Stereotactic Body Radiotherapy (SBRT) Versus Sublobar Resection for High-Risk Patients Non-Small Lung Cancer

Inclusion Criteria

* Patients must have a suspicious lung nodule for clinical stage I NSCLC.
* Pathologic confirmation at the time of surgery is acceptable. Patients randomized to SBRT require core biopsy for diagnosis prior to treatment.
* Patient must have a mass ≤ 5 cm maximum diameter by CT size estimate that is clinical stage I (T1N0, T2N0)
* Patient must have a CT scan of the chest and upper abdomen and PET-scan within 60 days prior to date of registration.
* Patient must have an Eastern Cooperative Oncology Group (ECOG) or Zubrod performance status 0, 1, or 2.
* Patient must meet at least one major criteria or meet a minimum of two minor criteria as described below:

Major Criteria:

* Forced expiratory volume in one second (FEV1) ≤ 50% predicted
* Carbon monoxide diffusing capacity (DLCO) ≤ 50% predicted

Minor Criteria:

* Age ≥75
* FEV1 51-60% predicted
* DLCO 51-60% predicted
* Pulmonary hypertension (defined as a pulmonary artery systolic pressure greater than 40 mmHg) as estimated by echocardiography or right heart catheterization
* Poor left ventricular function (defined as an ejection fraction of 40% or less)
* Resting or Exercise Arterial oxygen partial pressure (pO2) ≤ 55 mm Hg or blood oxygen saturation (SpO2) ≤ 88%
* pCO2 \> 45 mm Hg
* Modified Medical Research Council (MMRC) Dyspnea Scale ≥ 3.

Exclusion Criteria

* Patient must not have had previous intra-thoracic radiation therapy.
* No prior malignancy except adequately treated non-melanoma skin cancer, in situ cervical cancer, localized prostate cancer, stage 0 Chronic lymphocytic leukemia (CLL), or other cancer disease-free \> 3 yrs.