Radiotherapy Intensification for Solid Tumors: A Systematic Review of Randomized Trials
Abstract
Background Radiotherapy (RT) intensification, including both dose escalation and/or the use of altered fractionation, has been studied as a strategy to improve disease control for a number of malignancies. Here we systematically review the outcomes of randomized trials testing RT intensification. Methods We performed a literature search to identify randomized trials testing RT intensification for cancers of the central nervous system (CNS), head and neck, breast, lung, esophagus, rectum, and prostate. Findings were described qualitatively. Where adequate data were available, pooled estimates for the effect of RT intensification on local control (LC) or overall survival (OS) were obtained using the inverse variance method. Results In primary CNS tumors, esophageal cancer, and rectal cancer, randomized trials have not demonstrated that RT intensification improves clinical outcomes. In breast cancer and prostate cancer, dose escalation has been shown to improve LC or biochemical disease control but not OS. RT intensification may improve LC and OS in head and neck and lung cancers, but these benefits have generally been limited to studies that did not incorporate concurrent chemotherapy. Conclusions In randomized trials, the benefits of RT intensification have largely been restricted to trials in which concurrent chemotherapy was not utilized. Novel strategies to optimize the incorporation of RT in the multimodality treatment of solid tumors should be explored.
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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