Randomized Study Comparing Two Dosing Schedules for Hypofractionated Image-Guided Radiation Therapy

Inclusion Criteria:

Histologically or cytologically confirmed diagnosis of cancer (including epithelial carcinoma, sarcoma, and melanoma) The diagnosis can be done at MSKCC or at participating institutions.
Sites of metastatic disease to be treated on protocol are limited to bone, spine, soft tissue, and lymph nodes only.
Patients with American Joint Committee on Cancer (6th edition, 2002) Stage IV cancer with distant metastases
Age 18 years or older
Life expectancy >3 months
Maximum tumor dimension of ≤6 cm in lymph nodes, soft tissue, osseous metastases, or spinal metastases seen on imaging (computed tomography [CT], magnetic resonance imaging [MRI], or PET/CT) and considered amenable for RT.
If the lesion(s) to be treated are soft-tissue or lymph Nodes unidimensionally measurable disease is required. Bone & spine lesions are eligible even if considered non-measurable.
Measurable disease is defined as:
≥ 10mm for soft-tissue lesions
≥ 15mm on the short axis of lymph nodes
KPS ≥ 80
Patients must have normal bone marrow function as defined below:(within 2 months of registration) Hemoglobin ≥9.0 g/dl Absolute neutrophil count (ANC) ≥1,500/μl Platelets ≥100,000/μl

Exclusion Criteria:

Prior radiotherapy delivered to the target region
Disease to be treated on protocol is less than 2 mm from the spinal cord and therefore will not meet dose constraints*
Pregnancy or Breast-Feeding (Participants of child-bearing potential are eligible but must consent to using effective contraception during therapy and for at least 3 months after completing therapy).
Chemotherapy given on the day of the planned radiotherapy treatment
Lesions which comprise >70% of the width of weight bearing bones, such as the femur.
Existing cortical bone destruction, where orthopedic stabilization would be required.

Areas to be treated on protocol do not include metastases to liver, brain or lung.

Note: Patients with eligible and ineligible lesions will be accrued to this protocol. Only target eligible lesions will be treated per protocol. Other eligible and ineligible lesions will be treated at the discretion of the treating physician."