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