A Randomized Study of Primary Tumor Radiotherapy for Patients With MPE Stage IV NSCLC

Inclusion Criteria:

* Patients with pathological or cytological diagnosis, stage IV with malignant pleural effusion \[UICC 2017 staging eighth edition\] NSCLC patients;
* initial treatment (previously did not receive any treatment), it is recommended to complete the detection of driver genes (EGFR / ALK / ROS1) (tissue, blood);
* Age 18 to 80 years old, physical status score ECOG 0 to 2 or KPS ≥ 70 (see Annex 2); Metastatic lesions in the distant area: conscious when brain metastasis; the number of metastatic lesions in the lung does not affect lung function and may be treated with primary and/or partial metastases;
* no radiotherapy, EGFR-TKI and chemotherapy contraindications;
* primary tumor radiotherapy requires IMRT technology;
* Plan the design to give the primary tumor prescription dose (DTGTV) under the damage control threshold criteria;
* The planned dose includes 100% GTV, 90% of the prescribed dose includes 98%\~100% of PTV \[planned target dose (DTPTV)\]; normal lung (full lung volume minus GTV volume) V20 ≤ 32%, MLD≤20Gy;
* metastatic tumor radiotherapy is a three-dimensional radiotherapy technique (IMRT/SRT/SBRT/VMAT, etc.), and large-segment radiotherapy.
* Subjects have no major organ dysfunction, or laboratory test indicators must meet the following requirements: Hematology: normal range according to laboratory standards; cardiac function: normal range; liver function: normal range; renal function: normal range Lung function: FEV1\>50%, impaired light-moderate lung function.
* Informed consent (radiation, medication) before treatment;
* The patient has good compliance with the treatment and follow-up received.

Exclusion Criteria:

* Patients who do not meet the pathological type, stage, and survival status of the inclusion criteria;
* no malignant pleural effusion IV stage NSCLC;
* patients with malignant pericardial effusion; Diffuse liver metastasis, intrapulmonary metastasis and has seriously affected patients with liver and lung function;
* Patients with uncontrolled hypertension, diabetes, unstable angina, history of myocardial infarction, or symptomatic congestive heart failure or uncontrolled arrhythmias in the past 12 months; clinically diagnosed heart valve disease; • • •Active period of disease caused by bacteria, fungi or viruses; mental disorders; impaired severe lung function;
* pregnant, lactating patients;
* Patients with a history of other active malignancies other than small cell lung cancer before entering the group; non-melanoma skin basal cell carcinoma, in situ cervical cancer, and cured early prostate cancer;
* Patients with allergies and no known alternatives to known or suspected drugs in any study;
* Patients with poor compliance;
* Researchers believe that it is not appropriate to participate in this test.