RATIONALE: 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.

PURPOSE: This randomized phase III trial is studying 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.

OBJECTIVES: Primary

• Compare time to local recurrence, in terms of recurrence within the same lobe or hilum (N1 nodes) or progression at the staple line (after treatment effects [i.e., scarring] have subsided), in high-risk patients with stage I non-small cell lung cancer treated with sublobar resection with vs without intraoperative brachytherapy.

Secondary

• Compare procedure-specific morbidity and mortality in patients treated with these regimens.
• Compare overall and failure-free survival of patients treated with these regimens.
• Compare freedom from regional or distant recurrence in patients treated with these regimens.
• Determine the effect of histologically or cytologically positive resection margins on time to local recurrence in patients treated with these regimens.
• Determine the effect of brachytherapy on quality of life of these patients.
• Determine the effect of brachytherapy on pulmonary function in these patients.

OUTLINE: This is a randomized, multicenter study. Patients are randomized to 1 of 2 treatment arms.

• Arm I: Patients undergo open or thoracoscopic sublobar resection comprising either a wedge resection or anatomical segmentectomy.
• Arm II: Patients undergo surgery as in arm I. Patients also undergo intraoperative brachytherapy comprising an iodine I 125 implant at the resection margin. Quality of life is assessed at baseline and then at 3, 12, and 24 months.

After completion of study treatment, patients are followed at 3 and 6 months, every 6 months for 2.5 years, and then annually for 2 years.

PROJECTED ACCRUAL: A total of 226 patients (113 per treatment arm) will be accrued for this study within 3 years.

Ages Eligible for Study:  18 Years and above,  Genders Eligible for Study:  Both

Criteria

DISEASE CHARACTERISTICS:

• Suspected or proven non-small cell lung cancer (NSCLC), meeting both of the following criteria:
• Pre-operative criteria
• Lung nodule suspicious for clinical stage I NSCLC
• Mass ≤ 3 cm in maximum diameter by CT scan of the chest and upper abdomen
• Clinical stage IA OR selected stage IB with visceral pleural involvement
• Intra-operative criteria
• Histologically proven stage I NSCLC
• All suspicious mediastinal lymph nodes (> 1 cm short-axis dimension on CT scan OR positive on positron-emission tomography scan) must be negative by mediastinoscopy, endoesophageal ultrasound-guided needle aspiration, or CT-guided, video-assisted thoracoscopic, or open lymph node biopsy
• Meets ≥ 1 major OR ≥ 2 minor high-risk criteria, defined as the following:
• Major criteria
• FEV_1 ≤ 50%
• DLCO ≤ 50%
• Minor criteria
• Age 75 and over
• FEV_1 51-60% of predicted
• DLCO 51-60% of predicted
• Pulmonary hypertension, defined as pulmonary artery systolic pressure > 40 mm Hg by echocardiography or right heart catheterization
• LVEF ≤ 40%
• Resting or exercise arterial oxygen partial pressure ≤ 55 mm Hg or oxygen saturation ≤ 88% by pulse oximetry
• Arterial carbon dioxide partial pressure > 45 mm Hg
• Modified Medical Research Council Dyspnea Scale ≥ 3

PATIENT CHARACTERISTICS: Age

• 18 and over

Performance status

• ECOG 0-2 OR
• Zubrod 0-2

Life expectancy

• Not specified

Hematopoietic

• Not specified

Hepatic

• Not specified

Renal

• Not specified

Cardiovascular

• See Disease Characteristics

Pulmonary

• See Disease Characteristics

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY: Biologic therapy

• Not specified

Chemotherapy

• Not specified

Endocrine therapy

• Not specified

Radiotherapy

• No prior intrathoracic radiotherapy

Surgery

• Not specified

Other

• Concurrent enrollment on (correlative science protocol) allowed