Details
Category: Volume 07 Issue 07 July 2019
Hits: 981

Title: Comparison of CHARTWEL and conventional radiotherapy after neoadjuvant chemotherapy in locally advanced non small cell lung cancer

Authors: Dr Anil Rajani, Dr Rajesh Kumar, Dr H.S. Kumar, Dr Neeti Sharma, Dr S.L. Jakhar

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.101

Abstract

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.

References

  1. Cancer today [Internet]. Global Cancer Observatory. [cited 2019Jun10]. Available from: https://gco.iarc.fr/today/home.
  2. Kaneko S, Ishikawa KB, Yoshimi I, et al. Projection of Lung cancer mortality in Japan. Cancer Sci 2003;94(10):919.
  3. Park. Park’s Textbook of Preventive and Social Medicine, 21st edition. chapter no.6- Epidemiology of chronic non communicable disease and conditions. Page no. 353-54.
  4. Perez C, Pajak T, Rubin P, et al. Long-term observations of the patterns of failure in patients with unresectable non-oat cell carcinoma of the Lung treated with definitive radiotherapy. Report by the Radiation Therapy Oncology Group. Cancer 1987;59:1874-1881.
  5. Non-Small Cell Lung Cancer Survival Rates [Internet]. American Cancer Society. [cited 2019Jun20]. Available from: https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosis-staging/survival-rates.html
  6. Induction Chemotherapy [Internet]. Induction Chemotherapy - an overview | Science Direct Topics. [cited 2019Jun18]. Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/induction-chemotherapy
  7. [cited 2019Jun18]. Available from: http://ozradonc.wikidot.com/altered-fractionation
  8. Ml Saunders', A Rojas2, BE Lyn', K Pigott', M Powell', K Goodchild', PJ Hoskin', H Phillips' and N Verma. Experience with dose escalation using CHARTWEL (continuous hyperfractionated accelerated radiotherapy weekend less) in non-small-cell lung cancer. British Journal of Cancer 1 998; 7841 0: 1 323-1328.
  9. Jindal SK, Malik SK, Datta BN; Lung cancer in Northern India     in relation to age, sex and smoking habits. Eur J Respir Dis, 1987. Jan;70(1):23-28.
  10. Curran W, Scott C, Langer C, et al. Long-term benefit is observed in a phase III comparison of sequential vs. concurrent chemo-radiation for patients with unresected stage III nonsmall-cell lung cancer: Pro Am Soc Clin Oncol 2003;22:621.
  11. Rolland E, LE Chevalier T, Auperin A et al. sequential radio-chemotherapy vs concurrent radio-chemotherapy vs radiotherapy alone in Locally Advanced NSCLC; Two meta-analysis using Individual Patients Data(IPD) from randomized clinical trials (RCTs). J Thorac Oncol (
    2007) 2(8):s309-s310.
  12. Auperin A, Le Pechoux C, Rolland E, et al. Meta-analysis of CCRT verses sequential radiochemotherap in locally advanced non-small-cell lung cancer. J Clin Oncol 2010;28:2181-90.
  13. Curran WJ Jr1, Paulus R, Langer CJ, Komaki R, Lee JS, Hauser S, Movsas B, Wasserman T, Rosenthal SA, Gore E, Machtay M, Sause W, Cox JD. Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst.2011 Oct 5;103(19): 1452-60. doi: 10.1093/jnci/djr325. Epub 2011 Sep 8.
  14. Fournel P1, Robinet G, Thomas P, Souquet PJ, Léna H, Vergnenégre A, Delhoume JY, Le Treut J, Silvani JA, Dansin E, Bozonnat MC, Daurés JP, Mornex F, Pérol M; Groupe Lyon-Saint-Etienne d'Oncologie Thoracique-Groupe Français de Pneumo-Cancérologie. Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer: Groupe Lyon-Saint-Etienne d'Oncologie Thoracique-Groupe Français de Pneumo-Cancérologie NPC 95-01 Study. J Clin Oncol.2005 Sep 1;23(25):5910-7. Epub 2005 Aug 8.
  15. Aupérin A1, Le Péchoux C, Rolland E,  Curran WJ, Furuse K, Fournel P,  Belderbos J, Clamon G, Ulutin HC, Paulus R, Yamanaka T, Bozonnat MC, Uitterhoeve A, Wang X, Stewart L, Arriagada R, Burdett S, Pignon JP. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol. 2010 May 1;28(13):2181-90. doi: 10.1200/JCO.2009.26.2543. Epub 2010 Mar 29.
  16. Dillman R, Seagren S, Propert K, et al. A randomized trial of induction chemotherapy plus high-dose radiation versus radiation alone in stage III non-small-cell lung cancer. N Engl J Med 1990; 323:940-945.
  17. Vokes EE, Herndon JE 2nd, Kelley MJ, Cicchetti MG, Ramnath N, et al. induction chemotherapy followed by chemoradiotherapy compared with chemoradiotherapy alone for regionally advanced unresectable stage III Non-small-cell lung cancer: Cancer and Leukemia Group B. J Clin Oncol2007;25:1698-704.
  18. Belani CP, Choy H, Bonomi P, et al. Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-small-cell lung cancer: a randomized phase II locally advanced multi-modality protocol. J Clin Oncol 2005;23:5883-5891.
  19. Hotta, K., et al., Addition of platinum compounds to a new agent in patients with advanced non-small-cell lung cancer: a literature based meta-analysis of randomised trials. Ann Oncol, 2004. 15(12): p. 1782-9.
  20. Saunders M, Dische S, Barrett A, et al. Continuous, hyperfractionated, accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell Lung cancer: mature data from the randomised multicentre trial. Radiother Oncol 1999;52:137-148.
  21. I. Saunders, A. Rojasf1,B.E. Lyn,E. Wilson, H. Phillips. Dose-escalation with CHARTWEL (Continuous Hyperfractionated Accelerated Radiotherapy Week-End Less) Combined with Neo-adjuvant Chemotherapy in the Treatment of Locally Advanced Non-small Cell Lung Cancer. Clinical oncology, october 2002;14( 5): 352–360.

Corresponding Author

Dr Rajesh Kumar