CHART radiotherapy for non-small cell lung cancer
This information is about a treatment called CHART radiotherapy. It should ideally be read with our general information about radiotherapy.
CHART is a particular way of giving radiotherapy. The initials stand for Continuous Hyperfractionated Accelerated Radiotherapy. CHART may be given to some people with a type of lung cancer called non-small cell lung cancer (NSCLC).
Studies have shown that CHART may work better for some people with inoperable NSCLC than standard daily radiotherapy.
You will see your doctor regularly while you have this treatment so they can monitor its effects. This information should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.
Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells.
Each radiotherapy treatment is called a fraction. In standard radiotherapy for lung cancer, one fraction or treatment is given daily, Monday-Friday, usually for several weeks. In CHART, more than one fraction is given each day (hyperfractionation). Reducing the time between fractions means there is less time between each treatment for the fast-growing cancer cells to recover.
Unlike standard radiotherapy, where there is a break from treatment at the weekend, people having CHART are given treatment every day including weekends. A modified type of CHART, called CHARTWEL, gives a break at the weekend.
In CHART, the number of treatments will be about the same as standard radiotherapy but the course will be completed sooner (accelerated treatment). The total dose of radiotherapy is similar to that given with standard radiotherapy.
CHART radiotherapy is only available in some hospitals. Where it is available, it can be offered in particular situations to people with certain stages of NSCLC.
The stage of a cancer is a term used to describe its size, position and whether it has spread beyond where it started in the body. Stage 1 describes a cancer in an early stage when it is usually small in size and hasn’t spread. Stage 4 describes cancer at a more advanced stage when it has usually spread to other parts of the body. Stages 2 and 3 are in between these stages.
CHART radiotherapy can be offered to people with stage 1 and 2 NSCLC whose tumour can't be operated on and people that can't have, or don't want, surgery. It can also be given to those with stage 3 NSCLC who aren't fit enough for, or don't want to have, both chemotherapy and radiotherapy.
Sometimes it may not be possible to give CHART - for example, if the tumour is too near the spinal cord or if the tumour and affected lymph nodes are too far apart.
Radiotherapy has to be carefully planned to make sure it works as well as possible. You will usually have a CT scan to take x-rays of the area to be treated. Treatment planning is a very important part of radiotherapy, and it may take a couple of visits.
Pinprick ‘tattoos’, or permanent marks will be made on your skin. These help the radiographers, who give you your treatment, position you accurately and show where the treatment is to be directed. The marks are permanent because they must remain visible throughout your treatment. At the beginning of your treatment, you will be given instructions on how to look after your skin.
Before each session of radiotherapy the radiographers will position you on the couch in the same position as during your treatment planning. The radiographers will leave the room while your treatment is given, but they will watch you on CCTV from the treatment control area, and you'll be able to talk to them. The treatment is painless and only takes a few minutes. You need to lie as still as possible while your treatment is given.
A typical schedule is treatment three times a day for 12 days in a row, including the weekends. Each treatment has to be given at least six hours apart. This allows the normal cells that have been damaged to recover between treatments and reduces the chance of long-term damage to normal tissues.
The first treatment is given early in the morning (about 8am), followed by one around lunchtime (about 2pm) and another in the early evening (about 8pm). This means that you’ll usually have to stay in the hospital, or nearby, while having CHART radiotherapy.
Possible side effects of CHART
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Giving radiotherapy over two weeks should allow the radiotherapy to be completed before side effects develop. However, a few side effects may develop towards the end of treatment or after it is finished.
Problems with swallowing
The main side effect of CHART is a sore gullet (food pipe), which is called oesophagitis. This may make swallowing more difficult. You may also have heartburn or indigestion if the gullet has narrowed during treatment. This tends to develop towards the end of treatment and may be at its worst during the few weeks just after treatment. It will then gradually improve.
Let your doctor know if you’re having problems swallowing, as they can give you medicine to help. Some liquid medicines may be helpful as they create a protective layer over sore areas and soothe the lining of the gullet. If you don’t feel like eating or have problems swallowing, you can replace meals with thick fluids, such as soups and puddings, or nutritious, high-calorie drinks. These drinks are available from most chemists, and your GP can prescribe them.
You may find that you feel tired during your radiotherapy. This may get worse as you go through treatment but should improve over a few weeks after it finishes. Pay attention to how you feel and, if necessary, allow yourself extra time to rest, perhaps by taking a nap in the afternoons.
Radiotherapy may irritate the chest. This means you may develop a cough during or after your treatment. You can ask your doctor for something to help with this. It usually improves about two weeks after you finish your treatment.
This may get slightly worse during treatment but usually improves when treatment is finished. If you have any breathing problems that get worse after finishing your treatment, it’s important to let your doctors at the hospital know as soon as possible. This is because it could be due to inflammation of the lungs (known as pneumonitis), which may need immediate treatment.
Some people may find that they get a skin reaction like mild sunburn on the area being treated, although this is unusual. You will be given advice on how to look after your skin by the radiographer giving your treatment.
Possible long-term side effect of CHART - Lung fibrosis
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Radiotherapy can cause some damage to the normal lung tissue around the tumour. This can sometimes result in scarring of the lung (fibrosis), which develops 6-9 months after radiotherapy and can cause breathlessness. The frequency of lung fibrosis is slightly higher in people having CHART radiotherapy compared to those having standard radiotherapy treatment.
This information has been compiled using information from a number of reliable sources, including:
Scottish Intercollegiate Guidelines Network (SIGN). Management of patients with lung cancer: a national clinical guideline. 2005.
National Institute for Health and Clinical Excellence (NICE). The Diagnosis and Treatment of Lung Cancer. April 2011.
Syrigos KN, et al. Radical radiotherapy in the management of Locally Advanced Non-Small-Cell Lung Cancer. 2006. Springer.
Rowell NP, Williams C, Radical radiotherapy for stage I/II non-small cell lung cancer in patients not sufficiently fit for or declining surgery (medically inoperable). The Cochrane Library. Jan 2009.
Thanks to Peggotty Moore, Macmillan Specialist Radiographer, and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.