Radiation Therapy and Stereotactic Radiosurgery With or Without Temozolomide or Erlotinib in Treating Patients With Brain Metastases Secondary to Non-Small Cell Lung Cancer

You may be eligible if

• Histologically confirmed non-small cell lung cancer
• One to 3 intraparenchymal brain metastases by contrast-enhanced MRI, meeting the following criteria:
• * Well circumscribed tumor(s)
• * Maximum diameter ≤ 4.0 cm
• * If multiple lesions are present and one lesion is at the maximum diameter, the other lesions must not exceed 3.0 cm in maximum diameter
• * No metastases within 10 mm of the optic apparatus such that a portion of the optic nerve or chiasm would be included in the high-dose stereotactic radiosurgery boost field
• * No metastases in the brainstem, midbrain, pons, or medulla
• No prior complete resection of all known brain metastases
• * Subtotal resection allowed provided residual disease is ≤ 4.0 cm in maximum diameter
• No clinical or radiographic evidence of progression (other than study lesion\[s\]) within the past month
• * Patients with brain metastases at initial presentation do not require 1 month of scans documenting stable disease
• Stable extracranial metastases allowed
• * No known or pre-existing liver metastases
• No leptomeningeal metastases by MRI or cerebrospinal fluid evaluation
• Synchronous brain metastases at initial diagnosis allowed
• Performance status - Zubrod 0-1
• Hemoglobin ≥ 8 g/dL
• Absolute neutrophil count ≥ 1,000/mm\^3
• Platelet count ≥ 100,000/mm\^3
• AST \< 2 times upper limit of normal (ULN)
• Alkaline phosphatase \< 2 times ULN unless due to elevated bone metastases
• Total bilirubin normal
• Lactic dehydrogenase \< 2 times ULN
• Creatinine \< 1.5 times ULN
• No clinically active interstitial lung disease
• * Chronic stable asymptomatic radiographic changes allowed
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• HIV negative
• Neurologic function status 0-2
• No other major medical illness or psychiatric impairment that would preclude study participation
• No history of allergic reaction attributed to compounds of similar chemical or biologic composition to erlotinib or temozolomide
• No concurrent immunotherapy
• No concurrent biologic therapy, excluding growth factors and epoetin alfa
• No prior temozolomide or erlotinib
• No other concurrent chemotherapy during study radiotherapy
• * Other concurrent chemotherapy allowed after study radiotherapy, except for the following:
• * Temozolomide or erlotinib (arm I only)
• * Erlotinib (arm II only)
• * Temozolomide (arm III only)
• No prior cranial radiotherapy
• No concurrent intensity-modulated radiotherapy
• Concurrent radiotherapy to painful bone lesions allowed
• * No concurrent radiotherapy to more than 15% of bone marrow
• No other concurrent therapy for brain metastases unless a recurrence is detected
• More than 30 days since prior investigational drugs
• No concurrent enzyme-inducing antiepileptic drugs including, but not limited to, any of the following (for patients randomized to receive erlotinib):
• * Phenytoin
• * Carbamazepine
• * Rifampin
• * Phenobarbital
• * Primidone
• * Oxcarbazepine
• No other concurrent investigational drugs
• No concurrent Hypericum perforatum (St. John's wort)
• No drugs that alter gastric pH (e.g., proton pump inhibitors or H2 antagonists) within 4 hours after erlotinib administration (arm III patients only)