title: Radiation Therapy Intensification for Solid Tumors: A Systematic Review of Randomized Trials.
abstract: OBJECTIVE
  To systematically review the outcomes of randomized trials testing radiation therapy (RT) intensification, including both dose escalation and/or the use of altered fractionation, as a strategy to improve disease control for a number of malignancies.
  
  
  METHODS
  We performed a literature search to identify randomized trials testing RT intensification for cancers of the central nervous system, 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 central nervous system 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. Radiation therapy 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 used. Novel strategies to optimize the incorporation of RT in the multimodality treatment of solid tumors should be explored.
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Kosj
authors.initials: K
authors.lastname: Yamoah
authors.affiliation: Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: Timothy N
authors.initials: TN
authors.lastname: Showalter
authors.affiliation: Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. Electronic address: ohri.nitin@gmail.com.
authors.forename: Nitin
authors.initials: N
authors.lastname: Ohri
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy; D016543:Central Nervous System Neoplasms / Q000532:radiotherapy; D003131:Combined Modality Therapy; D004307:Dose-Response Relationship, Radiation; D004938:Esophageal Neoplasms / Q000532:radiotherapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy*; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000532:radiotherapy; D016896:Treatment Outcome