Concurrent EGFR-TKIs and Thoracic Radiation Therapy in Active EGFR Mutation for 1st Line Treatment of Stage IV NSCLC (CERTAIN)

Inclusion Criteria:

1. ECOG performance status≤2；
2. Cytologically or pathologically confirmed stage IV NSCLC ( controlled pleural effusion will be eligible) with active EGFR mutation;
3. Estimated survival time more than 3 months;
4. Age older than 18 years and under 75 years;
5. Adequate bone marrow, hepatic, and renal function;AST and ALT≤2.5 times the highest reference value when not associated with hepatic metastases, or ≤5 times when hepatic metastases occur;
6. Without history of therapy for primary and metastatic disease;
7. With pleural effusion but can be controlled;
8. Asymptomatic bone metastases without treatment;
9. Based on fusion images of 4DCT MIP sketch tumors and lymph nodes, and limit the mean lung dose: V20≤25%，V30≤18%，MLD≤14Gy，V5≤60%;
10. M1a or M1b for metastases, and the number of the distant lesions ≤10；
11. Voluntary to participate in this clinical trial and sign the consent form.

Exclusion Criteria:

1. Patients with serious functional damage of important organs;
2. Patients diagnosed adequately with other malignant tumors;
3. Pregnant or lactating women;
4. Patients in an active period of acute or chronic infectious diseases;
5. Patients who are allergic to any drugs or people with allergies;
6. With brain metastases;
7. With bone metastases needing radiotherapy;
8. Patients who participate in other clinical trials concurrently;
9. Uncontrolled pleural effusion which may intervene the radiotherapy to primary tumor in lung;
10. The number of the distant lesions>10；
11. Patients who are considered not eligible for the trial after evaluation by investigator.