A Phase II Trial of Concurrent Carboplatin/VP-16 and Radiation Followed by Paclitaxel (Taxol) for Poor-Risk Stage III Non-Small Cell Lung Cancer

Inclusion Criteria

DISEASE CHARACTERISTICS: Histologically confirmed newly diagnosed single primary
bronchogenic non-small cell lung cancer (NSCLC) Stage IIIA (T1-2 N2 M0; T3 N0-2 M0) or
IIIB (T4 or N3 M0, excluding malignant pleural effusion) Following NSCLC cellular types
are eligible: adenocarcinoma large cell carcinoma squamous cell carcinoma unspecified
Histology or cytology from involved mediastinal or supraclavicular nodes are sufficient
for diagnosis if a separate primary lesion of the lung parenchyma is clearly evident on
radiographs Radiographic evidence of mediastinal lymph nodes of at least 1.5 cm in the
largest diameter is sufficient to stage N2 or N3 If the largest mediastinal nodes are less
than 1.5 cm in diameter and this is the basis for stage III disease, then at least one of
the nodes has to be proven positive cytologically or histologically No bronchioloalveolar
carcinoma or stage IIIB tumor involving the superior sulcus Patients must meet at least
one of the following conditions: - FEV1 less than 2 liters and predicted FEV1 of the
contralateral lung no greater than 800 mL based on the quantitative split function testing
- Creatinine clearance less than 50 mL/min - Significant clinical hearing loss and
unwilling to accept the potential for worsening due to cisplatin - Controlled congestive
heart failure that, in the opinion of the investigator, may become decompensated due to
excessive hydration prior to cisplatin administration - SWOG performance status 2 and
either albumin less than 0.85 times upper limit of normal or weight loss of greater than
10% due to tumor Measurable or evaluable disease Patients with pleural effusion are
eligible only if: - pleural fluid must be a transudate with negative cytology if present
before mediastinoscopy or exploratory thoracotomy - pleural fluid can be either transudate
or exudate with negative cytology if present only after exploratory or staging thoracotomy
but not before - in any case, pleural effusion is present only on CT scan but not on
decubitus chest x-ray, and it is deemed too small to tap under either CT or ultrasound
guidance

PATIENT CHARACTERISTICS: Age: 18 and over Performance status: SWOG 0-2 Life expectancy:
Not specified Hematopoietic: WBC at least 3,500/mm3 Absolute neutrophil count at least
1,200/mm3 Platelet count at least 100,000/mm3 Hepatic: Bilirubin no greater than 1.5 times
upper limit of normal SGOT no greater than 1.5 times upper limit of normal Renal:
Creatinine clearance at least 20 mL/min Cardiovascular: No unstable congestive heart
failure No active angina No unstable cardiac arrhythmias Pulmonary: FEV1 at least 1.0
liter Also See Disease Characteristics Other: No uncontrolled peptic ulcer disease No
active infection No prior malignancy except adequately treated basal cell or squamous cell
skin cancer, in situ cervical cancer, or other cancer for which the patient has been
disease free for 5 years Not pregnant or nursing Adequate contraception required of all
fertile patients

PRIOR CONCURRENT THERAPY: Biologic therapy: Not specified Chemotherapy: No prior
chemotherapy Endocrine therapy: Not specified Radiotherapy: No prior radiation for lung
cancer Surgery: No prior surgery for lung cancer