Evaluating Stereotactic Body Radiation Therapy for Oligometastatic Disease of the Bone

Inclusion Criteria:

* Both cohorts:

  --≥18 years of age
  * ECOG performance status ≤2
  * Pathologically proven metastatic solid tumor (non-hematologic malignancy) of the bone (spine or non-spine bone)
  * Bony metastatic lesions must be ≤6 cm in maximum dimension and evaluable on either a CT or MRI scan; metastatic lesions in the spine must involve ≤3 contiguous vertebral bodies
  * No other active malignancy within the past 2 years, except for non-melanoma skin cancers or carcinoma in situ of the cervix
  * Ability to understand and the willingness to sign a written informed consent document
  * Surgery to the lesion in question is allowed if size criteria outlined above are met
  * Not currently pregnant or breast feeding
* Cohort 1: Oligometastatic state

  * Oligometastatic state is defined by ≤ 3 active sites of disease, including the primary site
  * Agreement of both the Chow et al.15 and TEACHH16 models, indicating a median life expectancy of \>3 months
  * Among patients with multiple sites of metastatic disease, the other sites that will not be treated on this protocol have either been previously treated or are planned for local treatment
* Cohort 2: Re-irradiation

  * Previous radiation in the current area of disease requiring radiation
  * Life expectancy of \>3 months as defined by agreement of both the Chow et al.15 and TEACHH16 models

Exclusion Criteria:

* SBRT target size \>6 cm in maximum diameter (or \>100 cc in volume)
* Hematologic malignancies (including lymphoma, multiple myeloma)
* Prior RT of greater dose intensity than 100 Gy2 based on a biological effective dose (BED) calculation \[BED (Gy2) = nd x (1+d/α/ß; where n=number of fractions, d=dose per fraction, α/ß=2)\]
* Epidural tumor \<2 mm from spinal cord
* Requirement of active receipt of systemic therapies concurrent with SBRT (concurrent hormonal therapies are allowed)
* Inability to lie flat and still for treatment delivery despite anti-anxiety and/or pain medications
* Non-English speakers are excluded from this study due to use of questionnaires which have not been validated in other languages.
* Patients lacking the capacity to describe their symptoms are excluded as that precludes them (or anyone on their behalf) from filling out the validated questionnaires about symptoms/toxicity.
* Pregnant women are excluded from this study because radiotherapy has the potential for teratogenic or abortifacient effects.
* Individuals with a history of a different malignancy are ineligible except for the following circumstances: if they have been disease-free for at least 2 years and are deemed by the investigator to be at low risk for recurrence of that malignancy; or if diagnosed and treated within the past 2 years for cervical cancer in situ or basal cell or squamous cell carcinoma of the skin.