Experience with CHART

Area of Science:

• Oncology
• Radiation Oncology
• Clinical Trials

Background:

• Continuous, hyperfractionated, accelerated radiotherapy (CHART) is an advanced radiation therapy technique.
• CHART has been implemented at Mount Vernon Cancer Treatment Center since 1985.
• The majority of patients treated with CHART have head and neck tumors or locally advanced non-oat cell lung carcinoma.

Purpose of the Study:

• To evaluate the efficacy and toxicity of CHART in patients with head and neck and lung cancers.
• To compare CHART outcomes with conventional radiotherapy.
• To assess the impact of CHART on tumor regression, survival rates, and late treatment-related morbidity.

Main Methods:

• Retrospective analysis of 263 patients treated with CHART.
• Comparison of outcomes (tumor regression, survival, late morbidity) with historical control groups treated with conventional radiotherapy.
• Detailed assessment of early and late reactions in skin, mucosae, connective tissues, and salivary glands.

Main Results:

• Complete tumor regression rates were 90% for head and neck cancers (vs. 62% historically) and 40% for lung cancers (vs. 12% historically).
• 1-year and 2-year survival rates were significantly improved with CHART for lung cancer patients (60% vs. 40% and 29% vs. 12%, respectively).
• Early mucosal reactions were pronounced but healed; skin reactions were less severe than conventional radiotherapy, and late changes appeared reduced, with the exception of radiation myelitis in four patients.

Conclusions:

• CHART demonstrates superior tumor control and improved survival for specific cancer types compared to conventional radiotherapy.
• CHART shows a potential for reduced late morbidity, although radiation myelitis requires careful monitoring.
• The promising results support ongoing multi-center randomized controlled trials comparing CHART with conventional fractionated radiotherapy.