Experience with dose escalation using CHARTWEL (continuous hyperfractionated accelerated radiotherapy weekend less)...

Area of Science:

• Radiation Oncology
• Thoracic Oncology
• Clinical Trials

Background:

• Continuous, hyperfractionated, accelerated radiotherapy (CHART) demonstrated improved survival in non-small-cell lung cancer (NSCLC) but had limitations in locoregional control.
• Interest in dose escalation with modified CHART schedules arose to improve treatment efficacy for locally advanced NSCLC.

Purpose of the Study:

• To compare the acute and late morbidity of two modified CHART schedules: CHART WeekEnd Less (CHARTWEL) at 54 Gy in 16 days versus 60 Gy in 18 days.
• To evaluate the feasibility of dose escalation in NSCLC treatment using modified radiotherapy schedules.

Main Methods:

• A comparative study involving patients with locally advanced NSCLC treated with CHARTWEL 54 Gy (16 days) or 60 Gy (18 days).
• Assessment of acute toxicity (dysphagia, analgesia) and late radiation-induced morbidity (pulmonary, spinal cord, oesophageal) using clinical and radiological criteria.

Main Results:

• CHARTWEL 60 Gy resulted in more severe and prolonged acute dysphagia and required more analgesia compared to 54 Gy (P< or = 0.02).
• Oesophagitis at 12 weeks was similar between groups; no consequential damage or significant late toxicities (myelitis, strictures, grade 2/3 lung morbidity) were observed.
• A higher incidence of mild pulmonary toxicity was noted after 6 months with CHARTWEL 60 Gy compared to 54 Gy, which may be clinically relevant if combined with chemotherapy.

Conclusions:

• The CHARTWEL 60 Gy schedule showed a manageable increase in acute toxicity and mild late pulmonary toxicity compared to 54 Gy in locally advanced NSCLC.
• These findings support the potential for further dose escalation or the incorporation of concurrent chemotherapy with modified CHART schedules.