Locally Invasive NSCLC Treated With NEo-Adjuvant Stereotactic Body RadioTherapy and REsection (LINNEARRE-I)

Inclusion Criteria:

• Patients will be included if they are aged 18 years or older,
• with biopsy proven NSCLC,
• clinically staged T3-T4 marginally resectable i.e. deemed at risk to achieve <R0 resection (such as invasion of critical mediastinal or hilar structures, nodal extra-capsular extension, chest wall, vertebral bodies, compromised bronchial stump margin, based on CT images of the chest).
• Patients also need to be pathologically staged N0-1 disease,
• with an SBRT CTV≤200cm3, based on planning CT images.
• ECOG status is required to be <2 within 4 weeks prior to registration and
• patients must be deemed medically operable by the surgical team.

Exclusion Criteria:

• Patients will be excluded if they are deemed medically inoperable by the surgical team
• and have a weight loss of ≥10% within 3 months prior to pathological diagnosis.
• Patients will also have no absolute contraindication to RT such as connective tissue disease, pacemaker-dependent patient with the pacemaker receiving higher than tolerance dose, had no had previous RT to the current region of the study, that would result in overlap of RT fields,
• patients must have no plans to receive other local therapy while on study, except at disease progression,
• patients have not had other malignancy within 2 years prior to the study (other than non-melanomatous skin cancers)