A Phase II Trial Measuring the Integration of Stereotactic Radiotherapy Plus Surgery in Early Non-Small Cell Lung Cancer

The advent of stereotactic ablative radiotherapy (SABR) has provided a novel, promising treatment for patients with early-stage non-small cell lung cancer. SABR uses modern radiotherapy planning and targeting technologies to precisely deliver larger, ablative doses of radiotherapy.

The use of SABR as neoadjuvant therapy prior to surgery may provide a novel therapeutic opportunity. In oncology, the use of neoadjuvant radiotherapy or chemoradiotherapy prior to surgery has become widespread for several types of cancer, and in many instances improves local control over and/or survival compared to surgery alone. Neoadjuvant radiotherapy provides several theoretical advantages, including potentially decreasing the rate of positive margins, decreasing the size of the required resection, or by sterilizing the tumor to avoid seeding of circulating tumor cells during surgery. Although radiologic outcomes after SABR illustrate local control rates of approximately 90% in many studies, the presence of residual post-treatment fibrosis may confound this assessment of recurrence.

The goal of this study is to evaluate a novel treatment approach: the combination of neoadjuvant SABR followed by surgical resection in patients with T1T2N0 non-small cell lung cancer, in order to measure the true pathologic rates of local control after SABR, to develop new imaging biomarkers or response, and to assess clinical outcomes, including toxicity, relapse patterns, and survival.

Inclusion criteria

• Age 18 or older
• Willing to provide informed consent
• Histologically confirmed non-small cell lung cancer
• Tumor stage T1 or T2a (less than or equal to 5 cm)
• No evidence of nodal disease (N0)
• No evidence of distant metastases (M0)
• Eastern Cooperative Oncology Group (ECOG) performance status 0-2 Life expectancy > 6 months
• Adequate forced expiratory volume at one second (FEV1), defined as a predicted post-operative FEV1 of 30% or greater

Exclusion criteria

• Serious medical comorbidities or other contraindications to radiotherapy or surgery
• Prior history of lung cancer within 5 years
• Prior thoracic radiation at any time
• Inability to attend full course of radiotherapy, surgery, or follow-up visits
• Contrast allergy
• Pregnant or lactating women