Trial of Either Surgery or Stereotactic Radiotherapy for Early Stage (IA) Lung Cancer

Inclusion Criteria:

* Patients with a cytological or histological diagnosis of stage IA non-cell lung cancer diagnosed in accordance with Dutch CBO guidelines \[2004\]. When no pathological diagnosis is available, a patient with a new or growing pulmonary lesion with radiological features consistent with malignancy AND a lesion showing uptake on a FDG-PET scan will be eligible \[Herder 2005\].
* No evidence of regional or distant metastases on a standardized FDG-PET scan within 6 weeks of any protocol treatment .
* The medial extension of tumors should be least 2 cm away from main and lobar bronchi, and also minimum of 1.5 cm from large peripheral blood vessels such as the aorta and main pulmonary artery. Lesions of at least 2 cm from the mediastinal pleura will be eligible if the responsible radiation oncologist judges that the specified normal tissue tolerance doses specified in the protocol will not be exceeded.
* Patients who are judged by a multi-disciplinary team to have 2 primary lung tumors (on the basis of clinical, radiological, FDG-PET and/or cyto-pathology findings) are eligible for randomization provided that both surgery and SRT can be performed in accordance with protocol requirements.
* Patient should be fit to undergo a complete surgical resection of the lesion in accordance with Dutch CBO guidelines \[2004\]
* Performance score of ECOG ≤ 2 before any treatment.
* Able to comply with post-treatment follow-up
* Patients must sign and date a written Independent Ethics Committee approved informed consent form.

Exclusion Criteria:

* Prior chemotherapy or radiotherapy for the present diagnosis of NSCLC.
* History of any active malignancy (other than NSCLC) unless treated more than 3 years with curative intent and no recurrence, with the exception of non-melanoma skin cancers or in-situ cervical cancers.
* Any unstable systemic disease (including active infection, uncontrolled hypertension, unstable angina, congestive heart failure, myocardial infarction within the previous year, severe cardiac arrhythmia requiring medication, hepatic, renal or metabolic disease).
* Concomitant treatment with any other experimental drug under investigation.
* Pregnancy
* Men and women of child-bearing potential not using effective means of contraception for 6 months after treatment has been completed.