Lung cancer is the most frequent cause of cancer death in both men and women in North America. In 2006, an estimated 22,700 Canadians will be diagnosed with lung cancer and 19,300 will die of it (Canadian Cancer Statistics 2006). Approximately 15-20% of NSCLC patients present with early or localized disease. Surgical resection of T1-2N0 NSCLC remains the treatment of choice for this population, and results in a 5-year survival rate of 50-70%. Patients deemed medically inoperable have been treated with non-surgical therapies, such as radiation therapy(RT), while some patients have simply been observed without any tumor therapy because of their co-morbid illnesses. Potential confounding issues in this patient population include some patients who are not referred to our Centre due to co-morbid disease, and some who are referred, but are not offered radical RT due to poor outcome expectations. In addition, patients may refuse treatment when offered. We have reviewed thepast 19 years’ experience at LRCP inmanagement of this group of patients.