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Veterans Affairs Lung Cancer Surgery Or Stereotactic Radiotherapy (VALOR)

Primary Purpose

Lung Neoplasm

Status

Recruiting

Phase

Not Applicable

Locations

United States

Study Type

Interventional

Intervention

Stereotactic Radiotherapy

Anatomic Pulmonary Resection

About this trial

This is an interventional treatment trial for Lung Neoplasm focused on measuring Carcinoma, Non-Small Cell Lung, Respiratory Tract Neoplasms, Thoracic Neoplasms, Neoplasms by Site, Neoplasms, Lung Diseases, Respiratory Tract Diseases, Carcinoma, Bronchogenic, Bronchial Neoplasms, Radiosurgery, Radiotherapy, Radiotherapy, Image-Guided, Lung Neoplasms

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Inclusion Criteria for Screening

Age 18 or older
Any patient with a preliminary diagnosis of stage I Non-Small Cell Lung Cancer (NSCLC), whether pathologically proven by biopsy, or highly suspicious by radiographic imaging. [Participants will ultimately need biopsy confirmation before enrolling]
Primary tumor size less than or equal to 5 cm by CT (may include CT images from PET/CT)
Karnofsky performance status greater than or equal to 70
Participant has willingness and ability to provided informed consent for participation

Inclusion Criteria for Randomization

Biopsy proven non-small cell lung cancer
Participant's case reviewed at multidisciplinary conference
Tumor size less than or equal to 5cm (measured on the most recent CT images available, and may include PET/CT images)
Tumor is equal to or greater than 1.0cm from the trachea, esophagus, brachial plexus, 1st bifurcation of the proximal bronchial tree, or spinal cord (measured on the most recent CT images available, and may include PET/CT images).
Mandatory FDG-PET/CT within 60 days of the randomization date (note: FDG-PET/CT may need to be repeated prior to treatment if outside of this requirement)
Mandatory pathological assessment of any lymph nodes >10mm with a SUV >2.5 seen on FDG- PET/CT
Mandatory biopsy of any additional concerning lesions seen on FDG-PET/CT, to make better determination that the patient is not harboring metastatic disease or a secondary primary malignancy.
Pre-operative FEV1 greater than or equal to 40% of predicted value and pre-operative DLCO greater than or equal to 40% of predicted value.
Formally evaluated and documented by a local thoracic surgeon to be medically fit to undergo a complete anatomic pulmonary resection (wedge resection not allowed)
Formally evaluated and documented by a local radiation oncologist to be eligible to receive protocol-defined stereotactic radiotherapy
Participant willingness to be randomized

Exclusion Criteria:

Exclusion Criteria for Screening

Previously evaluated by a local thoracic surgeon and determined to be medically inoperable
Pathological confirmation of nodal or distant metastasis
Prior history of lung cancer, not including current lesion
Prior history of thoracic surgery or lung or esophageal cancer. [prior cardiac surgery acceptable]
Prior history of radiotherapy to the thorax
Prior history of an invasive malignancy within the past 5 years, whether newly diagnosed or recurrent, excluding low-risk prostate cancer, non-melanoma skin cancers, and in-situ cancers
Ever diagnosed with stage IV metastatic cancer of any type
History of scleroderma
Positive Pregnancy test (for women <61 years of age or without prior hysterectomy)

Exclusion Criteria for Randomization

Pathological confirmation of nodal or metastatic disease

Sites / Locations

VA Long Beach Healthcare System, Long Beach, CARecruiting
VA Greater Los Angeles Healthcare System, West Los Angeles, CARecruiting
Bay Pines VA Healthcare System, Pay Pines, FLRecruiting
Miami VA Healthcare System, Miami, FLRecruiting
Edward Hines Jr. VA Hospital, Hines, ILRecruiting
Richard L. Roudebush VA Medical Center, Indianapolis, INRecruiting
Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MDRecruiting
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MARecruiting
VA Ann Arbor Healthcare System, Ann Arbor, MIRecruiting
Minneapolis VA Health Care System, Minneapolis, MNRecruiting
Durham VA Medical Center, Durham, NCRecruiting
Louis Stokes VA Medical Center, Cleveland, OHRecruiting
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PARecruiting
VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PARecruiting
Michael E. DeBakey VA Medical Center, Houston, TXRecruiting
Hunter Holmes McGuire VA Medical Center, Richmond, VA
Clement J. Zablocki VA Medical Center, Milwaukee, WIRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Stereotactic radiotherapy

Surgery

Arm Description

Stereotactic radiotherapy is an FDA approved treatment for lung cancer. However, for purposes of this study, it is being delivered to an operable population that is typically treated with surgical resection. Participants randomized to stereotactic radiotherapy will be treated according to the location of the tumor. Peripheral tumors will receive either 18 Gy x 3, 14 Gy x 4, or 11.5 Gy x 5 fractions, while central tumors will be treated with 10 Gy x 5. There will not be any elective coverage of local microscopic spread or regional lymph nodes.

Participants randomized to surgery will undergo a standard lobectomy or limited anatomic pulmonary resection (segmentectomy) under general anesthesia. Non-anatomic (wedge) resections are not permitted. Pathological specimens must contain a separately divided pulmonary artery and bronchus, as well as sampled lymph nodes from mediastinal lymph node stations. Participants found to have incidental nodal involvement after surgery will be referred for adjuvant chemotherapy, with our without postoperative radiotherapy.

Outcomes

Primary Outcome Measures

Overall Survival

Survival estimates will include death from any cause.

Secondary Outcome Measures

Patient reported health-related quality of life

The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and Lung Cancer (LC 13) survey instruments will assess patients' general state of physical, social/family, emotional and functional well-being.

Respiratory Function

The St George's Respiratory Questionnaire will evaluate respiratory symptoms, activity limitations from breathlessness, and impact of respiratory function on social and psychological functioning.

Health State Utilities

The EQ-5D-5L (EuroQOL-5D) survey will measure quality adjusted life years.

Lung cancer mortality

Cause of death will be determined by an independent adjudication committee.

Tumor patterns of failure

Post-treatment surveillance imaging will evaluate patients every 6 months for local, regional, and/or distant disease control.

Respiratory Function

The Forced Expiratory Volume at 1 second (FEV1) will evaluate an objective measure of breathing function.

Full Information

NCT ID

NCT02984761

First Posted

November 30, 2016

Last Updated

September 20, 2023

Sponsor

VA Office of Research and Development

1. Study Identification

Unique Protocol Identification Number

NCT02984761

Brief Title

Veterans Affairs Lung Cancer Surgery Or Stereotactic Radiotherapy

Acronym

VALOR

Official Title

CSP #2005 - Veterans Affairs Lung Cancer Surgery Or Stereotactic Radiotherapy Trial (VALOR)

Study Type

Interventional

2. Study Status

Record Verification Date

September 2023

Overall Recruitment Status

Recruiting

Study Start Date

April 13, 2017 (Actual)

Primary Completion Date

September 30, 2026 (Anticipated)

Study Completion Date

September 30, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Sponsor

Name of the Sponsor

VA Office of Research and Development

4. Oversight

Studies a U.S. FDA-regulated Drug Product

Studies a U.S. FDA-regulated Device Product

Yes

Device Product Not Approved or Cleared by U.S. FDA

Yes

Product Manufactured in and Exported from the U.S.

Data Monitoring Committee

Yes

5. Study Description

Brief Summary

Patients with stage I non-small cell lung cancer have been historically treated with surgery whenever they are fit for an operation. However, an alternative treatment known as stereotactic radiotherapy now appears to offer an equally effective alternative. Doctors believe both are good treatments and are therefore conducting this study to determine if one may be possibly better than the other.

Detailed Description

The standard of care for stage I non-small cell lung cancer has historically been surgical resection in patients who are medically fit to tolerate an operation. Recent data now suggests that stereotactic radiotherapy may be a suitable alternative. This includes the results from a pooled analysis of two incomplete phase III studies that reported a 15% overall survival advantage with stereotactic radiotherapy at 3 years. While these data are promising, the median follow-up period was short, the results underpowered, and the findings were in contradiction to multiple retrospective studies that demonstrate the outcomes with surgery are likely equal or superior. Therefore, the herein trial aims to evaluate these two treatments in a prospective randomized fashion with a goal to compare the overall survival beyond 5 years. It has been designed to enroll patients who have a long life-expectancy, and are fit enough to tolerate an anatomic pulmonary resection with intraoperative lymph node sampling. This study is designed to open at Veterans Affairs medical centers with expertise in both treatments. The recruitment process includes shared decision making and multi-disciplinary evaluations with lung cancer specialists. Mandatory evaluations before randomization include tissue confirmation of NSCLC, staging with FDG-PET/CT, and biopsies of all hilar and/or mediastinal lymph nodes >10mm that have a SUV >2.5. Pre-randomization elective lymph node sampling is strongly encouraged, but not required. Following treatment, patients will be followed for a minimum of 5 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Lung Neoplasm

Keywords

Carcinoma, Non-Small Cell Lung, Respiratory Tract Neoplasms, Thoracic Neoplasms, Neoplasms by Site, Neoplasms, Lung Diseases, Respiratory Tract Diseases, Carcinoma, Bronchogenic, Bronchial Neoplasms, Radiosurgery, Radiotherapy, Radiotherapy, Image-Guided, Lung Neoplasms

7. Study Design

Primary Purpose

Treatment

Study Phase

Not Applicable

Interventional Study Model

Parallel Assignment

Masking

None (Open Label)

Allocation

Randomized

Enrollment

670 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title

Stereotactic radiotherapy

Arm Type

Experimental

Arm Description

Arm Title

Surgery

Arm Type

Active Comparator

Arm Description

Intervention Type

Radiation

Intervention Name(s)

Stereotactic Radiotherapy

Other Intervention Name(s)

Stereotactic Body Radiation Therapy (SBRT) or Stereotactic Ablative Radiotherapy (SAbR)

Intervention Description

Stereotactic radiotherapy uses high doses of ionizing energy to treat cancer cells with image guidance. The treatment is delivered in an outpatient setting, and for purposes of this trial is delivered in 3-5 fractions.

Intervention Type

Procedure

Intervention Name(s)

Anatomic Pulmonary Resection

Other Intervention Name(s)

Lobectomy or Anatomic Segmentectomy

Intervention Description

An anatomic pulmonary resection is an oncologic procedure that dissects out an anatomically defined segment of the lung to remove all of the lung tissue around a lung tumor. It requires an operation with general anesthesia, with a short hospital stay. The procedure entails removal of lymph nodes inside the chest that might not be easily accessible without an operation.

Primary Outcome Measure Information:

Title

Overall Survival

Description

Survival estimates will include death from any cause.

Time Frame

From date of randomization through study completion, up to 10 years

Secondary Outcome Measure Information:

Title

Patient reported health-related quality of life

Description

Time Frame

5 years

Title

Respiratory Function

Description

The St George's Respiratory Questionnaire will evaluate respiratory symptoms, activity limitations from breathlessness, and impact of respiratory function on social and psychological functioning.

Time Frame

5 years

Title

Health State Utilities

Description

The EQ-5D-5L (EuroQOL-5D) survey will measure quality adjusted life years.

Time Frame

5 years

Title

Lung cancer mortality

Description

Cause of death will be determined by an independent adjudication committee.

Time Frame

From date of randomization until date of death from any cause, assessed up to 10 years.

Title

Tumor patterns of failure

Description

Post-treatment surveillance imaging will evaluate patients every 6 months for local, regional, and/or distant disease control.

Time Frame

5 years

Title

Respiratory Function

Description

The Forced Expiratory Volume at 1 second (FEV1) will evaluate an objective measure of breathing function.

Time Frame

5 years

10. Eligibility

Sex

All

Minimum Age & Unit of Time

18 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Inclusion Criteria for Screening Age 18 or older Any patient with a preliminary diagnosis of stage I Non-Small Cell Lung Cancer (NSCLC), whether pathologically proven by biopsy, or highly suspicious by radiographic imaging. [Participants will ultimately need biopsy confirmation before enrolling] Primary tumor size less than or equal to 5 cm by CT (may include CT images from PET/CT) Karnofsky performance status greater than or equal to 70 Participant has willingness and ability to provided informed consent for participation Inclusion Criteria for Randomization Biopsy proven non-small cell lung cancer Participant's case reviewed at multidisciplinary conference Tumor size less than or equal to 5cm (measured on the most recent CT images available, and may include PET/CT images) Tumor is equal to or greater than 1.0cm from the trachea, esophagus, brachial plexus, 1st bifurcation of the proximal bronchial tree, or spinal cord (measured on the most recent CT images available, and may include PET/CT images). Mandatory FDG-PET/CT within 60 days of the randomization date (note: FDG-PET/CT may need to be repeated prior to treatment if outside of this requirement) Mandatory pathological assessment of any lymph nodes >10mm with a SUV >2.5 seen on FDG- PET/CT Mandatory biopsy of any additional concerning lesions seen on FDG-PET/CT, to make better determination that the patient is not harboring metastatic disease or a secondary primary malignancy. Pre-operative FEV1 greater than or equal to 40% of predicted value and pre-operative DLCO greater than or equal to 40% of predicted value. Formally evaluated and documented by a local thoracic surgeon to be medically fit to undergo a complete anatomic pulmonary resection (wedge resection not allowed) Formally evaluated and documented by a local radiation oncologist to be eligible to receive protocol-defined stereotactic radiotherapy Participant willingness to be randomized Exclusion Criteria: Exclusion Criteria for Screening Previously evaluated by a local thoracic surgeon and determined to be medically inoperable Pathological confirmation of nodal or distant metastasis Prior history of lung cancer, not including current lesion Prior history of thoracic surgery or lung or esophageal cancer. [prior cardiac surgery acceptable] Prior history of radiotherapy to the thorax Prior history of invasive state I-III malignancy treated with surgery, radiation therapy, chemotherapy, immunotherapy, or targeted therapy in the past 2 years, excluding prostate cancer, low-risk papillary thyroid cancer (less than or equal to 1 cm), follicular lymphoma, or chronic lymphocytic leukemia. Prior history of IV malignancy, excluding follicular lymphoma, chronic lymphocytic leukemia, or hormone sensitive prostate cancer confined to the pelvis. Ever diagnosed with stage IV metastatic cancer of any type History of scleroderma Positive Pregnancy test (for women <61 years of age or without prior hysterectomy) Exclusion Criteria for Randomization Pathological confirmation of nodal or metastatic disease

Central Contact Person:

First Name & Middle Initial & Last Name or Official Title & Degree

Cheryl C Odle, MBA

Phone

(708) 202-8387

Ext

23117

cheryl.odle@va.gov

First Name & Middle Initial & Last Name or Official Title & Degree

Matt Leiner, MS

Phone

(708) 202-5853

Matt.Leiner@va.gov

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Drew Moghanaki, MD MPH

Organizational Affiliation

VA Greater Los Angeles Healthcare System, West Los Angeles, CA

Official's Role

Study Chair

First Name & Middle Initial & Last Name & Degree

David H Harpole, MD

Organizational Affiliation

Durham VA Medical Center, Durham, NC

Official's Role

Study Chair

Facility Information:

Facility Name

VA Long Beach Healthcare System, Long Beach, CA

City

Long Beach

State/Province

California

ZIP/Postal Code

90822

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Bahman Saatian, MD

Phone

562-826-5591

bahman.saatian@va.gov

First Name & Middle Initial & Last Name & Degree

Gelincik K Orakcilar, MS

Phone

5628268000

Ext

24172

gelincik.orakcilar@va.gov

Facility Name

VA Greater Los Angeles Healthcare System, West Los Angeles, CA

City

West Los Angeles

State/Province

California

ZIP/Postal Code

90073-1003

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Drew Moghanaki, MD MPH

Phone

804-306-9045

Drew.Moghanaki@va.gov

First Name & Middle Initial & Last Name & Degree

Vicki L Skinner, RN

Phone

(894) 675-5105

vicki.skinner@va.gov

First Name & Middle Initial & Last Name & Degree

Diane L Gage, MD

First Name & Middle Initial & Last Name & Degree

Drew Moghanaki, MD MPH

First Name & Middle Initial & Last Name & Degree

Robert B Cameron, MD

Facility Name

Bay Pines VA Healthcare System, Pay Pines, FL

City

Bay Pines

State/Province

Florida

ZIP/Postal Code

33744

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Edward Hong, MD

Phone

727-398-6661

Ext

6661

edward.hong@va.gov

First Name & Middle Initial & Last Name & Degree

Ryan J Burri, MD

Phone

7273986661

Ext

13912

ryan.burri@va.gov

Facility Name

Miami VA Healthcare System, Miami, FL

City

Miami

State/Province

Florida

ZIP/Postal Code

33125

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Gregory Holt, MD

Phone

305-575-7000

Ext

3227

gregory.holt@va.gov

First Name & Middle Initial & Last Name & Degree

Jalima Quintero

Phone

3059928621

Jalima.Quintero@va.gov

Facility Name

Edward Hines Jr. VA Hospital, Hines, IL

City

Hines

State/Province

Illinois

ZIP/Postal Code

60141-5000

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Cheryl Czerlanis, MD

Cheryl.Czerlanis@va.gov

First Name & Middle Initial & Last Name & Degree

Eliza Kintanar, RN

Eliza.kintanar@va.gov

Facility Name

Richard L. Roudebush VA Medical Center, Indianapolis, IN

City

Indianapolis

State/Province

Indiana

ZIP/Postal Code

46202-2884

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Catherine Sears, MD

Catherine.Sears@va.gov

First Name & Middle Initial & Last Name & Degree

Sharon Henson, RN

Sharon.Henson@va.gov

Facility Name

Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD

City

Baltimore

State/Province

Maryland

ZIP/Postal Code

21201

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Janaki Deepak, MD

Phone

410-605-7000

Janaki.Deepak@va.gov

First Name & Middle Initial & Last Name & Degree

Ma Inez A Ambata, MSN

MaInezAmparo.ambata@va.gov

Facility Name

VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

City

Boston

State/Province

Massachusetts

ZIP/Postal Code

02130

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Ronald Goldstein, MD

Phone

857-203-6478

ronald.goldstein@va.gov

First Name & Middle Initial & Last Name & Degree

Kathleen Lacerda

Phone

8572036295

Kathleen.Lacerda@va.gov

Facility Name

VA Ann Arbor Healthcare System, Ann Arbor, MI

City

Ann Arbor

State/Province

Michigan

ZIP/Postal Code

48105-2303

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Jane Deng, MD

Phone

734-845-3039

Jane.deng@va.gov

First Name & Middle Initial & Last Name & Degree

David Elliott, MD

Phone

7348453914

David.Elliott1@va.gov

Facility Name

Minneapolis VA Health Care System, Minneapolis, MN

City

Minneapolis

State/Province

Minnesota

ZIP/Postal Code

55417

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Erin Wetherbee, MD

Erin.Wetherbee.@va.gov

First Name & Middle Initial & Last Name & Degree

Taira Miller

Taira.Miller1@va.gov

Facility Name

Durham VA Medical Center, Durham, NC

City

Durham

State/Province

North Carolina

ZIP/Postal Code

27705

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Scott Shofer, MD

Scott.Shofer@va.gov

First Name & Middle Initial & Last Name & Degree

Melissa A Wagner, BS

Phone

9192860411

Ext

7599

melissa.wagner2@va.gov

Facility Name

Louis Stokes VA Medical Center, Cleveland, OH

City

Cleveland

State/Province

Ohio

ZIP/Postal Code

44106

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Charles Nock, MD

Phone

216-791-3800

Ext

64825

charles.nock@va.gov

First Name & Middle Initial & Last Name & Degree

Lisa Tucker

Phone

2167913800

Ext

63595

Lisa.Tucker@va.gov

Facility Name

Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA

City

Philadelphia

State/Province

Pennsylvania

ZIP/Postal Code

19104-4551

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Anil Vachani, MD

Phone

215-823-5800

Anil.vachani@va.gov

First Name & Middle Initial & Last Name & Degree

Jennifer Steltz

Jennifer.Steltz@va.gov

Facility Name

VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA

City

Pittsburgh

State/Province

Pennsylvania

ZIP/Postal Code

15240

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Charles W Atwood, MD

Phone

412-360-6316

charles.atwood@va.gov

First Name & Middle Initial & Last Name & Degree

Gregory A Owens, BA

Phone

4123601517

gregory.owens@va.gov

Facility Name

Michael E. DeBakey VA Medical Center, Houston, TX

City

Houston

State/Province

Texas

ZIP/Postal Code

77030

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Lorraine Cornwell, MD

Lorraine.Cornwell@va.gov

First Name & Middle Initial & Last Name & Degree

Adriana M Rueda, MS

Phone

7137947459

Adriana.Rueda@va.gov

Facility Name

Hunter Holmes McGuire VA Medical Center, Richmond, VA

City

Richmond

State/Province

Virginia

ZIP/Postal Code

23249

Country

United States

Individual Site Status

Terminated

Facility Name

Clement J. Zablocki VA Medical Center, Milwaukee, WI

City

Milwaukee

State/Province

Wisconsin

ZIP/Postal Code

53295-0001

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Andreea Anton, MD

Phone

414-384-2000

Ext

42895

Andreea.Anton@va.gov

First Name & Middle Initial & Last Name & Degree

Kayla Neuendorf, BSN

Kayla.Neuendorf@va.gov

12. IPD Sharing Statement

Plan to Share IPD

Citations:

PubMed Identifier

32736936

Citation

Elbanna M, Shiue K, Edwards D, Cerra-Franco A, Agrawal N, Hinton J, Mereniuk T, Huang C, Ryan JL, Smith J, Aaron VD, Burney H, Zang Y, Holmes J, Langer M, Zellars R, Lautenschlaeger T. Impact of Lung Parenchymal-Only Failure on Overall Survival in Early-Stage Lung Cancer Patients Treated With Stereotactic Ablative Radiotherapy. Clin Lung Cancer. 2021 May;22(3):e342-e359. doi: 10.1016/j.cllc.2020.05.024. Epub 2020 Jun 2.

Results Reference

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Veterans Affairs Lung Cancer Surgery Or Stereotactic Radiotherapy

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