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Prospective randomized clinical studies involving reirradiation: lessons learned


Nieder, Carsten; Langendijk, Johannes A; Guckenberger, Matthias; Grosu, Anca L (2016). Prospective randomized clinical studies involving reirradiation: lessons learned. Strahlentherapie und Onkologie, 192(10):679-686.

Abstract

BACKGROUND: Reirradiation is a potentially useful option for many patients with recurrent cancer. The purpose of this study was to review all recently published randomized trials in order to identify methodological strengths and weaknesses, comment on the results, clinical implications and open questions, and give advice for the planning of future trials.
MATERIALS AND METHODS: Systematic review of trials published between 2000 and 2015 (databases searched were PubMed, Scopus and Web of Science).
RESULTS: We reviewed 9 trials, most of which addressed reirradiation of head and neck tumours. The median number of patients was 69. Trial design, primary endpoint and statistical hypotheses varied widely. The results contribute mainly to decision making for reirradiation of nasopharynx cancer and bone metastases. The trials with relatively long median follow-up confirm that serious toxicity remains a concern after high cumulative total doses.
CONCLUSION: Multi-institutional collaboration is encouraged to complete sufficiently large trials. Despite a paucity of large randomized studies, reirradiation has been adopted in different clinical scenarios by many institutions. Typically, the patients have been assessed by multidisciplinary tumour boards and advanced technologies are used to create highly conformal dose distributions.

Abstract

BACKGROUND: Reirradiation is a potentially useful option for many patients with recurrent cancer. The purpose of this study was to review all recently published randomized trials in order to identify methodological strengths and weaknesses, comment on the results, clinical implications and open questions, and give advice for the planning of future trials.
MATERIALS AND METHODS: Systematic review of trials published between 2000 and 2015 (databases searched were PubMed, Scopus and Web of Science).
RESULTS: We reviewed 9 trials, most of which addressed reirradiation of head and neck tumours. The median number of patients was 69. Trial design, primary endpoint and statistical hypotheses varied widely. The results contribute mainly to decision making for reirradiation of nasopharynx cancer and bone metastases. The trials with relatively long median follow-up confirm that serious toxicity remains a concern after high cumulative total doses.
CONCLUSION: Multi-institutional collaboration is encouraged to complete sufficiently large trials. Despite a paucity of large randomized studies, reirradiation has been adopted in different clinical scenarios by many institutions. Typically, the patients have been assessed by multidisciplinary tumour boards and advanced technologies are used to create highly conformal dose distributions.

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3 citations in Web of Science®
3 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Radiation Oncology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:October 2016
Deposited On:12 Jan 2017 11:01
Last Modified:02 Feb 2018 10:30
Publisher:Springer
ISSN:0179-7158
OA Status:Closed
Publisher DOI:https://doi.org/10.1007/s00066-016-1024-6
PubMed ID:27534408

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