Tumor volum in lung cancerGTV differentially impacts locoregional control of non-small cell lung cancer (NSCLC) after different fractionation schedules: Subgroup analysis of the prospective randomized CHARTWEL trial
Section snippets
The CHARTWEL trial
The phase III multi-centre randomized CHARTWEL trial (ARO 97-1) was performed between 1997 and 2005. One hundred and sixty three of the 406 patients with NSCLC were treated in the Department of Radiation Oncology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Germany, and this was the largest subgroup in the study. Of the 163 patients, 81 were randomly assigned to conventional fractionation (CF) and 82 patients were randomized to CHARTWEL (CW). The treatment protocol has
Results
In contrast to the intent-to-treat complete dataset of all 406 patients treated in the randomized multicentre CHARTWEL trial [6], the analysis of this largest single centre subset revealed a significant decrease of locoregional failure (LF), which was found after accelerated hyperfractionated radiotherapy in univariate analysis (Table 2a). Disease free survival (DFS), distant metastases rate (DM) and overall survival (OS) did not differ significantly between the treatment arms (Table 2a). The
Discussion
The present re-analysis of a large single-centre subset of the CHARTWEL-bronchus randomized trial provides evidence that the size of the negative impact of GTV on tumour control after radiotherapy of NSCLC differs between conventional fractionation and hyperfractionated-accelerated treatment. While the hazard of LF increases with increasing tumour volume for both conventional fractionation and CHARTWEL, the increase for the latter was found to be much less pronounced and not significant, i.e.
Conflict of Interest
The authors have no financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work.
Acknowledgements
The CHARTWEL trial was supported by the Deutsche Krebshilfe (German Cancer Foundation, grant number T1/Ba1, #70-2206). M.S. was supported by a grant from the DAAD-GERLS (German academic exchange service – German Egyptian Research Long-term Scholarship), financed by DAAD and the Egyptian Ministry of Higher Education. MK and MB receive support by the Bundesministerium für Bildung und Forschung (BMBF, BMBF-ZIK program 01KS9602) and the German Consortium for Translational Cancer Research (DKTK).
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2019, Clinical and Translational Radiation OncologyCitation Excerpt :The logistic regression model for 2-year LRC based on the primary tumour volume could be improved by including the p16 status and the CD44 protein status, which is in line with the previous training cohort [1]. The volume of the primary tumour is a widely accepted prognostic biomarker for the outcome of radiotherapy in patients with HNSCC [20,22,34] and showed a significant correlation to LRC in the training cohort. In validation, the affected lymph node volume was significantly related to LRC, while the volume of the primary tumour showed no significant association.
- 1
Current address: MAASTRO (Maastricht Radiation Oncology), Radiotherapy Dept., Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- 2
Current address: Dept. of Radiation Oncology and OncoRay, Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.
- 3
Current address: Universitätsklinik für Radioonkologie, Eberhard-Karls-Universität Tübingen, Germany.
- 4
Shared first authorship.