Surgery With or Without Internal Radiation Therapy in Treating Patients With Stage I Non-Small Cell Lung Cancer

This randomized phase III trial studies surgery and internal radiation therapy to see how well they work compared to surgery alone in treating patients with stage I non-small cell lung cancer. Surgery may be an effective treatment for non-small cell lung cancer. Internal radiation uses radioactive material placed directly into or near a tumor to kill tumor cells. It is not yet known whether surgery and internal radiation therapy are more effective than surgery alone in treating non-small cell lung cancer.

Sex

All

Minimum age

18 Years

Inclusion Criteria:

* PART I: PRE-OPERATIVE CRITERIA (PRE-REGISTRATION/RANDOMIZATION)
* Patients must have a suspicious lung nodule for clinical stage I non-small cell lung cancer (NSCLC)
* Patient must have a mass =\< 3 cm maximum diameter by computed tomography (CT) size estimate: clinical stage Ia or selected Ib (i.e., with visceral pleural involvement)
* Patient must have a CT scan of the chest with upper abdomen within 60 days prior to date of pre-registration
* Eastern Cooperative Oncology Group (ECOG)/Zubrod performance status 0, 1, or 2
* Patient must meet at least one major criteria or meet a minimum of two minor criteria as described below:

  * Major criteria

    * Forced expiratory volume in 1 second (FEV1) =\< 50% predicted
    * Diffusing capacity of the lungs for carbon monoxide (DLCO) =\< 50% predicted
  * Minor criteria

    * Age \>= 75
    * FEV1 51-60% predicted
    * DLCO 51-60% predicted
    * Pulmonary hypertension (defined as a pulmonary artery systolic pressure greater than 40 mmHg) as estimated by echocardiography or right heart catheterization
    * Poor left ventricular function (defined as an ejection fraction of 40% or less)
    * Resting or exercise partial pressure of oxygen (pO2) =\< 55 mm Hg or peripheral capillary oxygen saturation (SpO2) =\< 88%
    * Partial pressure of carbon dioxide (pCO2) \> 45 mm Hg
    * Modified Medical Research Council (MMRC) Dyspnea Scale \>= 3
* Patient must not have had previous intra-thoracic radiation therapy
* Women of child-bearing potential must have negative serum or urine pregnancy test
* No prior invasive malignancy, unless disease-free for \>= 5 years prior to pre-registration (exceptions: non-melanoma skin cancer, in-situ cancers)
* PART II: INTRA-OPERATIVE CRITERIA (REGISTRATION)
* Patient must have biopsy-proven NSCLC
* Patient must have all suspicious mediastinal lymph nodes (\> 1 cm short-axis dimension on CT scan or positive on positron emission tomography \[PET\] scan) assessed by one of the following methods to confirm negative involvement with NSCLC (mediastinoscopy, endo-esophageal ultrasound guided needle aspiration, CT-guided, video-assisted thoracoscopic or open lymph node biopsy)

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