JUNIPER PUBLISHERS-OPEN ACCESS JOURNAL OF HEAD NECK & SPINE SURGERY

JUNIPER PUBLISHERS-OPEN ACCESS JOURNAL OF HEAD NECK & SPINE SURGERY


Did Randomized Clinical Trials (RCT) and Continually are Contributing Evidence for Progress in Radiation Oncology

Authored by Bogusław Maciejewski

Since clinical trials have been advocated as evidence based guidelines for radiotherapy many RCTs were carried out. Can they be considered compared with empirical studies, as a milestone progress in radiation oncology. Large heterogenous tumor sites and stages were enrolled into the trials on hyperoxygen therapy, radiosensitizers and altered fractionations raise some uncertainties and criticism regarding therapeutic gain usually reported as median end-points. Local tumor control rates have been and still are related to the tumor TNM status, but almost never to initial tumor volume (number of initial cancer stem cells) whereas the effect of irradiation is cell killing, not tumor stage killing. Many RCTs became disappointing or at least therapeutic gain has been lower than expected. Well known trials are reviewed and discussed. In contrary, some retrospective studies have provided important practical information’s, i.g. tumor volume is more predictive to design dose fractionation than T stage, overall treatment time has been show as a strong determinant of treatment outcome. This finding initiated series of altered fractionation trials. Alpha/beta values for H&N tumors and cell survival curves derived from skin cancer data were one of the first estimations based on empirical clinical studies. Identifying very low alpha/beta for prostate cancer has attracted stereotactic hypofractionated radiosurgery as an effective therapeutic modality. In this review we discuss the pros and cons of the trials and empirical studies and it looks they are complementary to one another.

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