Applicability of randomized trials in radiation oncology to standard clinical practice.

Abstract:

BACKGROUND:Randomized controlled trials (RCTs) are commonly used to inform clinical practice; however, it is unclear how generalizable RCT data are to patients in routine clinical practice. The authors of this report assessed the availability and applicability of randomized evidence guiding medical decisions in a cohort of patients who were evaluated for consideration of definitive management in a radiation oncology clinic. METHODS:The medical records of consecutive, new patient consultations between January and March 2007 were reviewed. Patient medical decisions were classified as those with (Group 1) or without (Group 2) available, relevant level I evidence (phase 3 RCT) supporting recommended treatments. Group 1 medical decisions were further divided into 3 groups based on the extent of fulfilling eligibility criteria for each RCT: Group 1A included decisions that fulfilled all eligibility criteria; Group 1B, decisions that did not fulfill at least 1 minor eligibility criteria; or Group 1C, decisions that did not fulfill at least 1 major eligibility criteria. Patient and clinical characteristics were tested for correlations with the availability of evidence. RESULTS:Of the 393 evaluable patients, malignancies of the breast (30%), head and neck (18%), and genitourinary system (14%) were the most common presenting primary disease sites. Forty-seven percent of all medical decisions (n = 451) were made without available (36%) or applicable (11%) randomized evidence to inform clinical decision making. Primary tumor diagnosis was significantly associated with the availability of evidence (P < .0001). CONCLUSIONS:A significant proportion of medical decisions in an academic radiation oncology clinic were made without available or applicable level I evidence, underscoring the limitations of relying solely on RCTs for the development of evidence-based health care.

journal_name

Cancer

journal_title

Cancer

authors

Apisarnthanarax S,Swisher-McClure S,Chiu WK,Kimple RJ,Harris SL,Morris DE,Tepper JE

doi

10.1002/cncr.28149

subject

Has Abstract

pub_date

2013-08-15 00:00:00

pages

3092-9

issue

16

eissn

0008-543X

issn

1097-0142

journal_volume

119

pub_type

杂志文章

相关文献

CANCER文献大全
  • Combined VM-26 and cytosine arabinoside in treatment of refractory childhood lymphocytic leukemia.

    abstract::On the basis of previous findings at this institution, VM-26 and Cytosine Arabinoside (ara-C) were used in combination to treat 33 children with refractory acute lymphocytic leukemia (ALL). Chemotherapy was given by vein twice a week for four weeks at dosage of 300 mg/m2 for ara-C and 50, 75, 110, 165, or 200 mg/m2 fo...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19800315)45:6<1284::aid-cncr2820

    authors: Rivera G,Aur RJ,Dahl GV,Pratt CB,Wood A,Avery TL

    更新日期:1980-03-15 00:00:00

  • Immunoblastic sarcoma of B-cells in a 24-month-old child. Report of a case.

    abstract::Immunoblastic sarcoma is a malignancy of transformed lymphocytes with a high association of occurrence in patients with immune disorders. The youngest previously reported case occurred in a 6-year-old child with immunoblastic lymphadenopathy. The authors report the finding of immunoblastic sarcoma of B-cells in a prev...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19841101)54:9<2032::aid-cncr2820

    authors: Larson T,Katz DA,Mailliard JA

    更新日期:1984-11-01 00:00:00

  • The role of serum CEA as a prognostic indicator in stage II and III breast cancer patients treated with adjuvant chemotherapy.

    abstract::Carcinoembryonic antigen (CEA) values in 529 patients treated in two consecutive adjuvant chemotherapy protocols were analyzed to determine if CEA values correlated with disease-free status or prognostic utility. CEA values were evaluated preoperatively, before chemotherapy, at the conclusion of chemotherapy, and duri...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19890301)63:5<828::aid-cncr28206

    authors: Theriault RL,Hortobagyi GN,Fritsche HA,Frye D,Martinez R,Buzdar AU

    更新日期:1989-03-01 00:00:00

  • Carcinoma cuniculatum (verrucous carcinoma of the skin): a clinicopathologic study of 46 cases with ultrastructural observations.

    abstract::Forty-six examples of carcinoma cuniculatum, a rare variant of squamous cell carcinoma of the skin, were studied by means of light and electron microscopy and immunoperoxidase techniques. The tumors usually presented as ulcerated, fungating, and polypoid masses with openings of sinus tracts onto the skin surface that ...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19820601)49:11<2395::aid-cncr282

    authors: Kao GF,Graham JH,Helwig EB

    更新日期:1982-06-01 00:00:00

  • Atypical glandular cells of undetermined significance: clinically significant lesions and means of patient follow-up.

    abstract:BACKGROUND:The clinical significance of atypical glandular cells of undetermined significance (AGUS) remains poorly understood, and patient management is not standardized. The authors evaluated the rate, qualification, and follow-up (FU) findings of AGUS patients. METHODS:Computerized records from the authors' institu...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:

    authors: Soofer SB,Sidawy MK

    更新日期:2000-08-25 00:00:00

  • Results of a multicenter, randomized, double-blind phase 2/3 study of lenalidomide in the treatment of pretreated relapsed or refractory metastatic malignant melanoma.

    abstract:BACKGROUND:The results of an international, multicenter, randomized, double-blind, controlled study assessing the efficacy and safety of lenalidomide treatment in patients with refractory stage IV metastatic malignant melanoma are reported. METHODS:The study compared treatment with lenalidomide (25 mg/d on Days 1-21 o...

    journal_title:Cancer

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1002/cncr.24686

    authors: Eisen T,Trefzer U,Hamilton A,Hersey P,Millward M,Knight RD,Jungnelius JU,Glaspy J

    更新日期:2010-01-01 00:00:00

  • Dynamic alterations of the extracellular environment of ovarian surface epithelial cells in premalignant transformation, tumorigenicity, and metastasis.

    abstract:BACKGROUND:Ovarian surface epithelial cells are positionally organized as a single cell layer by a sheet of basement membrane. It is believed that the contact of the ovarian surface epithelial cells with the basement membrane regulates cell growth and ensures the organization of the epithelium. Disabled-2 (Dab2), a sig...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/cncr.10870

    authors: Capo-Chichi CD,Smith ER,Yang DH,Roland IH,Vanderveer L,Cohen C,Hamilton TC,Godwin AK,Xu XX

    更新日期:2002-10-15 00:00:00

  • The treatment of lymphoblastic lymphoma with antithymocyte globulin.

    abstract::A 20-year-old man with previously treated lymphoblastic lymphoma, a known T-cell disorder, developed progressive disease despite intensive combination chemotherapy with doxorubicin, vincristine, and prednisone. He was subsequently treated with a 21-day course of intravenous antithymocyte globulin at a dose of approxim...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19820701)50:1<57::aid-cncr282050

    authors: Wong KK Jr,Sweet DL,Variakojis D

    更新日期:1982-07-01 00:00:00

  • Biopharmacological considerations for accelerating drug development of deguelin, a rotenoid with potent chemotherapeutic and chemopreventive potential.

    abstract::Deguelin is a rotenoid compound that exists in abundant quantities in the bark, roots, and leaves of the Leguminosae family of plants. An analysis of evidence from both in vitro and in vivo studies suggests that deguelin displays potent anticancer activity against multiple cancer types and exhibits chemopreventive pot...

    journal_title:Cancer

    pub_type: 杂志文章,评审

    doi:10.1002/cncr.32069

    authors: Varughese RS,Lam WS,Marican AABH,Viganeshwari SH,Bhave AS,Syn NL,Wang J,Wong AL,Kumar AP,Lobie PE,Lee SC,Sethi G,Goh BC,Wang L

    更新日期:2019-06-01 00:00:00

  • Bleomycin-induced pulmonary fibrosis mimicking recurrent metastatic disease in a patient with testicular carcinoma: case report of the CT scan appearance.

    abstract::Pulmonary fibrosis is a well-recognized complication of bleomycin therapy. Detection of bleomycin-induced pulmonary fibrosis by computed axial tomographic scanning (CT) has not been reported. We report on a patient in whom the development of lesions on chest CT scan following cessation of chemotherapy (including bleom...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19810115)47:2<236::aid-cncr28204

    authors: Nachman JB,Baum ES,White H,Cruissi FG

    更新日期:1981-01-15 00:00:00

  • Candida tropicalis and Candida albicans fungemia in children with leukemia.

    abstract::The records were reviewed for all patients hospitalized at a pediatric oncology center for complications of leukemia (n = 822) or lymphoma (n = 290) during an 8-year period. The results of surveillance cultures (throat, rectal, and urine) and blood cultures were analyzed to identify cases of Candida tropicalis and C. ...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19910801)68:3<594::aid-cncr28206

    authors: Marina NM,Flynn PM,Rivera GK,Hughes WT

    更新日期:1991-08-01 00:00:00

  • Selective modulation of postmenopausal women: cutting the Gordian knot of hormone replacement therapy with breast carcinoma.

    abstract:BACKGROUND:Hormone replacement therapy (HRT) has proven and presumable benefits for women desiring postmenopausal health preservation. Among HRT-associated risks, the fear of breast carcinoma intimidates women and physicians contemplating hormonal treatment and limits long-term compliance. Identifying effective alterna...

    journal_title:Cancer

    pub_type: 杂志文章,评审

    doi:10.1002/cncr.11049

    authors: Diamanti-Kandarakis E,Sykiotis GP,Papavassiliou AG

    更新日期:2003-01-01 00:00:00

  • Bone scan as a stratification variable in advanced prostate cancer.

    abstract::The serial technetium 99 (99Tc) bone scans of 76 patients with Stage D-2 prostate cancers were reviewed. Sites of metastases in skeletal areas in decreasing order were vertebrae, ribs, pelvis, long bones, and skull. Patients with one or two involved skeletal areas had a significantly longer progression-free interval a...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19910715)68:2<316::aid-cncr28206

    authors: Knudson G,Grinis G,Lopez-Majano V,Sansi P,Targonski P,Rubenstein M,Sharifi R,Guinan P

    更新日期:1991-07-15 00:00:00

  • Cancer risk in male veterans utilizing the Veterans Administration medical system.

    abstract::Age-specific incidence curves, cumulative rates, and relative risks were estimated for selected malignancies among male veterans utilizing the Veterans Administration (VA) medical system during 1970 to 1982. Relative risks for malignant tumors of the lung, bronchus, larynx, oral cavity, and esophagus in males using VA...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19890901)64:5<1160::aid-cncr2820

    authors: Harris RE,Hebert JR,Wynder EL

    更新日期:1989-09-01 00:00:00

  • Acute lymphoblastic leukemia in adults and children. Differences in response with similar therapeutic regimens.

    abstract::Twenty-three adult patients (ages greater than 15 years) and 75 children with acute lymphoblastic leukemia were treated with similar intensive, sequential cytotoxic protocols (L-2). The adult patients have lower remission rate (78%) than the children (98%). The duration of remission and the length of survival are also...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(197603)37:3<1256::aid-cncr282037

    authors: Gee TS,Haghbin M,Dowling MD,Cunningham I,Middleman MP,Clarkson BD

    更新日期:1976-03-01 00:00:00

  • Specific active immunotherapy in patients with adenocarcinoma of the colon utilizing tumor-associated antigens (TAA). A phase I clinical trial.

    abstract::Twenty-two patients received specific active immunotherapy (TAA vaccine once per month for 3 months), with the duration of follow-up, as of July 1984, ranging from 3 months to 36 months (median, 21 months). Of these, seven had Dukes B2, seven had Dukes C, and eight had Dukes D lesions. All received surgical resection,...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19850801)56:3<480::aid-cncr28205

    authors: Hollinshead A,Elias EG,Arlen M,Buda B,Mosley M,Scherrer J

    更新日期:1985-08-01 00:00:00

  • Psychosocial benefits of a cancer support group.

    abstract::Many clinicians use group support to reduce the psychosocial difficulties of persons with cancer. This study compared the long-term benefits of a thematic counseling model used both as a structure for group support and for counseling patients individually. The thematic model included eight counseling sessions focused ...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19860101)57:1<183::aid-cncr28205

    authors: Cain EN,Kohorn EI,Quinlan DM,Latimer K,Schwartz PE

    更新日期:1986-01-01 00:00:00

  • Estrogen receptors in patients with malignant melanoma.

    abstract::We detected cytoplasmic estrogen receptors (ER) in only 4 of 34 (12%) patients with malignant melanoma. The titers as assayed by the dextran-coated charcoal method were 3, 3, 4, and 5 fmol/mg, respectively. Our data indicate that the incidence of melanoma with detectable ER is low, which suggests that any potential cl...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19801015)46:8<1785::aid-cncr2820

    authors: Creagan ET,Ingle JN,Woods JE,Pritchard DJ,Jiang NS

    更新日期:1980-10-15 00:00:00

  • Rapid immunohistochemistry enhances the intraoperative diagnosis of sentinel lymph node metastases in invasive lobular breast carcinoma.

    abstract:BACKGROUND:The sensitivity of the intraoperative diagnosis of sentinel lymph node (SLN) micrometastases and the metastases of invasive lobular carcinoma (ILC) is low. The goal of the current study was to assess whether the use of intraoperative, rapid immunohistochistochemistry (IHC) enhances the intraoperative detecti...

    journal_title:Cancer

    pub_type: 临床试验,杂志文章

    doi:10.1002/cncr.21133

    authors: Leikola JP,Toivonen TS,Krogerus LA,von Smitten KA,Leidenius MH

    更新日期:2005-07-01 00:00:00

  • Cytologic scoring of endometrioid adenocarcinoma of the endometrium.

    abstract:BACKGROUND:Endometrial carcinoma is one of the most frequent malignancies in the female genital tract, and its incidence has been increasing in Japan. Histologic grade is an important factor for organizing treatment strategies, including hormone therapy, and for predicting the prognosis of the patient. The objective of...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/cncr.20787

    authors: Nishimura Y,Watanabe J,Jobo T,Hattori M,Arai T,Kuramoto H

    更新日期:2005-02-25 00:00:00

  • Matrix metalloproteinase-2 immunoreactive protein: a marker of aggressiveness in breast carcinoma.

    abstract:BACKGROUND:Previous studies have shown that matrix metalloproteinase-2 (MMP-2) (a 72-kilodalton Type IV collagenase/gelatinase A) is associated with breast carcinoma, but to the authors' knowledge there are no reports showing that it is prognostic for overall survival. METHODS:Expression of the immunoreactive protein ...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/(sici)1097-0142(19980915)83:6<1153::aid-cn

    authors: Talvensaari-Mattila A,Pääkkö P,Höyhtyä M,Blanco-Sequeiros G,Turpeenniemi-Hujanen T

    更新日期:1998-09-15 00:00:00

  • The frequency of a concomitant early esophageal cancer in male patients with oral and oropharyngeal cancer. Screening results using Lugol dye endoscopy.

    abstract:BACKGROUND:Male patients with oral and oropharyngeal cancer are known to have high risk of concomitant esophageal cancer developing. Thus, mass screening programs are pursued to detect such esophageal cancer early, and in a mass screening trial of patients with early oral and oropharyngeal cancer, the efficacy of Lugol...

    journal_title:Cancer

    pub_type: 临床试验,杂志文章

    doi:10.1002/1097-0142(19940415)73:8<2038::aid-cncr2820

    authors: Ina H,Shibuya H,Ohashi I,Kitagawa M

    更新日期:1994-04-15 00:00:00

  • Organ modeling in the quantitation of planar images for distribution studies.

    abstract:BACKGROUND:The advantage of whole-body imaging for distribution studies is that it accounts for all activities. The problem, however, is that the classic approach to determining distribution from planar images does not accommodate overlapping structures. That approach assumes implicitly that the sampling region is a pr...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19940201)73:3+<919::aid-cncr2820

    authors: Goris ML,Knox SA,Nielsen KR,Bouillant O

    更新日期:1994-02-01 00:00:00

  • Identification of high-grade cervical dysplasia by the detection of p16INK4a in cell lysates obtained from cervical samples.

    abstract:BACKGROUND:Current cervical cancer screening approaches are based on cytology supplemented by human papillomavirus (HPV) testing in some settings. Whereas cytology is laborious and depends on the cytologists' experience, HPV testing has limited specificity when it is used to detect high-grade lesions. A dichotomous tes...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/cncr.22247

    authors: Wentzensen N,Hampl M,Herkert M,Reichert A,Trunk MJ,Poremba C,Ridder R,von Knebel Doeberitz M

    更新日期:2006-11-01 00:00:00

  • Prediction of malignant transformation in oral epithelial lesions by image cytometry.

    abstract::The value of image analysis in predicting the malignant potential of oral epithelial lesions showing either hyperplasia or dysplasia was investigated; 5-micron formalin-fixed sections of 16 oral epithelial lesions, of which eight had later transformed to carcinoma and eight had not transformed during a follow-up of 10...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19881101)62:9<1981::aid-cncr2820

    authors: Abdel-Salam M,Mayall BH,Chew K,Silverman S Jr,Greenspan JS

    更新日期:1988-11-01 00:00:00

  • A possible association between aprotinin and improved survival after radical surgery for mesothelioma.

    abstract:BACKGROUND:Aprotinin has been used to decrease blood loss with complicated cardiac surgery but has not been investigated in extrapleural pneumonectomy, an operation that does not use cardiopulmonary bypass. In this prospective, randomized, placebo-controlled, double-blind trial, the authors investigated whether aprotin...

    journal_title:Cancer

    pub_type: 杂志文章,随机对照试验

    doi:10.1002/cncr.24108

    authors: Norman PH,Thall PF,Purugganan RV,Riedel BJ,Thakar DR,Rice DC,Huynh L,Qiao W,Wen S,Smythe WR

    更新日期:2009-02-15 00:00:00

  • Late side effects of chemotherapy in ovarian carcinoma: a cytogenetic, hematologic, and statistical study.

    abstract::Late side effects of chemotherapy were studied in 51 women who had received at least 300 mg of melphalan for ovarian cancer and had survived for at least three years. Hematologic, statistical, and cytogenetic methods were employed. Six cases of iatrogenic leukemia were found. They appeared to represent a hematologic e...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19820601)49:11<2234::aid-cncr282

    authors: Einhorn N,Eklund G,Franzén S,Lambert B,Lindsten J,Söderhäll S

    更新日期:1982-06-01 00:00:00

  • Parathyroid carcinoma of the oxyphil cell type. A report of two cases, light and electron microscopic study.

    abstract::Parathyroid adenomas are subdivided into chief cell and oxyphil cell variants. However, the parathyroid carcinomas described thus far have been only of the chief cell type. Two cases of oxyphil cell carcinoma of the parathyroid gland are reported, with light and electron microscopic study. The patients presented appar...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19850401)55:7<1482::aid-cncr2820

    authors: Obara T,Fujimoto Y,Yamaguchi K,Takanashi R,Kino I,Sasaki Y

    更新日期:1985-04-01 00:00:00

  • A comparative study of copper-67 radiolabeling and kinetic stabilities of antibody-macrocycle chelate conjugates.

    abstract:BACKGROUND:The development of new chelating agents and radiolabeling protocols is essential to progress in radioimmunotherapy with antibody-chelate conjugates. METHODS:Immunoconjugates of four polyazamacrocycles with N-bonded acetate groups were prepared by conjugation via 2-iminothiolane to Lym-1, a murine antilympho...

    journal_title:Cancer

    pub_type: 杂志文章

    doi:10.1002/1097-0142(19940201)73:3+<779::aid-cncr2820

    authors: Kukis DL,Diril H,Greiner DP,DeNardo SJ,DeNardo GL,Salako QA,Meares CF

    更新日期:1994-02-01 00:00:00

  • The role of postoperative chemoradiation for oropharynx carcinoma: a critical appraisal of the published literature and National Comprehensive Cancer Network guidelines.

    abstract::The National Comprehensive Cancer Network (NCCN) describes the presence of extracapsular spread and/or positive margins in oropharynx cancer (OPC) as an indication for the addition of chemotherapy to postoperative radiation. The guideline's category 1 consensus is based on what they term high-level evidence. For this ...

    journal_title:Cancer

    pub_type: 杂志文章,评审

    doi:10.1002/cncr.29242

    authors: Sinha P,Piccirillo JF,Kallogjeri D,Spitznagel EL,Haughey BH

    更新日期:2015-06-01 00:00:00