Study of Positron Emission Tomography and Computed Tomography in Guiding Radiation Therapy in Patients With Stage III Non-small Cell Lung Cancer

Inclusion Criteria:

   - Patients must have FDG-avid (maximum SUV >= 4.0) (from PET scan of any date, any
   scanner) and histologically or cytologically proven non-small cell lung cancer

   - Patients must be clinical American Joint Committee on Cancer (AJCC) stage IIIA or IIIB
   (AJCC, 7th ed.) with non-operable disease; non-operable disease will be determined by
   a multi-disciplinary treatment team, involving evaluation by at least 1 thoracic
   surgeon within 8 weeks prior to registration; Note: For patients who are clearly
   nonresectable, the case can be determined by the treating radiation oncologist and a
   medical oncologist, or pulmonologist

   - Patients with multiple, ipsilateral pulmonary nodules (T3 or T4) are eligible if a
   definitive course of daily fractionated radiation therapy (RT) is planned

   - History/physical examination, including documentation of weight, within 2 weeks prior
   to registration

   - FDG-PET/CT scan for staging and RT plan within 4 weeks prior to registration

   - CT scan or sim CT of chest and upper abdomen (IV contrast is recommended unless
   medically contraindicated) within 6 weeks prior to registration

   - CT scan of the brain (contrast is recommended unless medically contraindicated) or MRI
   of the brain within 6 weeks prior to registration

   - Pulmonary function tests, including diffusion capacity of carbon monoxide (DLCO),
   within 6 weeks prior to registration; patients must have forced expiratory volume in 1
   second (FEV1) >= 1.2 Liter or >= 50% predicted without bronchodilator

   - Zubrod performance status 0-1

   - Able to tolerate PET/CT imaging required to be performed at an American College of
   Radiology (ACR) Imaging Core Laboratory (Lab) qualified facility

   - Absolute neutrophil count (ANC) >= 1,500 cells/mm^3 (within 2 weeks prior to
   registration on study)

   - Platelets >= 100,000 cells/mm^3 (within 2 weeks prior to registration on study)

   - Hemoglobin (Hgb) >= 10.0 g/dL (note: the use of transfusion or other intervention to
   achieve Hgb >= 10.0 g/dL is acceptable) (within 2 weeks prior to registration on
   study)

   - Serum creatinine within normal institutional limits or a creatinine clearance >= 60
   ml/min within 2 weeks prior to registration

   - Negative serum or urine pregnancy test within 3 days prior to registration for women
   of childbearing potential

   - Women of childbearing potential and male participants must agree to use a medically
   effective means of birth control throughout their participation in the treatment phase
   of the study

   - The patient must provide study-specific informed consent prior to study entry

Exclusion Criteria:

   - Patients with any component of small cell lung carcinoma are excluded

   - Patients with evidence of a malignant pleural or pericardial effusion are excluded

   - Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free
   for a minimum of 3 years (for example, carcinoma in situ of the breast, oral cavity,
   or cervix are all permissible)

   - Prior systemic chemotherapy for the study cancer; 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

      - Acute bacterial or fungal infection requiring intravenous antibiotics at the time
      of registration

      - Chronic obstructive pulmonary disease exacerbation or other respiratory illness
      requiring hospitalization or precluding study therapy at the time of registration

      - Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects;
      note, however, that laboratory tests for liver function and coagulation
      parameters are not required for entry into this protocol

      - Acquired immune deficiency syndrome (AIDS) based upon current Centers for Disease
      Control (CDC) definition; note, however, that human immunodeficiency virus (HIV)
      testing is not required for entry into this protocol

   - Pregnancy or women of childbearing potential and men who are sexually active and not
   willing/able to use medically acceptable forms of contraception

   - Poorly controlled diabetes (defined as fasting glucose level > 200 mg/dL) despite
   attempts to improve glucose control by fasting duration and adjustment of medications;
   patients with diabetes will preferably be scheduled in the morning and instructions
   for fasting and use of medications will be provided in consultation with the patients'
   primary physicians

   - Patients with T4 disease with radiographic evidence of massive invasion of a large
   pulmonary artery and tumor causing significant narrowing and destruction of that
   artery are excluded