# CHART

Source: https://onco.cc/trials/chart-lung/  
OnCo record `chart-lung` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A British radiotherapy schedule, invented at Mount Vernon, that squeezed a six-week course into twelve days and cut the risk of death by about a quarter.

## Summary

Michele Saunders and Stanley Dische reasoned that tumour cells repopulate during a conventional six-week radiotherapy course, so they built a schedule that gave the whole dose in twelve consecutive days, three fractions a day, weekends included. The trial entered 563 patients through 13 centres and randomised them 3 to 2 to CHART or conventional radiotherapy.

CHART reduced the relative risk of death by 24 percent, lifting two-year survival from 20 percent to 29 percent (p = 0.004). In squamous cell carcinoma, which was 82 percent of the trial, the reduction was 34 percent and two-year survival went from 19 percent to 33 percent. Severe dysphagia in the first three months was commoner with CHART (19 percent against 3 percent) but there was no important difference in other morbidity. The mature analysis confirmed a 22 percent reduction in the relative risk of death and a 21 percent reduction in local progression, and found a 24 percent reduction in the relative risk of metastasis, which the authors read as evidence that better local control prevents spread. The schedule was logistically hard for departments to run, and the UK kept iterating on it with CHART-ED and INCH.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-25
- Also known as: Continuous Hyperfractionated Accelerated Radiotherapy; CHART lung trial
- Tags: uk; radiotherapy; lung
- Phase: 3
- Setting: Non-small-cell lung cancer treated with radical radiotherapy: 54 Gy in 36 fractions of 1.5 Gy given three times a day, six hours apart, over 12 consecutive days including weekends, against conventional 60 Gy in 30 fractions over six weeks
- Sponsor: Medical Research Council and the Cancer Research Campaign, run from Mount Vernon Hospital
- Enrolled: 563
- Result: 24 percent reduction in the relative risk of death and an absolute two-year survival gain of nine percentage points, from 20 to 29 percent (p = 0.004); in squamous cancers a 34 percent reduction and a 14-point gain.
- Outcomes: Two-year overall survival: CHART 29 percent vs Conventional radiotherapy 20 percent, HR 0.76

## Sources

- Lancet 1997: https://europepmc.org/article/MED/9250182
- Radiotherapy and Oncology 1999 (mature results): https://europepmc.org/article/MED/10577699

## Connected records

- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Squamous cell carcinoma of the lung](https://onco.cc/cancers/lung-squamous-cell-carcinoma/)
- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/)
- technologies: [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/)
- institutions: [Mount Vernon Cancer Centre](https://onco.cc/institutions/mount-vernon-cancer-centre/)
- trials: [CONVERT](https://onco.cc/trials/convert/)

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