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Background  This study investigates the outcome of synchronous stage  IV  non‐small cell lung cancer ( NSCLC ) patients who received radical thoracic radiotherapy ( TRT ).    Methods  We retrospectively reviewed the charts of stage  IV NSCLC  patients treated with  TRT  between  J anuary 2007 and  D ecember 2011. Radiotherapy was considered radical if it was the primary therapy with non‐symptom driven intent, or consolidation therapy after initial chemotherapy and the biologically equivalent dose ≥53 Gy halted disease progression. The patients' demographics, disease characteristics, and treatment parameters were uniformly collected.    Results  Eighty‐one patients were irradiated with radical intent, including 52% with more than five metastatic lesions. The minimum follow‐up was 31.5 months for survivors. The median overall survival ( OS ) was 20.8 months, with three and four‐year  OS  rates of 23% and 18%, respectively. The median progression‐free survival ( PFS ) was 8.2 months, with one and two‐year  PFS  rates of 23% and 9%, respectively. Partial response ( PR ) after TRT and administration of targeted therapy were predictive of longer  OS . The factors associated with favorable  PFS  included earlier local tunor node stage, absence of concurrent chemotherapy, and post‐ TRT PR . No correlation was found between the number of metastatic lesions and survival outcome. Incidences of grade ≥2 toxicities in the lung and esophagus were 9% and 26%, respectively.    Conclusions  Radical  TRT  may result in advantageous outcomes for selected stage  IV NSCLC  patients, regardless of the number of metastatic foci. Patients who achieved post‐ TRT PR  attained the best outcomes.

Radical thoracic radiotherapy may provide favorable outcomes for stage IV non‐small cell lung cancer