Despite numerous research articles published over the years to determine the most effective radiotherapy regimen for Stage IV non-small cell lung cancer (NSCLC), particularly for acute palliative care, a definitive consensus remains elusive. Both extended and short fraction regimens have been thoroughly investigated, yet the choice of regimen often hinges on institutional protocols, the preferences of the treating physician, and, most importantly, the general condition of the patient. Various countries and treatment centres may opt for different regimens based on resource availability, patient volume, and clinical experience. It has been observed that while long-duration regimens may offer better overall survival for patients in good condition, hypo-fractionated regimens provide comparable efficacy in symptom control with fewer treatment sessions. However, longer regimens may increase the risk of toxicity and adverse effects on critical structures. This ongoing uncertainty underscores the need for further research tailored to specific clinical settings.