Grant: Operating Grant

Patients who present with lung cancers confined to the lung measuring 5 cm or less are usually treated with complete surgical removal with a high chance of cure. However, about 20% of these patients have other illnesses such as severe chronic obstructive lung disease or cardiac disease where surgery is not possible and radiotherapy is recommended. Historically, radiation has been given in small amounts per day for about 15-30 treatments known as conventional radiotherapy (CRT). This approach controls the cancer in about 50-75% of cases. More recently advances in radiotherapy treatment planning and delivery have permitted radiation to be delivered in a more focused way directly to the cancer with very large doses per day in a much smaller number of treatments (3-8 over a shorter period of time in 2-3 weeks) called stereotactic body radiosurgery (SBRT). Studies of patients treated with SBRT suggest that local control of the tumor may be improved, but there remains concern about long-term side effects. This randomized trial will directly compare CRT to SBRT in early stage lung cancer patients who are medical inoperable. The main objective is to determine if SBRT improves local control compared to CRT. Other important objectives are to ensure that SBRT is no more toxic than CRT. SBRT requires specialized training and equipment to provide and it is not currently being used in all centres across Canada. If the trial demonstrates that SBRT results in improved cancer control at an acceptable cost with limited impact on overall quality of life, it would lead to wide adoption of SBRT as the standard of care in Canada.