Positron Emission Tomography (PET) Guided Stereotactic Body Radiation Therapy for the Treatment of Oligoprogressive Non-small Cell Lung Cancer, Melanoma, and Renal Cell Carcinoma

Inclusion Criteria:

• Documented informed consent of the participant and/or legally authorizedrepresentative

• Assent, when appropriate, will be obtained per institutional guidelines

• Agreement to allow the use of archival tissue from diagnostic tumor biopsies

• If unavailable, exceptions may be granted with study principal investigator (PI) approval

• Age: >= 18 years

• Eastern Cooperative Oncology Group (ECOG) =< 2

• Histologically or cytologically confirmed NSCLC with 1-5 sites of diseaseprogression while on or following systemic therapy with a checkpoint inhibitor withor without chemotherapy for at least 3 months with radiographic evidence ofprogression based on Response Evaluation Criteria in Solid Tumors (RECIST) orPositron Emission Tomography Response Criteria in Solid Tumors (PERCIST)

• Lesion(s) must all be amenable to SBRT which will be determined by the radiationoncologists. Active lesions should be a minimum size of >= 1 cm

• Primary tumor should be controlled for > 3 months in the metachronous setting; forsynchronouos progression of the primary and oligoprogressive site(s), the primaryshould be treated with curative/local control intent

• Patients eligible for the study must have at least one lesion for which the plannedradiation dose achieves a biologic effective dose (BED) < 100 (alpha/beta = 10) dueto organs at risk and dose constraints

• If the clinical scenario deem that other forms of local therapy may be more suitablefor the metastatic disease, such as surgical resection and interventionalradiology-guided ablation, patients would be able to undergo other forms of localtherapy after discussion with the study PI but at least one lesion must be treatedwith SBRT in this scenario

• Patients with brain metastases can be included but brain metastases must be treatedprior to enrollment and are not considered as a site of oligoprogression

• Life expectancy >= 3 months in the opinion of the treating investigators

Exclusion Criteria:

• Judgement by the investigator that the patient is unsuitable to participate in thestudy and the patient is unlikely to comply with study procedures, restrictions, andrequirements

• Those not eligible for SBRT after review by a radiation oncologist

• Unable to undergo a Pet/CT or do not have Pet active disease

• Pregnant and/or breastfeeding women are excluded from this study as these agents mayhave the potential for teratogenic or abortifacient effects. Female patients ofchildbearing potentially must have a negative urine or serum pregnancy test within 72 hours prior to receiving therapy

• Prospective participants who, in the opinion of the investigator, may not be able tocomply with all study procedures (including compliance issues related tofeasibility/logistics)