High-Dose or Standard-Dose Radiation Therapy and Chemotherapy With or Without Cetuximab in Treating Patients With Newly Diagnosed Stage III Non-Small Cell Lung Cancer That Cannot Be Removed by Surgery

Inclusion criteria:

1. Pathologically proven (either histologic or cytologic) diagnosis of Stage IIIA or IIIBnon-small cell lung cancer (NSCLC); excluding patients with N3 disease based onsupraclavicular or contralateral hilar adenopathy, [according to American JointCommittee on Cancer (AJCC) Staging, 6th edition; see appendix III] within 12 weeks ofregistration; patients who present with N2 or N3 disease and an undetectable NSCLCprimary tumor also are eligible.
2. Patients must be considered unresectable or inoperable; Note: Patients who have had anodal recurrence after surgery for an early-stage NSCLC are eligible if the followingcriteria are met:

• Nodal recurrence must be N1 or N2; N3 is not eligible.
• The initial primary must have been staged as T1-2, N0, M0.
• The node must be biopsied within 12 weeks of registration.
• The node must be measurable.
• The patient must not have received prior chemotherapy or radiation for this lungcancer.
• Prior curative surgery must have been at least 6 months prior to the nodalrecurrence.
• The exception to a prior invasive malignancy does not apply to the initial lungprimary.

3. Stage III A or B disease, including no distant metastases, based upon the followingminimum diagnostic workup are acceptable:

• History/physical examination, including documentation of height, weight, bodysurface area (BSA), and vital signs within 8 weeks prior to registration;
• Computed tomographic (CT)/Magnetic Resonance Imaging (MRI) imaging of the lungand upper abdomen through the adrenal glands within 6 weeks prior toregistration;
• An MRI of the brain with contrast (or CT with contrast if MRI is medicallycontraindicated) within 6 weeks prior to registration; Note: The use ofintravenous contrast is required for the MRI or CT. An MRI without contrast isonly permitted if the patient has a contrast allergy.
• Whole-body fluorodeoxyglucose (FDG) - Positron Emission Tomography(PET) or PET/CTor if no PET is available, a bone scan is required within 6 weeks prior toregistration; Note: If a PET is done that shows clear adrenals and lungs, then aCT scan of chest only is permitted.

4. If a pleural effusion is present, the following criteria must be met to excludemalignant involvement (incurable T4 disease):

• When pleural fluid is visible on both the CT scan and on a chest x-ray, apleuracentesis is required to confirm that the pleural fluid is cytologicallynegative.
• Exudative pleural effusions are excluded, regardless of cytology;
• Effusions that are minimal (i.e. not visible on chest x-ray) that are too smallto safely tap are eligible.

5. Patients must have measurable or evaluable disease.
6. Patients with post-obstructive pneumonia are eligible.
7. Patients must be at least 3 weeks from prior thoracotomy (if performed).
8. Zubrod Performance Status 0-1;
9. Age ≥ 18;
10. Pulmonary function tests (PFTs) including forced expiratory volume in one second (FEV1) within 12 weeks prior to registration; for FEV1, the best value obtained pre-or post bronchodilator must be ≥ 1.2 liters/second or ≥ 50% predicted.
11. Complete blood count (CBC)/differential obtained within 2 weeks prior to registrationon study, with adequate bone marrow function defined as follows:

• Absolute neutrophil count (ANC) ≥ 1,800 cells/mm3;
• Platelets ≥ 100,000 cells/mm3;
• Hemoglobin ≥ 10.0 g/dl (Note: The use of transfusion or other intervention toachieve Hgb ≥ 10.0 g/dl is acceptable.)

12. Serum creatinine within normal institutional limits or creatinine clearance ≥60ml/min;
13. Bilirubin must be within or below normal institutional limits;
14. Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) < 2.5 x theinstitutional upper limit of normal (IULN);
15. Patient must sign study specific informed consent prior to study entry.

Exclusion Criteria:

1. N3 supraclavicular disease;
2. Greater than minimal, exudative, or cytologically positive pleural effusions;
3. Involved contralateral hilar nodes (i.e. greater than 1.5 cm on short axis or positiveon PET scan);
4. ≥ 10% weight loss within the past month;
5. Prior invasive malignancy (except non-melanomatous skin cancer) unless disease freefor a minimum of 3 years; non-invasive conditions such as carcinoma in situ of thebreast, oral cavity, or cervix are all permissible.
6. Prior systemic chemotherapy for the study cancer; note that prior chemotherapy for adifferent cancer is allowable.
7. Prior radiotherapy to the region of the study cancer that would result in overlap ofradiation therapy fields;
8. Prior therapy that specifically and directly targets the epidermal growth factorreceptor (EGFR) pathway;
9. Prior severe infusion reaction to a monoclonal antibody;
10. Severe, active co-morbidity, defined as follows:

• Significant history of uncontrolled cardiac disease; i.e., uncontrolledhypertension, unstable angina, myocardial infarction within the last 6 months,uncontrolled congestive heart failure, and cardiomyopathy with decreased ejectionfraction.
• Transmural myocardial infarction within the last 6 months;
• Acute bacterial or fungal infection requiring intravenous antibiotics at the timeof registration;
• Chronic Obstructive Pulmonary Disease exacerbation or other respiratory illnessrequiring hospitalization or precluding study therapy within 30 days beforeregistration;
• Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects;
• Acquired Immune Deficiency Syndrome (AIDS) based upon current Centers for DiseaseControl and Prevention (CDC) definition; note, however, that humanimmunodeficiency virus (HIV) testing is not required for entry into thisprotocol. The need to exclude patients with AIDS from this protocol is necessarybecause the treatments involved in this protocol may be significantlyimmunosuppressive. Protocol-specific requirements may also excludeimmuno-compromised patients.

11. Pregnancy or women of childbearing potential and men who are sexually active and notwilling/able to use medically acceptable forms of contraception; this exclusion isnecessary because the treatment involved in this study may be significantlyteratogenic.
12. Any history of allergic reaction to paclitaxel or other taxanes, or to carboplatin;
13. Uncontrolled neuropathy grade 2 or greater regardless of cause.