Objective: The unresectable stage III non-small-cell lung cancer (NSCLC) is usually treated with concurrent chemo-radiotherapy. To overcome the normal tissue toxicity without affecting tumor control a new regimen was modified as CHARTWEL (continuous accelerated hyper-fractionated radiotherapy week-end less). In the present study we compared the results (in terms of loco-regional control & overall survival) of induction CT followed by CHARTWEL v/s conventional radiotherapy+chemotherapy.

Materials and Methods: Total 50 patients with unresectable stage III NSCLC were first given four cycles of neo-adjuvant chemotherapy (Inj. Cisplatin 75 mg/m² divided into day 1 and day 2 and Inj. Paclitaxel 175 mg/m² intravenous on day 1). After it 25 patients received 58.5Gy/39fr in 17 days (1.5 Gy/# , 3#/day, 6 hours apart) week-end less while other 25 received 66Gy/33fr with conventional fractionation. Disease response was evaluated by RECIST criteria at 6 month. Then follow up was done after 1, 2 and 3 year to evaluate the overall survival.

Results: Overall 28% of patients in study arm and 20% in control arm had complete response at 6 month. Loco-regional disease control was 44% and 32% in study & control arm respectively (p value>0.05) at 6 month. There was no statistical difference in grades of toxicities. Overall survival rates (primary end point) at 1, 2 and 3 years were 60%, 16.67% and 16.67% respectively in control (conventional RT) arm while in study (CHARTWEL) arm those values were 60%,30% & 20% respectively, but statistically non-significant.

Conclusion: Study suggests that CHARTWEL can be used in combination with neo-adjuvant chemotherapy to treat locally advanced lung cancer. Although, large multi-variate studies still needed to ascertain the need and benefits of CHARTWEL with neo-adjuvant chemotherapy.

Keywords: Unresectable stage III non-small-cell lung cancer, conventional radiation, CHARTWEL.

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Dr Rajesh Kumar