Randomised multicentre trials of CHART vs conventional radiotherapy in head and neck and non-small-cell lung cancer: an interim report. CHART Steering Committee

Abstract

Summary While radiotherapy is proceeding. tumour cells may proliferate. The use of small individual doses reduces late morbidity. Continuous hy-perfractionated accelerated radiation therapy (CHART). which reduces overall treatment from 6-7 weeks to 12 days and gives 36 small fractions. has now been tested in multicentre randomised controlled clinical trials. The trial in non-small-cell lung cancer included 563 patients and showed improvement in survival: 30% of the CHART patients were alive at 2 years compared with 20% in the control group (P=0.006). In the 918 head and neck cases. there was only a small. non-significant improvement in the disease-free interval. In this interim anlavsis there was a trend for those with more advanced disease (T3 and T4) to show advantage: this will be subject to further analysis when the data are more mature. The earlv mucosal reactions appeared sooner and were more troublesome with CHART. however they quickly settled: so far no difference in long-term morbidity has emerged. These results support the hypothesis that tumour cell repopulation can occur during a conventional course of radiotherapy and be a cause of treatment failure.

Treatment-induced mucositis: an old problem with new remedies

“…In this study, there was a trend for improved local control of advanced tumours, particularly laryngeal cancer (Saunders et al, 1996). Acute skin reactions were less than with conventional regimens, as was late treatment-related morbidity.…”

“…The problem is particularly associated with accelerated hyperfractionated regimens. Mucosal reactions tend to peak earlier and are more severe but are of shorter duration than those after conventional treatment (Saunders et al, 1996). As these regimens are associated with improved local control, particularly in advanced disease (Horiot et al, 1997), any effective measure that can reduce this side-effect will be very useful to patients treated by twice or three times daily radiation regimens.…”

A Prospective Investigation of Swallowing, Nutrition, and Patient-rated Functional Impact Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

“…The use of altered fractionation radiotherapy (AFRT) for treatment of oropharyngeal cancer has demonstrated superiority in locoregional control and long-term survival when compared with conventionally fractionated radiotherapy [1][2][3] . AFRT with concomitant boost (AFRT-CB) delivers radiotherapy in an accelerated format without total dose reduction, resulting in heightened toxicity which may persist longer and result in a higher incidence of severe functional injury, including possible deleterious effects on swallowing and nutrition [4][5][6][7][8][9] .…”

What is the role of radiation-chemotherapy in the radical non-surgical management of carcinoma of the oesophagus?

“…Some statisticians and clinical triallists would prefer an approach to interim analyses that is more flexible and pragmatic to the stopping rules used in the Herskovic trial, formally and informally taking into account the degree of 'scepticism' prevalent at the time of a trial. A so-called Bayesian approach to monitoring trials (Parmar et (Saunders et al, 1996, one of the main conclusions was that overall treatment time was shown to be important with respect to survival in the management of squamous carcinomas of the bronchus . Perhaps future investigational therapy should involve a shorter overall treatment time for carcinoma of the oesophagus and indeed CHART for oesophageal carcinoma is currently being investigated (Powell et al, 1997).…”