Radiation Oncology/Randomized

Meta-analysis and Systemic Review
A

Acute Lymphoblastic Leukemia (ALL) Acute Myeloid Leukemia (AML) Adolescents, Cancer in   Adrenocortical Carcinoma AIDS-Related Cancers Kaposi Sarcoma (Soft Tissue Sarcoma) AIDS-Related Lymphoma (Lymphoma) Primary CNS Lymphoma (Lymphoma) Anal Cancer Appendix Cancer - see Gastrointestinal Neuroendocrine Tumors Astrocytomas, Childhood (Brain Cancer) Atypical Teratoid/Rhabdoid Tumor, Childhood, Central Nervous System (Brain Cancer)

B

Basal Cell Carcinoma of the Skin - see Skin Cancer Bile Duct Cancer Bladder Cancer Bone Cancer (includes Ewing Sarcoma and Osteosarcoma and Malignant Fibrous Histiocytoma) Brain Tumors Breast Cancer Bronchial Tumors (Lung Cancer) Burkitt Lymphoma - see Non-Hodgkin Lymphoma

C

Carcinoma of Unknown Primary Central Nervous System Atypical Teratoid/Rhabdoid Tumor, Childhood (Brain Cancer) Medulloblastoma and Other CNS Embryonal Tumors, Childhood (Brain Cancer) Germ Cell Tumor, Childhood (Brain Cancer) Primary CNS Lymphoma Cervical Cancer Childhood Cancers Childhood Cardiac Tumors Treatment Cancers of Childhood, Rare Cholangiocarcinoma - see Bile Duct Cancer Chordoma, Childhood (Bone Cancer) Chronic Lymphocytic Leukemia (CLL) Chronic Myelogenous Leukemia (CML) Chronic Myeloproliferative Neoplasms Colorectal Cancer Craniopharyngioma, Childhood (Brain Cancer) Cutaneous T-Cell Lymphoma - see Lymphoma (Mycosis Fungoides and Sézary Syndrome)

D

Ductal Carcinoma In Situ (DCIS) - see Breast Cancer

E

Embryonal Tumors, Medulloblastoma and Other Central Nervous System, Childhood (Brain Cancer) Endometrial Cancer (Uterine Cancer) Ependymoma, Childhood (Brain Cancer) Esophageal Cancer Esthesioneuroblastoma (Head and Neck Cancer) Ewing Sarcoma (Bone Cancer) Extracranial Germ Cell Tumor, Childhood Extragonadal Germ Cell Tumor Eye Cancer Intraocular Melanoma Retinoblastoma

F

Fallopian Tube Cancer

G

Gallbladder Cancer Gastric (Stomach) Cancer Gastrointestinal Neuroendocrine Tumors Gastrointestinal Stromal Tumors (GIST) (Soft Tissue Sarcoma) Germ Cell Tumors Childhood Central Nervous System Germ Cell Tumors (Brain Cancer) Childhood Extracranial Germ Cell Tumors Extragonadal Germ Cell Tumors Ovarian Germ Cell Tumors Testicular Cancer Gestational Trophoblastic Disease

H

Hairy Cell Leukemia Head and Neck Cancer Heart Tumors, Childhood Hepatocellular (Liver) Cancer Histiocytosis, Langerhans Cell Hodgkin Lymphoma Hypopharyngeal Cancer (Head and Neck Cancer)

I

Intraocular Melanoma Islet Cell Tumors, Pancreatic Neuroendocrine Tumors

K

Kaposi Sarcoma (Soft Tissue Sarcoma) Kidney (Renal Cell) Cancer

L

Langerhans Cell Histiocytosis Laryngeal Cancer (Head and Neck Cancer) Leukemia Lip and Oral Cavity Cancer (Head and Neck Cancer) Liver Cancer Lung Cancer (Non-Small Cell, Small Cell, Pleuropulmonary Blastoma, Pulmonary Inflammatory Myofibroblastic Tumor, and Tracheobronchial Tumor) Lymphoma

M

Male Breast Cancer Melanoma Melanoma, Intraocular (Eye) Merkel Cell Carcinoma (Skin Cancer) Mesothelioma, Malignant Metastatic Cancer Metastatic Squamous Neck Cancer with Occult Primary (Head and Neck Cancer) Midline Tract Carcinoma With NUT Gene Changes Mouth Cancer (Head and Neck Cancer) Multiple Endocrine Neoplasia Syndromes Multiple Myeloma/Plasma Cell Neoplasms Mycosis Fungoides (Lymphoma) Myelodysplastic Syndromes, Myelodysplastic/Myeloproliferative Neoplasms Myelogenous Leukemia, Chronic (CML) Myeloid Leukemia, Acute (AML) Myeloproliferative Neoplasms, Chronic

N

Nasal Cavity and Paranasal Sinus Cancer (Head and Neck Cancer) Nasopharyngeal Cancer (Head and Neck Cancer) Neuroblastoma Neuroendocrine Tumors (Gastrointestinal) Non-Hodgkin Lymphoma Non-Small Cell Lung Cancer

O

Oral Cancer, Lip and Oral Cavity Cancer and Oropharyngeal Cancer (Head and Neck Cancer) Osteosarcoma and Undifferentiated Pleomorphic Sarcoma of Bone Treatment Ovarian Cancer

P

Pancreatic Cancer Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Papillomatosis (Childhood Laryngeal) Paraganglioma Paranasal Sinus and Nasal Cavity Cancer (Head and Neck Cancer) Parathyroid Cancer Penile Cancer Pharyngeal Cancer (Head and Neck Cancer) Pheochromocytoma Pituitary Tumor Plasma Cell Neoplasm/Multiple Myeloma Pleuropulmonary Blastoma (Lung Cancer) Pregnancy and Breast Cancer Primary Central Nervous System (CNS) Lymphoma Primary Peritoneal Cancer Prostate Cancer Pulmonary Inflammatory Myofibroblastic Tumor (Lung Cancer)

R

Rare Cancers of Childhood Rectal Cancer Recurrent Cancer Renal Cell (Kidney) Cancer Retinoblastoma Rhabdomyosarcoma, Childhood (Soft Tissue Sarcoma)

S

Salivary Gland Cancer (Head and Neck Cancer) Sarcoma Childhood Rhabdomyosarcoma (Soft Tissue Sarcoma) Childhood Vascular Tumors (Soft Tissue Sarcoma) Ewing Sarcoma (Bone Cancer) Kaposi Sarcoma (Soft Tissue Sarcoma) Osteosarcoma (Bone Cancer) Soft Tissue Sarcoma Uterine Sarcoma Sézary Syndrome (Lymphoma) Skin Cancer Small Cell Lung Cancer Small Intestine Cancer Soft Tissue Sarcoma Squamous Cell Carcinoma of the Skin - see Skin Cancer Squamous Neck Cancer with Occult Primary, Metastatic (Head and Neck Cancer) Stomach (Gastric) Cancer

T

T-Cell Lymphoma, Cutaneous - see Lymphoma (Mycosis Fungoides and Sèzary Syndrome) Testicular Cancer Throat Cancer (Head and Neck Cancer) Nasopharyngeal Cancer Oropharyngeal Cancer Hypopharyngeal Cancer Thymoma and Thymic Carcinoma Thyroid Cancer Tracheobronchial Tumors (Lung Cancer) Transitional Cell Cancer of the Renal Pelvis and Ureter (Kidney (Renal Cell) Cancer)

U

Unknown Primary, Carcinoma of   Ureter and Renal Pelvis, Transitional Cell Cancer (Kidney (Renal Cell) Cancer    Urethral Cancer    Uterine Cancer, Endometrial    Uterine Sarcoma

V

Vaginal Cancer Vascular Tumors (Soft Tissue Sarcoma) Vulvar Cancer

W

Wilms Tumor and Other Childhood Kidney Tumors

Y

Young Adults, Cancer in

Randomized Evidence
(In the process of being crosslinked)
 * Anal canal
 * Benign Diseases
 * Bladder
 * Brain Metastases
 * Breast
 * Cervix
 * Cholangiocarcinoma
 * Colon
 * Endometrial
 * Epilepsy
 * Esophagus
 * Gastric
 * Gliomas
 * Head & Neck
 * Hodgkin's Disease
 * Heel Spurs
 * Kaposi's Sarcoma
 * Lung, NSCLC
 * Lung, SCLC
 * Lymphoma, Non-Hodgkin's
 * Medulloblastoma
 * Mesothelioma
 * Melanoma, Cutaneous
 * Melanoma, Ocular
 * Pancreas
 * Prostate
 * Rectum
 * Sarcoma
 * Skin Non-melanoma
 * Spinal Cord Compression
 * Superior Vena Cava Syndrome
 * Testis, NSGCT
 * Thymoma
 * Vascular Brachytherapy
 * Wilms' Tumor (Nephroblastoma)
 * Hyperthermia
 * Supportive Care
 * RT Technology
 * Proton Therapy

Literature Review

 * Kentucky; 2009 PMID 19111269 -- "Randomized prospective trials of innovative radiotherapy technology are necessary." (Halperin EC, J Am Coll Radiol. 2009 Jan;6(1):33-7.)
 * "It is possible to identify innovations that should be required to meet the standard of proof of a benefit in a randomized prospective clinical trial before being introduced into widespread clinical practice."


 * NCI Canada; 2008 (1975–2004) PMID 18955452 -- "Evolution of the Randomized Controlled Trial in Oncology Over Three Decades." (Booth CM, J Clin Oncol. 2008 Oct 27. [Epub ahead of print])
 * 321 reports evaluating RCT in systemic therapy for breast, CRC, and NSCLC reviewed.
 * Outcome: Number and size of RCT increased substantially. For profit sponsorship increased substantially (4% to 57%, SS). Effect size remained stable, but authors have become more likely to strongly endorse experimental arm (SS). Endorsement of experimental arm strongly associated with industry sponsorship


 * Wisconsin; 2008 PMID 18237799 -- "Randomized controlled trials in health technology assessment: Overkill or overdue?" (Bentzen SM, Radiother Oncol. 2008 Jan 29 [Epub ahead of print])


 * Oxford; 2007 PMID 17303884 -- "When are randomised trials unnecessary? Picking signal from noise." (Glasziou P, BMJ. 2007 Feb 17;334(7589):349-51.)


 * RTOG; 2005 (1968–2002) PMID 15728168 -- "Evaluation of new treatments in radiation oncology: are they better than standard treatments?" (Soares HP, JAMA. 2005 Feb 23;293(8):970-8.)
 * Review of all completed Phase III RTOG trials. 57 trials, 12734 patients
 * Outcome: survival OR for intervention arm over standard arm 1.01 (NS). Only 10% significantly better, 88% inconclusive
 * Toxicity: treatment-related mortality intervention arm worse OR 1.76 over standard arm (SS)
 * Conclusion: Results of individual trials cannot be predicted in advance


 * COG; 2005 (1955–1997) PMID 16299015 -- "Are experimental treatments for cancer in children superior to established treatments? Observational study of randomised controlled trials by the Children's Oncology Group." (Kumar A, BMJ. 2005 Dec 3;331(7528):1295. Epub 2005 Nov 18.)
 * Review of completed Phase III trials. 126 trials, 36567 patients
 * Outcome: survival OR 0.96 (NS)
 * Conclusion: New treatments in childhood cancer are as likely to be inferior as they are to be superior to standard treatments