Specialized Radiation Therapy and Chemotherapy in Treating Patients With Stage III Non-Small Cell Lung Cancer That Cannot Be Removed by Surgery

DISEASE CHARACTERISTICS:

• Histologically or cytologically documented non-small cell lung cancer (NSCLC)
• Stage: IIIA or IIIB NSCLC; patients who present with N2 or N3 disease and an undetectable primary tumor are also eligible
• Tumor Site: Thoracic disease without supraclavicular or contralateral hilar involvement

• Pleural Effusion: When pleural fluid is visible on both computed tomography (CT) scan and on a chest x-ray, a pleuracentesis is required to confirm that the pleural fluid is cytologically negative

  • Exudative pleural effusions are excluded regardless of cytology
  • Patients with effusions that are minimal (i.e., not visible on chest x-ray) and too small to safely tap are eligible

• Patients must have measurable disease

  • Lesions that can be accurately measured in at least one dimension (longest diameter to be recorded) as ≥ 2 cm with conventional techniques or as ≥ 1 cm with spiral CT scan

  • Patients with non-measurable disease are not eligible; all other lesions, including small lesions (longest diameter < 20 mm with conventional techniques or < 10 mm with spiral CT scan) and truly nonmeasurable lesions; lesions that are considered non-measurable include the following:

    • Bone lesions
    • Leptomeningeal disease
    • Ascites
    • Pleural/pericardial effusion
    • Inflammatory breast disease
    • Lymphangitis cutis/pulmonis
    • Abdominal masses that are not confirmed and followed by imaging techniques
    • Cystic lesions

PATIENT CHARACTERISTICS:

• ECOG performance status 0-1
• No patients that are known to be pregnant or nursing
• Granulocytes ≥ 1,500/μl
• Platelet count ≥ 100,000/μl
• Bilirubin ≤1.5 times upper limit of normal (ULN)
• AST (SGOT) ≤ 2.0 times ULN
• Serum creatinine ≤ 1.5 times ULN OR calculated creatinine clearance ≥ 70 mL/min
• FEV-1 ≥ 1.2 L/sec or 50% predicted

PRIOR CONCURRENT THERAPY:

• No prior radiotherapy or chemotherapy for non-small cell lung cancer (NSCLC)
• No prior mediastinal or thoracic radiotherapy
• Patients with complete surgical resection of disease are not eligible, however; patients with surgical resection and measurable gross residual disease present on imaging are considered eligible