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Prospective randomized clinical studies involving reirradiation

Lessons learned

Prospektiv randomisierte Studien über Rebestrahlung

Gewonnene Erkenntnisse

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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.

Zusammenfassung

Hintergrund

Eine Rebestrahlung kann für viele Patienten mit rezidivierenden Malignomen eine nützliche Option bieten. Der Zweck dieser Studie bestand darin, alle in der jüngeren Vergangenheit publizierten randomisierten Studien zu beurteilen, da deren methodische Stärken und Schwächen, Ergebnisse und resultierende Implikationen bzw. offene Fragen die Planung künftiger Studien wesentlich beeinflussen können.

Material und Methoden

Systematische Übersicht aller zwischen 2000 und 2015 veröffentlichten Studien (Literatursuche über PubMed, Scopus und Web of Science).

Ergebnisse

Ausgewertet wurden 9 Studien, in die vor allem Patienten mit Kopf-Hals-Tumoren eingeschlossen waren. Im Median hatten 69 Patienten teilgenommen. Das Studiendesign, der primäre Endpunkt und die statistischen Hypothesen waren sehr unterschiedlich. Die Resultate tragen hauptsächlich zur Wahl von Rebestrahlungskonzepten für Nasopharynxkarzinome und Knochenmetastasen bei. Die Studien mit längerer Nachbeobachtungszeit bestätigen, dass ernste Nebenwirkungen nach hohen kumulativen Totaldosen ein Problem darstellen.

Schlussfolgerung

Um Studien mit ausreichender Fallzahl abschließen zu können, sind multizentrische Kollaborationen erforderlich. Obwohl man sich auf wenige große randomisierte Studien stützen kann, haben viele Institutionen eine Rebestrahlung für zahlreiche klinische Fragestellungen etabliert. Geeignete Patienten werden meist in interdisziplinären Tumorboards vorgestellt und mittels fortschrittlicher Techniken hochkonformal und möglichst schonend bestrahlt.

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Authors and Affiliations

  1. Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway

    Carsten Nieder MD

  2. Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9038, Tromsø, Norway

    Carsten Nieder MD

  3. Department of Radiation Oncology, University Medical Centre Groningen, 9713, Groningen, The Netherlands

    Johannes A. Langendijk MD

  4. Department of Radiation Oncology, University Hospital Zürich, 8091, Zürich, Switzerland

    Matthias Guckenberger MD

  5. Department of Radiation Oncology, University Hospital Freiburg, 79106, Freiburg, Germany

    Anca L. Grosu MD

Authors
  1. Carsten Nieder MD
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  2. Johannes A. Langendijk MD
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  3. Matthias Guckenberger MD
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  4. Anca L. Grosu MD
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Corresponding author

Correspondence to Carsten Nieder MD.

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Conflict of interest

C. Nieder, J. A. Langendijk, M. Guckenberger and A. L. Grosu declares that they have no competing interests.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Nieder, C., Langendijk, J.A., Guckenberger, M. et al. Prospective randomized clinical studies involving reirradiation. Strahlenther Onkol 192, 679–686 (2016). https://doi.org/10.1007/s00066-016-1024-6

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  • DOI: https://doi.org/10.1007/s00066-016-1024-6

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