The Oligometastatic State in NSCLC: Where Does Radiotherapy Fit?

Abstract

Non-small cell lung cancer (NSCLC) remains the leading cause of cancer-related mortality worldwide, with the majority of patients presenting with or developing metastatic disease. The concept of oligometastatic disease (OMD) an intermediate state between localised and widely disseminated disease has emerged as a therapeutically relevant entity. Growing evidence supports the integration of local ablative therapies (LAT), particularly stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy (SABR), into the management of oligometastatic NSCLC (OM-NSCLC) alongside systemic therapy. This review synthesises the clinical rationale, key randomized trial data, and the evolving role of radiotherapy in both driver-mutation-negative and driver-mutation-positive OM-NSCLC. We discuss the interplay of radiotherapy with immunotherapy and targeted therapies, specific metastatic sites, and emerging strategies including oligoprogressive disease management. Challenges of patient selection, optimal timing, dose-fractionation, and the provocative negative results of the NRG-LU002 trial are also addressed. Finally, ongoing and future trials that will shape the next decade of practice are outlined.