose of this study was to investigate the role of consolidative lung radiotherapy for the primary lesion only in metastatic NSCLC with any number of distant lesions in terms of PFS, OS, toxicity and quality of life.
A total of 75 patients with metastatic NSCLC, which received first line systemic treatment either chemotherapy or targeted therapy without progressive disease at clinical oncology and nuclear medicine department, Menoufia university in the period from 1 January 2021 to 31December 2022 were randomized 1:1 to radiotherapy arm (consolidative radiotherapy followed by standard treatment/ observation) vs control arm (standard treatment/ observation).
No significant difference was observed between the studied arms in terms of different clinicopathological factors and treatment parameters except significantly higher smoking index, T classification and auto lung metastases in the radiotherapy arm (P= 0.011, 0.042 & 0.010) respectively.
No significant difference in the baseline symptoms between the radiotherapy arm and the control arm in cough, pneumonitis, dysphagia, radiation dermatitis, chest wall pain and dyspnea. At 3 months it was observed that a significantly higher chest wall pain in radiotherapy arm (p=0.005) and significantly lower cough (p0.033). While at 9 months dyspnea, dysphagia and pain were significantly better in the radiotherapy arm (p=0.013, 0.031, 0.004) respectively.
Radiotherapy achieved a better local control with significantly lower locoregional progression (p=0.015). Median progression free survival for the radiotherapy arm was 15.3 months and it was significantly longer than the control arm which was10.93 months (p=0.010). A univariate HR 1.991 {(1.162 – 3.412) p = 0.012}.
Median overall survival for the radiotherapy arm was 18.30 months vs 13.73months in the control arm and it was near the statistical significance (p=0.054) with univariate HR 1.843 {(0.981 – 3.464) p=0.057}.
No baseline significant difference in the EORTC QLQ-C30 score in both arms similarly at 3 months follow up. While at 9 months cognitive and social functions were significantly better in the radiotherapy arm (p=0.033, 0.006) respectively. along with a significantly lower fatigue rates in the radiotherapy arm (p=0.038).
Conclusion:
Finally, this study concluded that consolidative radiotherapy to the primary lesion only in metastatic NSCLC after response to first line systemic therapy was well tolerated, significantly improved PFS and can be a good alternative option for metastatic NSCLC patients especially those with expected more toxicity from SBRT due to the distant metastasis’s location or number also for poor countries lacking SBRT modality in most of their radiation centers.