Surgery With or Without Internal Radiation Therapy in Treating Patients With Stage I Non-Small Cell Lung Cancer

The recruitment status of this study is unknown because the information has not been verified recently.
Verified January 2010 by National Cancer Institute (NCI).
Recruitment status was  Active, not recruiting
Information provided by:
National Cancer Institute (NCI) Identifier:
First received: April 5, 2005
Last updated: January 7, 2012
Last verified: January 2010

RATIONALE: Surgery may be an effective treatment for non-small cell lung cancer. Internal radiation uses radioactive material placed directly into or near a tumor to kill tumor cells. It is not yet known whether surgery and internal radiation therapy are more effective than surgery alone in treating non-small cell lung cancer.

PURPOSE: This randomized phase III trial is studying surgery and internal radiation therapy to see how well they work compared to surgery alone in treating patients with stage I non-small cell lung cancer.

Condition Intervention Phase
Lung Cancer
Procedure: conventional surgery
Procedure: therapeutic thoracoscopy
Radiation: brachytherapy
Radiation: iodine I 125
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Primary Purpose: Treatment
Official Title: A Randomized Phase III Study of Sublobar Resection Versus Sublobar Resection Plus Brachytherapy in High Risk Patients With Non-Small Cell Lung Cancer (NSCLC), 3cm or Smaller

Resource links provided by NLM:

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Time to local recurrence [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Specific morbidity and mortality [ Designated as safety issue: No ]
  • Overall survival and failure-free survival [ Designated as safety issue: No ]
  • Freedom from regional or distant recurrence [ Designated as safety issue: No ]
  • Effect of histological or cytologic positive resection margins on time to local recurrence [ Designated as safety issue: No ]
  • Quality of life [ Designated as safety issue: No ]
  • Pulmonary function [ Designated as safety issue: No ]

Estimated Enrollment: 226
Study Start Date: July 2005
Estimated Primary Completion Date: August 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Arm I
Patients undergo open or thoracoscopic sublobar resection comprising either a wedge resection or anatomical segmentectomy.
Procedure: conventional surgery
No information available
Procedure: therapeutic thoracoscopy
No information available
Experimental: Arm II
Patients undergo surgery as in arm I. Patients also undergo intraoperative brachytherapy comprising an iodine I 125 implant at the resection margin.
Procedure: conventional surgery
No information available
Procedure: therapeutic thoracoscopy
No information available
Radiation: brachytherapy
No information available
Radiation: iodine I 125
No information available

Detailed Description:



  • Compare time to local recurrence, in terms of recurrence within the same lobe or hilum (N1 nodes) or progression at the staple line (after treatment effects [i.e., scarring] have subsided), in high-risk patients with stage I non-small cell lung cancer treated with sublobar resection with vs without intraoperative brachytherapy.


  • Compare procedure-specific morbidity and mortality in patients treated with these regimens.
  • Compare overall and failure-free survival of patients treated with these regimens.
  • Compare freedom from regional or distant recurrence in patients treated with these regimens.
  • Determine the effect of histologically or cytologically positive resection margins on time to local recurrence in patients treated with these regimens.
  • Determine the effect of brachytherapy on quality of life of these patients.
  • Determine the effect of brachytherapy on pulmonary function in these patients.

OUTLINE: This is a randomized, multicenter study. Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients undergo open or thoracoscopic sublobar resection comprising either a wedge resection or anatomical segmentectomy.
  • Arm II: Patients undergo surgery as in arm I. Patients also undergo intraoperative brachytherapy comprising an iodine I 125 implant at the resection margin.

Quality of life is assessed at baseline and then at 3, 12, and 24 months.

After completion of study treatment, patients are followed at 3 and 6 months, every 6 months for 2.5 years, and then annually for 2 years.

PROJECTED ACCRUAL: A total of 226 patients (113 per treatment arm) will be accrued for this study within 3 years.


Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No


  • Suspected or proven non-small cell lung cancer (NSCLC), meeting both of the following criteria:

    • Pre-operative criteria

      • Lung nodule suspicious for clinical stage I NSCLC

        • Mass ≤ 3 cm in maximum diameter by CT scan of the chest and upper abdomen
        • Clinical stage IA OR selected stage IB with visceral pleural involvement
    • Intra-operative criteria

      • Histologically proven stage I NSCLC

        • All suspicious mediastinal lymph nodes (> 1 cm short-axis dimension on CT scan OR positive on positron-emission tomography scan) must be negative by mediastinoscopy, endoscopic ultrasound-guided needle aspiration, or CT-guided, video-assisted thoracoscopic, or open lymph node biopsy
  • Meets ≥ 1 major OR ≥ 2 minor high-risk criteria, defined as the following:

    • Major criteria

      • FEV_1 ≤ 50% of predicted
      • DLCO ≤ 50% of predicted
    • Minor criteria

      • Age 75 and over
      • FEV_1 51-60% of predicted
      • DLCO 51-60% of predicted
      • Pulmonary hypertension, defined as pulmonary artery systolic pressure > 40 mm Hg by echocardiography or right heart catheterization
      • LVEF ≤ 40%
      • Resting or exercise arterial oxygen partial pressure ≤ 55 mm Hg or oxygen saturation ≤ 88% by pulse oximetry
      • Arterial carbon dioxide partial pressure > 45 mm Hg
      • Modified Medical Research Council Dyspnea Scale ≥ 3



  • 18 and over

Performance status

  • ECOG 0-2 OR
  • Zubrod 0-2

Life expectancy

  • Not specified


  • Not specified


  • Not specified


  • Not specified


  • See Disease Characteristics


  • See Disease Characteristics


  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • More than 5 years since prior invasive malignancy unless non melanoma skin cancer or in-situ cancer


Biologic therapy

  • Not specified


  • Not specified

Endocrine therapy

  • Not specified


  • No prior intrathoracic radiotherapy


  • Not specified


  • Concurrent enrollment on ACOSOG-Z4031 (correlative science protocol) allowed
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00107172

  Hide Study Locations
United States, Arizona
Mayo Clinic Scottsdale
Scottsdale, Arizona, United States, 85259-5499
United States, California
University of California Davis Cancer Center
Sacramento, California, United States, 95817
United States, Florida
Mayo Clinic - Jacksonville
Jacksonville, Florida, United States, 32224
United States, Georgia
Winship Cancer Institute of Emory University
Altanta, Georgia, United States, 30322
United States, Illinois
Evanston Hospital
Evanston, Illinois, United States, 60201-1781
Cancer Institute at St. John's Hospital
Springfield, Illinois, United States, 62702
Regional Cancer Center at Memorial Medical Center
Springfield, Illinois, United States, 62781-0001
Simmons Cooper Cancer Institute
Springfield, Illinois, United States, 62794-9677
United States, Maryland
Cancer Institute at St. Joseph Medical Center
Towson, Maryland, United States, 21204
United States, Massachusetts
Boston University Cancer Research Center
Boston, Massachusetts, United States, 02118
United States, Michigan
University of Michigan Comprehensive Cancer Center
Ann Arbor, Michigan, United States, 48109-0942
United States, Minnesota
Mayo Clinic Cancer Center
Rochester, Minnesota, United States, 55905
United States, Missouri
Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis
Saint Louis, Missouri, United States, 63110
United States, New Hampshire
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center
Lebanon, New Hampshire, United States, 03756-0002
United States, New Jersey
Valley Hospital - Ridgewood
Ridgewood, New Jersey, United States, 07450
United States, New York
South Nassau Communities Hospital
Oceanside, New York, United States, 11572
James P. Wilmot Cancer Center at University of Rochester Medical Center
Rochester, New York, United States, 14642
SUNY Upstate Medical University Hospital
Syracuse, New York, United States, 13210
United States, North Carolina
Presbyterian Cancer Center at Presbyterian Hospital
Charlotte, North Carolina, United States, 28233-3549
United States, Ohio
Charles M. Barrett Cancer Center at University Hospital
Cincinnati, Ohio, United States, 45267
United States, Oregon
Knight Cancer Institute at Oregon Health and Science University
Portland, Oregon, United States, 97239-3098
United States, Pennsylvania
Jameson Memorial Hospital - North Campus
New Castle, Pennsylvania, United States, 16105
Abramson Cancer Center of the University of Pennsylvania
Philadelphia, Pennsylvania, United States, 19104-4283
Fox Chase Cancer Center - Philadelphia
Philadelphia, Pennsylvania, United States, 19111-2497
Kimmel Cancer Center at Thomas Jefferson University - Philadelphia
Philadelphia, Pennsylvania, United States, 19107-5541
Allegheny Cancer Center at Allegheny General Hospital
Pittsburgh, Pennsylvania, United States, 15212
UPMC Cancer Centers
Pittsburgh, Pennsylvania, United States, 15232
McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center
Reading, Pennsylvania, United States, 19612-6052
United States, Rhode Island
Miriam Hospital
Providence, Rhode Island, United States, 02906
Rhode Island Hospital Comprehensive Cancer Center
Providence, Rhode Island, United States, 02903
United States, Tennessee
U.T. Medical Center Cancer Institute
Knoxville, Tennessee, United States, 37920-6999
United States, Texas
Methodist Hospital
Houston, Texas, United States, 77030
United States, Utah
Jon and Karen Huntsman Cancer Center at Intermountain Medical Center
Murray, Utah, United States, 84157
United States, Virginia
University of Virginia Cancer Center
Charlottesville, Virginia, United States, 22908
United States, Washington
Floyd and Delores Jones Cancer Institute at Virginia Mason Medical Center
Seattle, Washington, United States, 98111
Swedish Cancer Institute at Swedish Medical Center - First Hill Campus
Seattle, Washington, United States, 98122-4307
United States, Wisconsin
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center
Madison, Wisconsin, United States, 53792-6164
Canada, Ontario
London Regional Cancer Program at London Health Sciences Centre
London, Ontario, Canada, N6A 4L6
Sponsors and Collaborators
American College of Surgeons
Study Chair: Hiran C. Fernando, MD Boston Medical Center
  More Information

Additional Information:
Additional publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: David M. Ota, American College of Surgeons Oncology Group Identifier: NCT00107172     History of Changes
Other Study ID Numbers: CDR0000422346, ACOSOG-Z4032
Study First Received: April 5, 2005
Last Updated: January 7, 2012
Health Authority: United States: Federal Government

Keywords provided by National Cancer Institute (NCI):
stage I non-small cell lung cancer

Additional relevant MeSH terms:
Carcinoma, Non-Small-Cell Lung
Lung Neoplasms
Bronchial Neoplasms
Carcinoma, Bronchogenic
Lung Diseases
Neoplasms by Site
Respiratory Tract Diseases
Respiratory Tract Neoplasms
Thoracic Neoplasms processed this record on July 01, 2015