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Prospective randomized clinical studies involving reirradiation : Lessons learned
Carsten Nieder1,2, Johannes A Langendijk3, Matthias Guckenberger4
1Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway. carsten.nieder@nlsh.no.
Summary
Reirradiation, the use of radiation therapy more than once, is a viable option for recurrent cancer. However, high cumulative doses can lead to serious toxicity, necessitating careful planning for future trials.
Area of Science:
- Oncology
- Radiation Oncology
- Clinical Trials
Background:
- Reirradiation offers a potential treatment avenue for patients experiencing recurrent cancer.
- Evaluating past randomized trials is crucial for understanding reirradiation's efficacy and limitations.
Purpose of the Study:
- To systematically review randomized trials on reirradiation published between 2000 and 2015.
- To identify methodological strengths and weaknesses in existing reirradiation trials.
- To provide guidance for future clinical trial design in reirradiation.
Main Methods:
- Systematic review of randomized controlled trials.
- Literature search conducted across PubMed, Scopus, and Web of Science databases.
- Focus on trials published from 2000 to 2015.
Main Results:
- Nine trials were reviewed, predominantly focusing on head and neck cancers.
- Significant variability observed in trial design, primary endpoints, and statistical hypotheses.
- Results primarily inform reirradiation decisions for nasopharynx cancer and bone metastases.
- Serious toxicity is a concern with high cumulative doses, even with longer follow-up.
Conclusions:
- Multi-institutional collaboration is vital for conducting adequately powered reirradiation trials.
- Despite limited large-scale studies, reirradiation is increasingly used in clinical practice.
- Patient assessment by multidisciplinary teams and advanced conformal radiotherapy techniques are standard.
