Continuous Hyperfractionated Accelerated Radiotherapy (CHART) and Non-conventionally Fractionated Radiotherapy in the Treatment of Non-small Cell Lung Cancer: a Review and Consideration of Future Directions

There is a well-established role for radiation treatment in the management of non-small cell lung cancer. As a single modality, it is indicated as a radical treatment option for patients deemed unsuitable for chemotherapy with inoperable locoregional disease or who decline surgery. In this patient group, the evidence shows advantages for accelerated treatment regimes, e.g. continuous hyperfractionated accelerated radiotherapy (CHART). Research efforts should be directed towards dose escalation with the application of the new technologies available. The multi-modality approach of chemoradiotherapy is established in the radical treatment of non-small cell lung cancer in those who are inoperable, radically treatable and fit enough to receive chemotherapy. How best these two modalities are combined remains unclear, and the combination of CHART and other non-conventionally fractionated radiotherapy schedules with chemotherapy and targeted agents is another potentially productive research area.