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)

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • on behalf of the CHARTWEL-Bronchus studygroup - (Author)
  • M. Baumann - , Department of Radiotherapy and Radiooncology, University Hospital Carl Gustav Carus Dresden (Author)
  • T. Herrmann - , University Hospital Carl Gustav Carus Dresden, Department of Radiation Oncology (Author)
  • R. Koch - , University Hospital Carl Gustav Carus Dresden, Institute for Medical Informatics and Biometry (Author)
  • W. Matthiessen - , Lungenfachklinik Coswig (Author)
  • S. Appold - , Department of Radiotherapy and Radiooncology, University Hospital Carl Gustav Carus Dresden (Author)
  • B. Wahlers - , Hemer Hemer Lung Clinic Deutscher Gemeinschafts-Diakonieverband GmbH (Author)
  • L. Kepka - , Maria Sklodowska-Curie Institute of Oncology (Author)
  • G. Marschke - , Görlitz Clinic (Author)
  • D. Feltl - , Charles University Prague (Author)
  • R. Fietkau - , University of Rostock (Author)
  • V. Budach - , Charité – Universitätsmedizin Berlin (Author)
  • J. Dunst - , Martin Luther University Halle-Wittenberg (Author)
  • R. Dziadziuszko - , Medical University of Gdańsk (Author)
  • M. Krause - , Department of Radiotherapy and Radiooncology, University Hospital Carl Gustav Carus Dresden (Author)
  • D. Zips - , University Hospital Carl Gustav Carus Dresden, Department of Radiation Oncology (Author)

Abstract

Background: Continuous hyperfractionated accelerated radiotherapy (CHART) counteracts repopulation and may significantly improve outcome of patients with non-small-cell lung cancer (NSCLC). Nevertheless high local failure rates call for radiation dose escalation. We report here the final results of the multicentric CHARTWEL trial (CHART weekend less, ARO 97-1). Patients and methods: Four hundred and six patients with NSCLC were stratified according to stage, histology, neoadjuvant chemotherapy and centre and were randomized to receive 3D-planned radiotherapy to 60 Gy/40 fractions/2.5 weeks (CHARTWEL) or 66 Gy/33 fractions/6.5 weeks (conventional fractionation, CF). Results: Overall survival (OS, primary endpoint) at 2, 3 and 5 yr was not significantly different after CHARTWEL (31%, 22% and 11%) versus CF (32%, 18% and 7%; HR 0.92, 95% CI 0.75-1.13, p = 0.43). Also local tumour control rates and distant metastases did not significantly differ. Acute dysphagia and radiological pneumonitis were more pronounced after CHARTWEL, without differences in clinical signs of pneumopathy. Exploratory analysis revealed a significant trend for improved LC after CHARTWEL versus CF with increasing UICC, T or N stage (p = 0.006-0.025) and after neoadjuvant chemotherapy (HR 0.48, 0.26-0.89, p = 0.019). Conclusions: Overall, outcome after CHARTWEL or CF was not different. The lower total dose in the CHARTWEL arm was compensated by the shorter overall treatment time, confirming a time factor for NSCLC. The higher efficacy of CHARTWEL versus CF in advanced stages and after chemotherapy provides a basis for further trials on treatment intensification for locally advanced NSCLC.

Details

Original languageEnglish
Pages (from-to)76-85
Number of pages10
JournalRadiotherapy and oncology
Volume100
Issue number1
Publication statusPublished - Jul 2011
Peer-reviewedYes

External IDs

PubMed 21757247
ORCID /0000-0003-1776-9556/work/171065847

Keywords

Sustainable Development Goals

Keywords

  • Accelerated radiotherapy, Non-small cell lung cancer, Randomized trial, Time factor