open access

Ahead of print
Other materials agreed with the Editors
Published online: 2021-08-20
Get Citation

Individually personalized radiotherapy vs. evidence (trials) based standards – paradigms and dilemmas

Bogusław A. Maciejewski, Adam Maciejczyk
DOI: 10.5603/NJO.a2021.0049

open access

Ahead of print
Review article
Published online: 2021-08-20

Abstract

This paper is open to discussion whether some questions, points of view, and doubts counterbalance the belief and dogmas that randomized clinical trials (mainly in radiotherapy) should be considered as the only source of guidelines to design novel therapeutic standards in radiotherapy. A number of the physics, radiotherapy, clinical radiobiology and genetic and molecular tumor’s characteristics suggest that radiotherapy protocols designed based on the “evidence based trials” seem to be antonymous to the individually personalized therapy. The major goal of this paper is to consider and discuss whether individually personalized radiotherapy is already attainably and reliable or is still the more or less probable expectation.

Abstract

This paper is open to discussion whether some questions, points of view, and doubts counterbalance the belief and dogmas that randomized clinical trials (mainly in radiotherapy) should be considered as the only source of guidelines to design novel therapeutic standards in radiotherapy. A number of the physics, radiotherapy, clinical radiobiology and genetic and molecular tumor’s characteristics suggest that radiotherapy protocols designed based on the “evidence based trials” seem to be antonymous to the individually personalized therapy. The major goal of this paper is to consider and discuss whether individually personalized radiotherapy is already attainably and reliable or is still the more or less probable expectation.

Get Citation

Keywords

physical vs biological doses; randomized trials; personalized radiotherapy; " caveat emptor"

About this article
Title

Individually personalized radiotherapy vs. evidence (trials) based standards – paradigms and dilemmas

Journal

Nowotwory. Journal of Oncology

Issue

Ahead of print

Article type

Other materials agreed with the Editors

Published online

2021-08-20

DOI

10.5603/NJO.a2021.0049

Keywords

physical vs biological doses
randomized trials
personalized radiotherapy
"caveat emptor"

Authors

Bogusław A. Maciejewski
Adam Maciejczyk

References (22)
  1. Fowler JF, Tomé WA, Fenwick JD, et al. A challenge to traditional radiation oncology. Int J Radiat Oncol Biol Phys. 2004; 60(4): 1241–1256.
  2. Tomé WA, Fowler JF. Selective boosting of tumor subvolumes. Int J Radiat Oncol Biol Phys. 2000; 48(2): 593–599.
  3. Johnson CR, Thames HD, Huang DT, et al. The tumor volume and clonogen number relationship: tumor control predictions based upon tumor volume estimates derived from computed tomography. Int J Radiat Oncol Biol Phys. 1995; 33(2): 281–287.
  4. Bentzen SM. Quantitative clinical radiobiology. Acta Oncol. 1993; 32(3): 259–275.
  5. Withers HR. Biological aspects of conformal therapy. Acta Oncol. 2000; 39(5): 569–577.
  6. Withers HR, Thames HD, Peters LJ. A new isoeffect curve for change in dose per fraction. Radiother Oncol. 1983; 1(2): 187–191.
  7. Maciejewski B, Withers HR, Taylor JM, et al. Dose fractionation and regeneration in radiotherapy for cancer of the oral cavity and oropharynx: tumor dose-response and repopulation. Int J Radiat Oncol Biol Phys. 1989; 16(3): 831–843.
  8. Steel GG. Basic clinical radiobiology. 3rd ed. Arnold – Oxford Univ. Press, New York 2002: 1–246.
  9. Withers HR, Taylor J, Maciejewski B. The hazard of accelerated tumor clonogen repopulation during radiotherapy. Acta Oncol. 2009; 27(2): 131–146.
  10. Maciejewski B, Suwiński R, Blamek S. Radiobiologia kliniczna w radioonkologii. Medycyna Praktyczna. 2019: 65–97.
  11. Withers HR. Biological bases for modifying conventional fractionation regimens in radiotherapy. Strahlentherapie. 1984; 160(11): 670–677.
  12. Brizel D. Radiotherapy and concurrent chemotherapy for the treatment of locally advanced head and neck squamous cell carcinoma. Semin Radiat Oncol. 1998; 8(4): 237–246.
  13. Bernier J. Current state-of-the-art for concurrent chemoradiation. Semin Radiat Oncol. 2009; 19(1): 3–10.
  14. Pignon JP, Bourhis J, Domenge C, et al. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet. 2000; 355(9208): 949–955.
  15. Peters LJ, Wendt CD. Tumor volume as a predictor of radiocurability--a drop in the bucket? Int J Radiat Oncol Biol Phys. 1990; 19(2): 497–498.
  16. Brenner D. Dose, volume, and tumor-control predictions in radiotherapy. Int J Radiat Oncol Biol Phys. 1993; 26(1): 171–179.
  17. Bentzen SM. Towards evidence based radiation oncology: improving the design, analysis, and reporting of clinical outcome studies in radiotherapy. Radiother Oncol. 1998; 46(1): 5–18.
  18. Glatstein E. Personal thoughts on statistic: pitfals or lies, dam lies and statistics. Int J Radiat Oncol Biol Phys. 2004; 58: 1329–1333.
  19. Fastner G, Gaisberger C, Kaiser J, et al. ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy with electrons (IOERT) in breast cancer. Radiother Oncol. 2020; 149: 150–157.
  20. Leemans CR, Brakhuis BJ, Bratzenhoff RH. The molecular biology of head and neck cancer. Nat Rev Cancer. 2011; 1: 9–22.
  21. Baumann M, Kurth I, Cordes N. Molecular cancer and radiation biology. In: Principles and Practice of Radiation Oncology. 7th ed. Wolter and Kluwer 2019: 71–86.
  22. Baumann M, Krause M, Hill R. Exploring the role of cancer stem cells in radioresistance. Nat Rev Cancer. 2008; 8(7): 545–554.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Wydawcą serwisu jest VM Media sp. z o.o. VM Group sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl