Continuous Hyperfractionated Accelerated Radiotherapy (CHART) for Non-small Cell Lung Cancer (NSCLC): 7 Years' Experience From Nine UK Centres

P Sanganalmath; J E Lester; A G Bradshaw; T Das; C Esler; A E F Roy; E Toy; J F Lester; M Button; P Wilson; C Comins; P Atherton; R Pickles; K Foweraker; G A Walker; M Keni; M Q Hatton

doi:10.1016/j.clon.2017.12.019

Continuous Hyperfractionated Accelerated Radiotherapy (CHART) for Non-small Cell Lung Cancer (NSCLC): 7 Years' Experience From Nine UK Centres

Clin Oncol (R Coll Radiol). 2018 Mar;30(3):144-150. doi: 10.1016/j.clon.2017.12.019. Epub 2018 Jan 12.

Authors

P Sanganalmath¹, J E Lester¹, A G Bradshaw², T Das¹, C Esler³, A E F Roy⁴, E Toy⁵, J F Lester⁶, M Button⁶, P Wilson⁷, C Comins⁷, P Atherton⁸, R Pickles⁸, K Foweraker⁹, G A Walker¹⁰, M Keni¹⁰, M Q Hatton¹¹

Affiliations

¹ Weston Park Hospital, Sheffield, UK.
² Weston Park Hospital, Sheffield, UK; Newcastle on Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle, UK.
³ University Hospitals of Leicester NHS Trust, Leicester, UK.
⁴ Plymouth Hospitals NHS Trust, Plymouth, UK.
⁵ Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
⁶ Velindre Cancer Centre, Cardiff, UK.
⁷ University Hospitals Bristol NHS Trust, Bristol, UK.
⁸ Newcastle on Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle, UK.
⁹ Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK.
¹⁰ Derby Hospitals NHS Trust, Royal Derby Hospital, UK.
¹¹ Weston Park Hospital, Sheffield, UK. Electronic address: matthew.hatton@sth.nhs.uk.

PMID: 29336865
DOI: 10.1016/j.clon.2017.12.019

Abstract

Aim: Continuous hyperfractionated accelerated radiotherapy (CHART) remains an option to treat non-small cell lung cancer (NSCLC; NICE, 2011). We have previously published treatment outcomes from 1998-2003 across five UK centres. Here we update the UK CHART experience, reporting outcomes and toxicities for patients treated between 2003 and 2009.

Materials and methods: UK CHART centres were invited to participate in a retrospective data analysis of NSCLC patients treated with CHART from 2003 to 2009. Nine (of 14) centres were able to submit their data into a standard database. The Kaplan-Meier method estimated survival and the Log-rank test analysed the significance.

Results: In total, 849 patients had CHART treatment, with a median age of 71 years (range 31-91), 534 (63%) were men, 55% had undergone positron emission tomography-computed tomography (PET-CT) and 26% had prior chemotherapy; 839 (99%) patients received all the prescribed treatment. The median overall survival was 22 months with 2 and 3 year survival of 47% and 32%, respectively. Statistically significant differences in survival were noted for stage IA versus IB (33.2 months versus 25 months; P = 0.032) and IIIA versus IIIB (20 months versus 16 months; P = 0.018). Response at 3 months and outcomes were significantly linked; complete response showing survival of 34 months against 19 months, 15 months and 8 months for partial response, stable and progressive disease, respectively (P < 0.001). Age, gender, performance status, prior chemotherapy and PET-CT did not affect the survival outcomes. Treatment was well tolerated with <5% reporting ≥grade 3 toxicity.

Conclusion: In routine practice, CHART results for NSCLC remain encouraging and we have been able to show an improvement in survival compared with the original trial cohort. We have confirmed that CHART remains deliverable with low toxicity rates and we are taking a dose-escalated CHART regimen forward in a randomised phase II study of sequential chemoradiotherapy against other accelerated dose-escalated schedules.

Keywords: CHART (continuous hyperfractionated accelerated radiotherapy); NSCLC (non-small cell lung cancer).

Publication types

Multicenter Study

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung / radiotherapy*
Dose Fractionation, Radiation*
Female
Humans
Lung Neoplasms / radiotherapy*
Male
Middle Aged
Retrospective Studies
Treatment Outcome
United Kingdom