Comparing Photon Therapy To Proton Therapy To Treat Patients With Lung Cancer

Inclusion Criteria:

Histologically or cytologically proven diagnosis of non-small cell lung cancer

Clinical American Joint Committee on Cancer (AJCC) (AJCC, 7th ed.) II, IIIA or IIIB (with non-operable disease; non-operable disease will be determined by a multi-disciplinary treatment team within 60 days prior to registration; note: for patients who are clearly nonresectable, the case can be determined by the treating radiation oncologist and/or a medical oncologist or pulmonologist

Patients who present with N2 or N3 disease and an undetectable NSCLC primary tumor are eligible
Patients who refuse surgery are eligible
Patients who develop local recurrence after surgery and rendered candidate for definitive concurrent chemoradiation are also eligible
Patients who have received systemic treatment (up to 4 cycles of induction chemotherapy, or up to 6 months of targeted therapy) are eligible

Appropriate stage for protocol entry, including no distant metastases, based upon the following minimum diagnostic workup:

History/physical examination within 30 days prior to registration including resting heart rate;
Fludeoxyglucose F 18 (FDG)-positron emission tomography (PET)/computed tomography (CT) scan for staging within 60 days prior to registration
Magnetic resonance imaging (MRI) scan with contrast of the brain (preferred) or CT scan of the brain with contrast within 60 days prior to registration;

Forced expiratory volume in one second (FEV1) >= 0.8 liter or >= 35% predicted with or without bronchodilator within 90 days prior to registration;

Patients who meet the criterion above without oxygen (O2), but who need acute (started within 10 days prior to registration) supplemental oxygen due to tumor-caused obstruction/hypoxia are eligible, provided the amount of the O2 needed has been stable
Zubrod performance status 0-1 within 30 days prior to registration
Absolute neutrophil count (ANC) >= 1,500 cells/mm^3 obtained within 30 days prior to registration
Platelets >= 100,000 cells/mm^3 obtained within 30 days prior to registration
Hemoglobin >= 9.0 g/dl (note: the use of transfusion or other intervention to achieve hemoglobin [Hgb] >= 9.0 g/dl is acceptable), obtained within 30 days prior to registration

Serum glutamic oxaloacetic transaminase (SGOT) or serum glutamate pyruvate transaminase (SGPT) within 30 days prior to registration

It is highly recommended but not required that SGOT or SGPT be =< 1.5 upper limit of normal

Total bilirubin =< 1.5 within 30 days prior to registration

It is highly recommended but not required that total bilirubin be =< 1.5 upper limit of normal
Serum creatinine < 1.5 mg/dL or calculated creatinine clearance >= 50 mL/min within 30 days prior to registration estimated by the Cockcroft-Gault formula
Peripheral neuropathy =< grade 1 at the time of registration

Patients with non-malignant pleural effusion are eligible

If a pleural effusion is present, the following criteria must be met to exclude malignant involvement:

When pleural fluid is visible on both the 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
Effusions that are minimal (i.e, not visible on chest x-ray) that are too small to safely tap are eligible
Patients must have measurable or evaluable disease
Women of childbearing potential must have a negative serum pregnancy test within 14 days prior to registration
Women of childbearing potential and male participants must practice adequate contraception
Patient must provide study-specific informed consent prior to study entry

Exclusion Criteria:

Prior invasive malignancy unless disease free for a minimum of 3 years; however, skin cancer and in situ carcinomas of the breast, oral cavity, cervix, and other organs and are permissible
Patients with prior history of either small cell lung cancer or NSCLC regardless of the treatment received, other than patients who have recurrent disease following resection
Prior systemic chemotherapy for the study cancer, if more than 4 cycles of induction chemotherapy or more than 6 months of targeted therapy; note that prior chemotherapy for a different cancer is allowable
Prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields

Severe, active co-morbidity, defined as follows:

Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months;
Transmural myocardial infarction within the last 6 months;
Chronic obstructive pulmonary disease exacerbation or other respiratory illness other than the diagnosed lung cancer requiring hospitalization or precluding study therapy within 30 days before registration;
Acquired immune deficiency syndrome (AIDS) based upon current Centers for Disease Control and Prevention (CDC) definition; note, however, that human immunodeficiency virus (HIV) testing is not required for entry into this protocol
Unintentional weight loss > 10% within 30 days prior to registration
Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception