Historically, patients with metastatic disease may undergo palliative low-dose radiotherapy for bleeding, pain, or other symptom control from localized progression of disease. However, the advent of increasingly effective systemic therapies has led to interest in exploring how consolidative high-dose locoregional therapies can prolong beneficial effects from systemic therapy in metastatic disease. Investigators have explored local therapy directed at metastatic foci in addition to treatment of in situ primary tumors. In oligometastatic cancers, for patients who did not progress with systemic therapy, the addition of local therapy directed at metastasis has demonstrated an improvement to overall survival (OS) compared with systemic therapy alone in early randomized studies.1,2 In low-volume metastatic prostate cancer, the addition of primary-directed radiotherapy has also improved OS.3