G-CSF and Pegfilgrastim in Treating Neutropenia in Patients Undergoing Radiation Therapy and Chemotherapy for Limited Stage Small Cell Lung Cancer

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed small cell carcinoma of the lung

  • Limited stage disease, defined as any of the following:

    • Tumor confined to one hemithorax
    • T4 tumor not based on malignant pleural effusion
    • N3 disease not based on contralateral supraclavicular involvement
• No complete tumor resection
• Measurable or evaluable disease

• Pleural effusion allowed provided the following conditions are present:

  • Effusion is too small to tap under CT guidance and is not evident on chest x-ray
  • Effusion appears only after a thoracotomy or other invasive procedure
• Must have certification by a Radiation Oncologist that the tumor can be encompassed by limited radiotherapy fields without significantly compromising pulmonary function
• No distant metastases

PATIENT CHARACTERISTICS:

• Zubrod performance status 0-1
• ANC ≥ 1,800 cells/mm³
• Platelet count ≥ 100,000 cells/mm³
• Hemoglobin ≥ 10.0 g/dL (transfusion or other intervention to achieve hemoglobin ≥ 8.0 g/dL allowed)
• Total bilirubin ≤ 1.5 mg/dL
• AST or ALT ≤ 2 times the upper limit of normal (ULN)
• Alkaline phosphatase < 2.5 times ULN (< 5 times ULN if judged by the investigator to be related to liver metastases)
• Creatinine ≤ 1.5 mg/dL
• Creatinine clearance ≥ 50 mL/min
• Must have best value of FEV1 ≥ 1.5 liters/second obtained on two measurements taken before and after use of a bronchodilator
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for ≥ 60 days after the last study treatment
• No prior invasive malignancy, except non-melanomatous skin cancer or other micro-invasive malignancy, or carcinoma in situ of the breast, oral cavity, or cervix, unless the patient has been disease-free for a minimum of 3 years
• No weight loss > 5% for any reason within the past 3 months

• No severe, active comorbidity, defined as follows:

  • Unstable angina and/or congestive heart failure requiring hospitalization within the past 6 months
  • Transmural myocardial infarction within the past 6 months
  • Acute bacterial or fungal infection requiring intravenous antibiotics
  • Chronic Obstructive Pulmonary Disease exacerbation with FEV1 < 1.5 liters/second or other respiratory illness requiring hospitalization or precluding study therapy within the past 30 days
  • Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects
  • AIDS
• No prior allergic reaction to the study drugs

PRIOR CONCURRENT THERAPY:

• No prior systemic chemotherapy for lung cancer

  • Prior chemotherapy for a different cancer is allowed, provided it was completed ≥ 5 years prior to registration
• No prior radiotherapy to the region of the study cancer that would result in overlap of radiotherapy fields
• No concurrent intensity-modulated radiotherapy
• No concurrent amifostine