Randomized Study to Compare CyberKnife to Surgical Resection In Stage I Non-small Cell Lung Cancer

Inclusion Criteria:

   1. Histological confirmation of non-small cell cancer will be required by either biopsy
   or cytology. The following primary cancer types are eligible: squamous cell carcinoma,
   adenocarcinoma with or without BAC features, large cell carcinoma with or without
   neuroendocrine features, neuroendocrine carcinoma, bronchioloalveolar cell carcinoma,
   or non-small cell carcinoma not otherwise specified.

   2. Eligible patients must have appropriate staging studies identifying them as specific
   subsets of the revised IASCL state IA or IB based on only one of the following
   combinations of TNM staging:

   T1, N0, M0 or T2 (<=4 cm), N0, M0

   3. A PET/CT scan is required. Patients with hilar or mediastinal lymph nodes with short
   axis diameter < 1 cm and no abnormal hilar or mediastinal uptake on PET will be
   considered N0. Patients with > 1 cm short axis diameter of hilar or mediastinal lymph
   nodes on CT or abnormal PET (including suspicious but non-diagnostic uptake) may still
   be eligible if directed tissue biopsy of all abnormally identified areas are negative
   for cancer. Solitary pulmonary lesions <4 mm will not be considered significant.

   4. The patients must be considered a reasonable candidate for surgical resection of the
   primary tumor. Standard justification for deeming a patient medically operable based
   on pulmonary function for surgical resection of NSCLC may include any of the
   following: Baseline FEV1 > 40% predicted, post-operative predicted FEV1 > 30%
   predicted, diffusion capacity > 40% predicted, absent baseline hypoxemia and/or
   hypercapnia, exercise oxygen consumption > 50% predicted, absent severe pulmonary
   hypertension, absent severe cerebral, cardiac, or peripheral vascular disease, and
   absent severe chronic heart disease.

   5. Patients must be ≥ 18 years of age.

   6. The patient's Zubrod performance status must be Zubrod 0-2.

   7. Mandatory staging studies: Must be done within 8 weeks prior to study entry

   8. Patients must sign a study-specific consent form.

   9. Patients (men and women) of child bearing potential should use an effective (for them)
   method of birth control throughout their participation in this study.

Exclusion Criteria:

   1. Patients with primary tumors > 4 cm;

   2. Patients with well-differentiated neuroendocrine carcinoma (carcinoid tumor)

   3. Direct evidence of regional or distant metastases after appropriate staging studies,
   or synchronous primary or prior malignancy in the past 5 years other than
   nonmelanomatous skin cancer or in situ cancer;

   4. Previous lung or mediastinal radiotherapy;

   5. Plans for the patient to receive other concomitant local therapy (including standard
   fractionated radiotherapy and surgery) while on this protocol except at disease
   progression;

   6. Pregnant or lactating women, as treatment involves unforeseeable risks to the embryo
   or fetus;

   7. Cannot achieve acceptable SRT planning to meet minimal requirement of target coverage
   and dose-volume constraints of critical structures (see RT techniques).