Study: NCT05717166

Intervention type: RADIATION
Group type: EXPERIMENTAL
Intervention: Palliative Radiotherapy
Description: Radiotherapy for patients in the standard arm should follow the principles of palliative radiotherapy as per the individual institution, with the goal of alleviating symptoms or preventing imminent complications. Recommended dose fractionations in this arm will include 8 Gy in 1 fraction, 20 Gy in 5 fractions, and 30 Gy in 10 fractions.

Intervention type: RADIATION
Group type: ACTIVE_COMPARATOR
Intervention: Palliative Radiotherapy
Description: Radiotherapy for patients in the standard arm should follow the principles of palliative radiotherapy as per the individual institution, with the goal of alleviating symptoms or preventing imminent complications. Recommended dose fractionations in this arm will include 8 Gy in 1 fraction, 20 Gy in 5 fractions, and 30 Gy in 10 fractions.

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Chemotherapy
Description: Pre-specified based on the standard of care approach for that patient.

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Chemotherapy
Description: Pre-specified based on the standard of care approach for that patient.

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Hormone therapy
Description: Pre-specified based on the standard of care approach for that patient.

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Hormone therapy
Description: Pre-specified based on the standard of care approach for that patient.

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Immunotherapy
Description: Pre-specified based on the standard of care approach for that patient.

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Immunotherapy
Description: Pre-specified based on the standard of care approach for that patient.

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Targeted Systemic Therapy
Description: Pre-specified based on the standard of care approach for that patient.

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Targeted Systemic Therapy
Description: Pre-specified based on the standard of care approach for that patient.

Intervention type: OTHER
Group type: EXPERIMENTAL
Intervention: Observation
Description: Pre-specified based on the standard of care approach for that patient.

Intervention type: OTHER
Group type: ACTIVE_COMPARATOR
Intervention: Observation
Description: Pre-specified based on the standard of care approach for that patient.

Intervention type: RADIATION
Group type: EXPERIMENTAL
Intervention: Stereotactic Ablative Radiotherapy
Description: The primary tumor may be treated with SABR or with other local modalities at the discretion of the treating team and/or the local multidisciplinary tumor board.~Preferred doses are 20 Gy in 1 fraction, 30 Gy in 3 fractions (every second day), and 35 Gy in 5 fractions (daily).

Intervention type: PROCEDURE
Group type: EXPERIMENTAL
Intervention: Surgery
Description: Treatment to the primary tumor and metastases, with SABR preferred, but other options all allowable if those are deemed to be preferable by the treating oncologists.~The primary tumor may be treated with SABR or with other local modalities at the discretion of the treating team and/or the local multidisciplinary tumor board. Because of the convenience in using SABR for all lesions, non-SABR modalities should only be used if they are likely to provide a benefit over SABR.

Intervention type: OTHER
Group type: EXPERIMENTAL
Intervention: Radiofrequency Therapy (RFA)
Description: Treatment to the primary tumor and metastases, with SABR preferred, but other options all allowable if those are deemed to be preferable by the treating oncologists.

Intervention type: RADIATION
Group type: EXPERIMENTAL
Intervention: Fractionated Radiation
Description: Treatment to the primary tumor and metastases, with SABR preferred, but other options all allowable if those are deemed to be preferable by the treating oncologists.~Tumors in the esophagus, stomach, small intestine or colon should be treated with either fractionated radiation or a lower SABR dose (e.g. 25 Gy in 5 fractions) to minimize the risk of perforation.