Stereotactic Radiosurgery Followed by Wedge Resection in Treating Patients With Early Stage Peripheral Non-small Cell Lung Cancer

PRIMARY OBJECTIVES:

I. To assess the safety and feasibility of a wedge resection following stereotactic body
radiation therapy (SBRT) for early stage peripheral non-small cell lung cancer (NSCLC).

SECONDARY OBJECTIVES:

I. To assess pathologic response rates to SBRT as determined by pathologic examination of
resected tumors.

II. To prospectively assess patient quality of life when treated with SBRT and wedge
resection.

TERTIARY OBJECTIVES:

I. To describe the location of viable tumor and to correlate pathologic response rates with
radiation dose, size of tumor, and tumor histology.

II. To correlate pathologic response rates and functional imaging with pre- and
post-treatment dual-input perfusion (DP)-computed tomography (CT) and positron emission
tomography (PET)-CT.

III. To correlate changes in serum levels of deoxyribonucleic acid (DNA) methylation and
circulating tumor cells (CTC) with pathologic response rates.

OUTLINE:

Patients undergo stereotactic radiosurgery every other day for 3 or 5 fractions (depending
on the size tumor and proximity to the chest wall). Within 4-6 weeks after completion of
stereotactic radiosurgery, patients undergo wedge resection.

After completion of study treatment, patients are followed up at 1, 3, 6, and 12 months.

Inclusion Criteria:

- Eastern Cooperative Oncology Group (ECOG) performance status 0, 1, or 2

- Biopsy proven non-small cell lung cancer

- Maximum tumor dimension =< 5 cm

- No clinical evidence of N1, N2 or N3 lymph nodes as assessed by CT and/or PET-CT

- No evidence of distant metastatic disease

- Tumor verified by a thoracic surgeon to be in a location that will permit a sublobar
resection

- Tumor located peripherally within the lung (peripheral defined as not touching any
surface within 2 cm of the proximal bronchial tree in all directions) and not
touching the mediastinal pleura

- Pulmonary function tests (PFTs) with diffusing capacity of the lung for carbon
monoxide (DLCO) within 90 days prior to registration

- Patient at high-risk of complications from lobectomy meeting a minimum of one major
criteria or two minor criteria as described below:

- Major criteria

- Predicted postoperative forced expiratory volume in one second (FEV1) =<
40%

- Predicted postoperative DLCO =< 40%

- Age >= 72

- Minor criteria

- Predicted postoperative FEV1 41-60%

- Predicted postoperative DLCO 41-60%

- Pulmonary hypertension (defined by a pulmonary artery systolic pressure
greater than 40 mm Hg) as estimated by echocardiography or right heart
catheterization

- Poor left ventricular function (defined as an ejection fraction 40% or
less)

- Resting or exercising arterial partial pressure of oxygen (pO2) =< 55 mmHg
or oxygen saturation (SpO2) =< 88%

- Partial pressure of carbon monoxide (pCO2) > 45 mm Hg

- Modified Medical Research Council Dyspnea Scale >= 3

- Women of child-bearing potential and men must agree to use adequate contraception
(hormonal or barrier method of birth control; abstinence) prior to study entry, for
the duration of study participation, and for 90 days following completion of therapy;
should a woman become pregnant or suspect she is pregnant while participating in this
study, she should inform her treating physician immediately

- A female of child-bearing potential is any woman (regardless of sexual
orientation, having undergone a tubal ligation, or remaining celibate by choice)
who meets the following criteria:

- Has not undergone a hysterectomy or bilateral oophorectomy; or

- Has not been naturally postmenopausal for at least 12 consecutive months
(i.e., has had menses at any time in the preceding 12 consecutive months)

- Ability to understand and the willingness to sign a written informed consent

Exclusion Criteria:

- Pregnant women

- Patients with central tumors within the proximal tree or touching the mediastinal
pleura

- Patients with evidence of distant metastatic disease