S0220: Chemoradiotherapy Followed By Surgery and Docetaxel in Treating Patients With Pancoast Tumors

Inclusion Criteria

• •DISEASE CHARACTERISTICS:
• •Histologically or cytologically confirmed non-small cell lung cancer
• •* Any of the following stages due to involvement of the superior sulcus:
• •* Stage IIB (T3, N0), IIIA (T3, N1), or IIIB (T4, N0-1)
• •* Newly diagnosed
• •* Primary bronchogenic
• •Must meet 1 of the following tumor involvement criteria:
• •* An apical tumor associated with the Pancoast syndrome (arm or shoulder pain and/or neurologic findings corresponding to the roots of C-8 and/or T-1 or the inferior trunk of the bronchial plexus with or without Horner's syndrome) without rib or vertebral body involvement
• •* Superior sulcus tumors with involvement of the chest wall (T3), usually ribs 1 and 2 by CT scan or MRI, with or without an associated Pancoast syndrome
• •* Superior sulcus tumors with invasion of the vertebral bodies or involvement of the subclavian vessels (T4) by CT scan or MRI, with or without an associated Pancoast syndrome
• •No more than 1 parenchymal lesion in the same lung or in both lungs
• •No involvement of the following lymph node groups as determined by mediastinal exploration\* (i.e., mediastinoscopy, mediastinotomy, thoracoscopy, or thoracotomy) within the past 42 days:
• •* Single-level or multi-level ipsilateral or contralateral mediastinal nodal (N2 or N3) disease by mediastinoscopy, thoracoscopy, mediastinotomy, thoracotomy, or transbronchial Wang needle biopsy, regardless of whether enlarged nodes are visible or not on chest x-ray or CT scan
• •* Supraclavicular (scalene) nodes
• •* Any nodes evident on physical exam must be biopsied by fine needle aspiration or open biopsy
• •* Left upper lobe tumors with left vocal cord paralysis by indirect laryngoscopy (presumes N2 nodes in the A-P window) NOTE: \*Mediastinal exploration is not required for patients whose mediastinum is negative by both positron-emission tomography (PET) and CT scan
• •No pleural effusions except if 1 of the following criteria are met:
• •* Pleural effusion present before mediastinoscopy or thoracotomy with negative cytology on 2 separate thoracenteses
• •* Pleural effusion present only after exploratory or staging thoracotomy, with negative cytology on a single thoracentesis
• •* Present only on CT scan and too small to tap
• •No pericardial effusions or superior vena cava syndrome
• •No brain metastases by CT scan or MRI
• •No evidence of distant metastatic disease by bone scan or PET
• •Must be a candidate for potential future pulmonary resection
• •PATIENT CHARACTERISTICS:
• •Age
• •Not specified
• •Performance status
• •Zubrod 0-2
• •* Patients with Zubrod performance status 2 must have an albumin level at least 0.85 times lower limit of normal and weight loss no greater than 10%
• •Life expectancy
• •Not specified
• •Hematopoietic
• •Absolute neutrophil count at least 1,500/mm\^3
• •Platelet count at least 100,000/mm\^3
• •Hepatic
• •Bilirubin no greater than 1.5 times upper limit of normal (ULN)\*
• •SGOT or SGPT no greater than 1.5 times ULN\* NOTE: \*Unless due to a documented benign disease
• •Renal
• •Creatinine clearance at least 50 mL/min
• •Cardiovascular
• •No myocardial infarction within the past 3 months
• •No active angina
• •No unstable heart rhythms
• •No clinically evident congestive heart failure
• •Pulmonary
• •Preresection FEV\_1 at least 2.0 L OR
• •Predicted postresection FEV\_1 greater than 1.0 L
• •Other
• •Not pregnant or nursing
• •Fertile patients must use effective contraception
• •No uncontrolled peptic ulcer disease
• •No grade 2 or greater sensory neuropathy
• •No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer or carcinoma in situ of the cervix
• •PRIOR CONCURRENT THERAPY:
• •Biologic therapy
• •No concurrent colony-stimulating factors during chemoradiotherapy or course 1 of consolidation therapy
• •Chemotherapy
• •No prior chemotherapy for lung cancer
• •Endocrine therapy
• •Not specified
• •Radiotherapy
• •No prior radiotherapy to the neck or thorax
• •No concurrent intensity-modulated radiotherapy
• •Surgery
• •Prior exploratory thoracotomy allowed only for diagnosis or staging purposes
• •Other
• •No concurrent amifostine