Final results of the randomized phase III CHARTWEL-trial (ARO 97-1) comparing hyperfractionated-accelerated versus conventionally fractionated radiotherapy in non-small cell lung cancer (NSCLC)

Baumann, Michaël; Herrmann, Thomas; Koch, Rainer; Matthiessen, W; Appold, Steffen; Wahlers, B; Kępka, Lucyna; Marschke, Gerald; Feltl, David; Fietkau, Rainer; Budach, Volker; Dunst, Jürgen; Dziadziuszko, Rafał; Krause, Mechthild; Zips, Daniel

doi:10.1016/j.radonc.2011.06.031

Cited by 128 publications

(76 citation statements)

References 40 publications

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“…The present results (Table 2) attempt to remove some conflicts of earlier research findings, and they also confirm some earlier reported results [16,[27][28][29][30][31][32][33][34][35][36][37][38]. These has been shortly described above.…”

Section: Conclusion and Discussionsupporting

confidence: 91%

“…Here the overall treatment time is negatively significantly associated with the mean OST ( Table 2), but it is positively associated in [16]. The present result disagrees with the result in [16], but it agrees with the results, which have pointed that from a radiological point of views, shorter treatment (less than 28 days) can improve the mean OST of NSCLC patients [36,37]. It is also pointed in the earlier studies that a decrease in tumor control approximately 1.6% per day after a 6-week duration of radiation therapy, and approximately 2.0% increase in the risk of death for each day of prolongation in therapy [38].…”

Section: Conclusion and Discussionsupporting

confidence: 63%

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Joint Mean-Variance Overall Survival Time fitted Models from Stage III Non-Small Cell Lung Cancer

Das¹,

Mukherjee²

2017

Epidemiology (Sunnyvale)

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Objectives: The current article aims to derive the joint mean-variance fitted models for the overall survival time from stage III non-small cell lung cancer patients. In addition, it aims to identify the determinants of the overall survival time, based on 239 subjects with 23 factors / variables.Background: Overall survival time is positive, heterogeneous, and non-normal which is generally modeled either by the Log-normal or the gamma models. Little is known about the joint mean-variance models for overall survival time from stage III non-small cell lung cancer patients.

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Section: Conclusion and Discussionsupporting

confidence: 91%

Section: Conclusion and Discussionsupporting

confidence: 63%

Joint Mean-Variance Overall Survival Time fitted Models from Stage III Non-Small Cell Lung Cancer

Das¹,

Mukherjee²

2017

Epidemiology (Sunnyvale)

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“…This study suggested that patients with stage III NSCLC treated with accelerated HFX RT with or without CT may have better freedom from local progression and survival compared to those receiving standard RT, especially for nonsquamous histology. Furthermore, 3 studies evaluated the benefit of accelerated schedules: 1.2 Gy t2/daily, 1.5 Gy /2/ daily, and 1.5 Gy 3/daily /13 fractions vs 66 Gy 2/daily (RTOG 8311, EORTC CHART, and CHARTWEL, respectively) in NSCLC (34)(35)(36). Despite some limitations of the CHART and CHART-WEL studies, a higher local control was found for hyperfractionated accelerated RT schedules, providing a basis for further trials exploring treatment intensification for locally advanced NSCLC with eventual combination with CT. Only a few studies tested dose escalation and/or acceleration CT (29) A u t h o r p e r s o n a l c o p y through hypofractionation in NSCLC.…”

Section: Combined Chemoradiation: Considerations On Radiotherapymentioning

confidence: 99%

Combined Modality Therapy for Thoracic and head and Neck Cancers: A Review of Updated Literature Based on a Consensus Meeting

Franco

Fiorentino

Dionisi³

et al. 2016

Tumori

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Purpose: Combined modality therapy is a mainstay option for thoracic malignancies and head and neck cancers. The integration of different strategies is based on the multidisciplinary approach of modern clinical oncology. Radiation oncologists have to be educated, trained, and updated to provide state-of-the-art care to cancer patients and thus educational meetings are crucial. Methods: The Italian Association of Radiation Oncology Young Members Working Group (AIRO Giovani) organized its 8 th national meeting, focused on combination therapy in lung, esophageal, and head and neck cancer (with a specific focus on larynx-preservation strategies for larynx/hypopharynx tumors), involving young professionals working in Italy. The meeting was addressed to young radiation oncologists, presenting state-of-the-art knowledge, based on the latest evidence in this field. We performed a review of the current literature based on the highlights of the Congress. Results: The multimodality approach of head and neck and thoracic malignancies includes surgery, chemotherapy, and radiotherapy, but also has to take into account new information and data coming from basic and translational research and including molecular biology, genetics, and immunology. All these aspects are crucial for the treatment of non-small-cell lung cancer and esophageal, esophagogastric junction, and larynx/hypopharynx malignancies. The integration of different treatments in the clinical decision-making process to combine therapies is crucial. Conclusions: Combination therapy has proved to be a consolidated approach in these specific oncologic settings, highlighting the importance of multimodality management in modern clinical oncology. Dedicated meetings on specific topics are helpful to improve knowledge and skills of young professionals in radiation oncology.

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“…In subgroup analysis, CHART showed an even greater improvement for squamous cell carcinomas, with an overall survival at 3 years of 21% compared with 11% for the conventional regime. On the basis of these results, this schema was modified to have a more practical schedule in which treatment was not applied on weekends and therefore named "CHART-WEL", standing for CHART "weekend less" (24). A phase III trial was conducted to test the delivery of 60 Gy over a 2.5 week period using this schema, which includes the 1.5 Gy for a three times daily regime, as in CHART excluding therapy during the weekend.…”

Section: Hyperfractionated Accelerated Rtmentioning

confidence: 99%

Definitive Radiotherapy in Locally Advanced Non-Small Cell Lung Cancer: Dose and Fractionation

Dağoğlu¹,

Sule²,

Arifoglu³

et al. 2015

Balkan Med J

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Lung cancer is the leading cause of cancer-related mortality for both men and women. Among all cases, non-small cell lung cancer (NSCLC) accounts for 70-80% and almost half of the cases are considered to be locally advanced (LA) or unresectable disease at first presentation (1). Until only a decade ago, conventional fractionated radiotherapy (RT) alone applied at a dose of 60 Gy in 2 Gy fractions over 6 weeks was accepted as the standard nonsurgical treatment for these patients. However, the results were discouraging as the median survival obtained was less than a year and the 2-year survival rate did not go above 15-20% (2).After the impact of RT dose for lung cancer was established (3), a number of trials were structured in the quest for better local control and overall survival by either dose escalation or shortening the total treatment time through conventional/altered fractionation, even in combination with chemotherapy (CT) and other targeted agents.This review summarises the results of significant trials on dose and altered fractionation in the treatment of LA-NSCLC with an emphasis on possible future perspectives. The included trials were evaluated under two main titles as "Dose and Dose Escalation" and "Treatment Duration and Altered Fractionation". It should be noted that there is not always a distinct differentiation among the trials as some of the studies address both aspects. In the case of overlap, trials were grouped according to the main hypothesis which they were designed to answer. DOSE AND DOSE ESCALATIONSeveral studies have confirmed the relationship for dose and tumour response that led to an ameliorated local control and survival (Table 1).The first trial that validated the advantage of dose escalation for LA-NSCLC was the Radiation Therapy Oncology Group (RTOG) 73-01 trial, where 376 patients were randomised into four arms (2). Three arms included standard fractionation with doses of 40, 50 and 60 Gy in 2 Gy fractions and the fourth arm included a split course RT that was applied in 4 Gy fraction size to a total dose of 40 Gy over 5 weeks with a 3 week interruption in the middle. The overall 3 year intrathoracic failure rate was 33% for patients treated in the 60 Gy arm; this was significantly lower when compared to the other arms, with reDefinitive radiotherapy plays a major role in the treatment of locally advanced non-small cell lung cancer (LA NSCLC). After the impact of RT dose for lung cancer was established, a number of trials were structured with the aim of better local control and overall survival by either dose escalation or shortening the total treatment time through conventional/altered fractionation, even in combination with chemotherapy (CT) and other targeted agents. In spite of the increased number of these studies, the optimal dose or fractionation still remains to be determined. Another aspect questioned is the incorporation of these higher doses and shorter treatment times with chemotherapy or targeted agents. This review summarises the results of significant trials on d...

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Final results of the randomized phase III CHARTWEL-trial (ARO 97-1) comparing hyperfractionated-accelerated versus conventionally fractionated radiotherapy in non-small cell lung cancer (NSCLC)

Cited by 128 publications

References 40 publications

Joint Mean-Variance Overall Survival Time fitted Models from Stage III Non-Small Cell Lung Cancer

Joint Mean-Variance Overall Survival Time fitted Models from Stage III Non-Small Cell Lung Cancer

Combined Modality Therapy for Thoracic and head and Neck Cancers: A Review of Updated Literature Based on a Consensus Meeting

Definitive Radiotherapy in Locally Advanced Non-Small Cell Lung Cancer: Dose and Fractionation

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