Inclusion Criteria:

• Histologically-confirmed non-small cell cancer by biopsy or cytology. Squamous cell carcinoma, adenocarcinoma, large cell carcinoma, bronchioalveolar carcinoma, or non-small cell carcinoma (not otherwise specified) are allowed.

• Staging studies must identify patient as AJCC Stage I or II based on only 1 of following combinations of TNM staging:

  • T1, N0, M0
  • T2 (<5cm), N0, M0
  • T3 (<5cm), N0, M0

• Primary tumor must be arising in one of the following central chest locations:

  • Within or touching the zone of the proximal bronchial tree (a volume 2cm in all directions around the proximal bronchial tree [carina, R & L main bronchi, R & L upper lobe bronchi, intermedius bronchus, R middle lobe bronchus, lingular bronchus, R & L lower lobe bronchi]) - see Figure 1
  • Adjacent to (within 5 mm) or invading the mediastinal pleura
  • Adjacent to (within 5 mm) or invading the parietal pericardium
• Patients with hilar or mediastinal lymph nodes <1cm and no abnormal hilar or mediastinal uptake on PET will be considered N0. Patients with >1cm hilar or mediastinal lymph nodes on CT or abnormal PET (including suspicious but non-diagnostic uptake) may be eligible if directed tissue biopsy of all abnormally identified areas are negative for cancer.
• Primary tumor must be technically resectable by an experienced thoracic cancer clinician, with a reasonable possibility of obtaining a gross total resection with negative margins (potentially curative resection, PCR). However, patients must have underlying physiological medical problems prohibiting PCR (i.e., problems with general anesthesia, the operation, the post-op recovery period, or removal of adjacent functioning lung). Deeming a patient medically inoperable based on pulmonary function for surgical resection may include any of the following: baseline FEV1 <40% predicted; post-operative predicted FEV1 <30% predicted; severely reduced diffusion capacity; baseline hypoxemia and/or hypercapnia; exercise oxygen consumption <50% predicted; severe pulmonary hypertension; diabetes with severe end organ damage; severe cerebral, cardiac, or peripheral vascular disease; or severe chronic heart disease. Any one of these problems will qualify a patient for this trial.
• Age >18.
• Zubrod performance status 0-2.
• Women/Men of childbearing potential must use effective contraception.
• No direct evidence of regional or distant metastases after appropriate staging studies. No synchronous primary or prior malignancy in past 2 years except non-melanoma skin cancer or in situ cancer.
• No previous lung or mediastinal radiation therapy.
• No plans for concomitant antineoplastic therapy (including standard fractionated RT, chemo, biologic, vaccine therapy, or surgery) while on this protocol except at disease progression.
• No active systemic, pulmonary, or pericardial infection.
• No pregnant or lactating women.

• PRESTUDY REQUIREMENTS:

  • History and Physical Examination, Weight, Zubrod performance status (within 4 weeks pre-study entry)
  • Evaluation by thoracic cancer clinician (within 8 weeks pre-study entry)
  • Pregnancy test, if applicable (serum or urine, within 72 hours prior to treatment start.)
  • CXR*
  • CT* (preferably with contrast unless medically contraindicated; both lungs, mediastinum, liver, adrenals)
  • PET* (using FDG with visualization of primary tumor and draining lymph node basins in hilar and mediastinal regions)
  • PFTs - include routine spirometry, lung volumes, diffusion capacity,
  • CCI, CIRS-G, hospitalization history (strongly encouraged, not required) within 45 days pre-study entry.
• Signed informed consent.

Exclusion Criteria:

There is no exclusion criteria associated with this protocol. Please see the above inclusion criteria.-