Neoadjuvant Chemoradiotherapy Followed By Surgery in Treating Patients With Limited-Stage Small Cell Lung Cancer

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed small cell lung cancer

  • Limited stage disease (clinical stage I-IIIA) and meets the following criteria:

    • Confined to 1 hemithorax
    • No T4 disease based on malignant pleural effusion
    • No N3 disease based on contralateral hilar or supraclavicular involvement
  • Contralateral mediastinal (N3) nodes greater than 1.5 cm on CT scan must be biopsied to rule out pathologic involvement
• Measurable or evaluable disease
• Tumor must be able to be encompassed by limited radiotherapy field without significantly compromising pulmonary function
• No pleural effusion visible on chest x-ray (regardless of cytology)
• No prior complete tumor resection

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• Karnofsky 70-100%

Life expectancy

• Not specified

Hematopoietic

• Absolute granulocyte count at least 1,800/mm^3
• Platelet count at least 100,000/mm^3

Hepatic

• Bilirubin no greater than 1.5 mg/dL
• No known Gilbert's disease

Renal

• Creatinine no greater than 1.5 mg/dL
• Calcium less than 12.0 mg/dL

Cardiovascular

• No myocardial infarction within the past 6 months
• No congestive heart failure
• No uncontrolled arrhythmias
• No active unstable angina

Pulmonary

• Calculated postoperative FEV_1 at least 800 cc
• No chronic obstructive pulmonary disease with FEV_1 no greater than 1 L or uncontrolled bronchospasm in the unaffected lung

Other

• Not pregnant
• Negative pregnancy test
• Fertile patients must use effective contraception
• No other malignancy within the past 2 years except curatively treated basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, or any other noninvasive malignancy
• No history of seizures
• No history of uncontrolled psychiatric illness that would preclude giving informed consent or complying with study
• No active or uncontrolled infection
• No uncontrolled diabetes mellitus (random blood sugar at least 250 mg/dL)
• No other concurrent serious medical illness
• HIV negative

PRIOR CONCURRENT THERAPY:

Biologic therapy

• Not specified

Chemotherapy

• No prior irinotecan
• No prior topotecan

Endocrine therapy

• Not specified

Radiotherapy

• No prior radiotherapy to the chest or other areas containing 30% or more of marrow-bearing bone

Surgery

• See Disease Characteristics

Other

• No concurrent phenytoin, phenobarbital, or other antiepileptic prophylactic drugs
• No concurrent amifostine