Hyperfractionated accelerated radiotherapy (hart) for inoperable, nonmetastatic non-small cell lung carcinoma of the lung (nsclc): results of a phase ii study for patients ineligible for combination radiochemotherapy

Koutaissoff, S.; Wellmann, D; Coucke, Philippe; Ozşahin, Mahmut; Pampallona, Sandro; Mirimanoff, René-Olivier

doi:10.1016/s0360-3016(99)00307-7

Cited by 9 publications

(10 citation statements)

References 36 publications

(35 reference statements)

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“…Data from a total of 19 trials were selected. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The equivalent dose for fractionation 2 Gy per fraction was calculated. The number of patients and the number of responders was also used and the Poisson model was used to estimate the dose versus 1-year-survival curve.…”

Section: -Year Survivalmentioning

confidence: 99%

Clinical survey for registering treatment decision criteria in advanced non-small-cell lung cancer radiotherapy and determination of the dose–response relationship for 1-year survival

et al. 2013

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Purpose: Recent studies have suggested significant variations in radiotherapy schedules used to treat advanced non-small-cell lung cancer (NSCLC), both between different centers in one country as well as between countries. In this study, different treatment methodologies have been explored using management plans proposed by radiation oncologists regarding general questions and theoretical case histories for patients with advanced NSCLC.Materials and methods: The survey was conducted by sending a questionnaire to 24 radiotherapy centers in Europe. The questionnaire was composed of two sections. The first section concerned reasons for giving radiotherapy, parameters that influence the choice of total dose and fractionation for radiotherapy and kind of equipment used. The second section concerned the management of five theoretical patients (A-E) regarding the selection of the radiotherapy technique and the aim of treatment (radical or palliative). Furthermore, 19 trials comparing different regimens of palliative radiotherapy in patients with NSCLC were reviewed. There were marked differences in the doses of the investigated radiotherapy schemes, the patient characteristics and the assessed outcome measures.Results: 70% of the responders answered that the most important factors for deciding what dose and fractionation scheme to use were: metastases, performance status (PS) of the patient, lung function and size of the primary tumour. The most common reasons for giving the treatment were symptom relief, prolongation of life and, in some cases, possibly cure. More than 95% of the responders stated that they would give radiotherapy in each of these cases. The total doses proposed where 20 Gy in five fractions or 30 Gy in ten fractions in 2 weeks for the cases A and D. If the previous two schemes were converted to a fractionation scheme delivering 2 Gy per fraction, the equivalent doses would be 23 and 33 Gy, respectively. For the cases B, C and E, the proposed fractionation schemes were 2 Gy daily to 60-68 Gy in 18 6 weeks or 2 Gy daily to 68 Gy in 7 weeks. For the case E, 20% of the responders suggested Stereotactic Body Radiotherapy (SBRT) giving 21 Gy three times a week with a day apart to 63 Gy. The total dose and number of fractions of radiotherapy are related to the perceived aims and expectations of treatment. Those aiming at extending life would give significantly higher total doses in a larger number of fractions, whereas those aiming at relieving symptoms would give significantly lower total doses. There is evidence for an increase in survival, in patients who are given higher radiotherapy doses, especially in those patients with better PS.Conclusions: This survey demonstrates a range of treatment strategies for advanced and inoperable NSCLC within Europe. There are a number of factors that influence the perceived aims of treatment and treatment planning. These factors should be taken into account when evaluating the effectiveness of different irradiation techniques, especially in the determination of radiobio...

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Section: -Year Survivalmentioning

confidence: 99%

Clinical survey for registering treatment decision criteria in advanced non-small-cell lung cancer radiotherapy and determination of the dose–response relationship for 1-year survival

et al. 2013

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“…38,39 Novel fractionation schedules have been explored with the aim of improving local tumor control and survival without increasing late morbidity (Table 2). [40][41][42][43][44][45][46][47][48][49][50][51] In hyperfractionated radiotherapy, the dose per fraction is reduced and the total dose is increased to give improved tumor control without increased late morbidity. The RTOG clinical trials used hyperfractionated radiotherapy, 1.2 'Gy/fraction, twice a day, for a total dose of 69.6 'Gy.…”

Section: Fractionationmentioning

confidence: 99%

“…5,15, [41][42][43] More recently, continuous hyperfractionated accelerated radiotherapy (CHART) and hyperfractionated accelerated radiation therapy (HART) have been investigated. [45][46][47][48][49][50][51] CHART consisted of 36 small fractions of 1.5 'Gy given three times per day, to give 54 'Gy in only 12 consecutive days, including the weekend. CHART, compared with conventional radiotherapy, gave a significant improvement in the survival of patients with NSCLC.…”

Section: Fractionationmentioning

confidence: 99%

“…HART consisted of a total dose of 57.6 'Gy in 36 fractions, delivered over 15 days, with the use of three daily fractions with a 4-h interval between fractions and an 8-h interval between on-cord fields. 48,49 Patients are not treated on weekends. The results of a phase III study which compared standard thoracic radiotherapy with HART after induction chemotherapy for patients with unresectable NSCLC were reported from the Eastern Cooperative Oncology Group (ECOG).…”

Section: Fractionationmentioning

confidence: 99%

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Chemoradiotherapy for lung cancer: current status and perspectives

Ohe

2004

Int J Clin Oncol

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For many years, thoracic radiotherapy had been regarded as the standard treatment for patients with unresectable locally advanced non-small cell lung cancer. However, meta-analyses show that cisplatin-containing chemoradiotherapy is significantly superior to radiotherapy alone in terms of survival. Moreover, concurrent chemoradiotherapy yields a significantly increased response rate and enhanced survival duration when compared with the sequential approach. Cisplatin-based chemotherapy with concurrent thoracic radiotherapy yields a 5-year survival rate of approximately 15% for patients with unresectable locally advanced non-small cell lung cancer. The state-of-the-art treatment for limited-stage small cell lung cancer is considered to be four cycles of combination chemotherapy with cisplatin plus etoposide combined with early concurrent twice-daily thoracic irradiation (45 Gy). If patients achieve complete remission, prophylactic cranial irradiation should be administered. A 5-year survival rate of approximately 25% is expected with the state-of-the-art treatment for limited-stage small cell lung cancer. Chemoradiotherapy is considered to be a standard treatment for both unresectable locally advanced non-small cell lung cancer and limited-stage small cell lung cancer. Several new strategies are currently being investigated to improve the survival of these patients. The incorporation of target-based drugs such as gefitinib is considered to be the most promising strategy for unresectable locally advanced non-small cell lung cancer. The incorporation of irinotecan is also a promising strategy to improve the survival of patients with limited-stage small cell lung cancer. The Japan Clinical Oncology Group is conducting clinical trials to develop new treatment strategies for both unresectable locally advanced non-small cell lung cancer and limited-stage small cell lung cancer.

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“…To overcome some of these logistic problems accelerated RT regimens without treatment at weekends (HART or CHARTWEL) have been developed in Europe (50) and the USA (51,52).…”

Section: Overviewmentioning

confidence: 99%

A Systematic Overview of Radiation Therapy Effects in Non-Small Cell Lung Cancer

et al. 2003

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A systematic review of radiation therapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation of the scientific literature are described separately (Acta Oncol 2003; 42: 357-365). This synthesis of the literature on radiation therapy for non-small cell lung cancer (NSCLC) is based on data from 4 meta-analyses and 31 randomized trials. Moreover, data from 12 prospective studies, 12 retrospective studies and 6 other articles were used. In total, 65 scientific articles are included, involving 18 310 patients. The results were compared with those of a similar overview from 1996 including 28 172 patients. The conclusions reached can be summarized as follows: Extensive clinical experience indicates that radiotherapy for medically inoperable patients or patients refusing surgery with NSCLC stage I/II prolongs survival, 15 -20% of these patients reaching long-term (5-year) survival. However, no randomized trials have addressed this issue. There is strong evidence that postoperative radiotherapy in radically resected stage I/II NSCLC does not prolong survival compared with observation alone. There is some evidence that continuous hyperfractionated accelerated radiotherapy (CHART) is associated with increased survival compared to conventional radiotherapy in locally advanced NSCLC and also in medically unfit patients with stage I/II NSCLC. However, the benefit is limited to squamous cell histology. There is strong evidence that combined modality treatment with platinum-based chemotherapy and radiotherapy, either neoadjuvant or concomitant, is superior to radiotherapy alone in terms of survival in locally advanced unresectable NSCLC and should be the standard of care in patients with good performance status. There is some evidence that concomitant chemo-radiotherapy is associated with increased survival compared with sequential chemo-radiotherapy, albeit at the price of increased toxicity Comment: Combined chemo-radiotherapy of primary non-resectable stage III NSCLC followed by surgery in responders lacks evidence from prospective randomized trials and cannot be recommended for routine use. There is strong evidence that radiotherapy can palliate symptoms associated with the intrathoracic tumour burden. There is some evidence that two large fractions may be as effective as conventional schedules consisting of 10-13 smaller fractions in terms of palliation of symptoms. There is some evidence that endobronchial brachytherapy for palliation of symptoms associated with endobronchial tumours is not superior to external beam radiotherapy.

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Hyperfractionated accelerated radiotherapy (hart) for inoperable, nonmetastatic non-small cell lung carcinoma of the lung (nsclc): results of a phase ii study for patients ineligible for combination radiochemotherapy

Cited by 9 publications

References 36 publications

Clinical survey for registering treatment decision criteria in advanced non-small-cell lung cancer radiotherapy and determination of the dose–response relationship for 1-year survival

Clinical survey for registering treatment decision criteria in advanced non-small-cell lung cancer radiotherapy and determination of the dose–response relationship for 1-year survival

Chemoradiotherapy for lung cancer: current status and perspectives

A Systematic Overview of Radiation Therapy Effects in Non-Small Cell Lung Cancer

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