Evidence map›Paper›PMID 23468460›Full record

SynthesisJournal of the National Cancer Institute2013

Radiotherapy protocol deviations and clinical outcomes: a meta-analysis of cooperative group clinical trials.

Nitin Ohri, Xinglei Shen, Adam P Dicker, Laura A Doyle, Amy S Harrison, Timothy N Showalter

Abstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of the National Cancer Institute, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 125 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
125citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

125 citing papers in PubMed, 7 syntheses or guidelines pooled it.

  1. Pooled it
  2. Guideline
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  6. Radiation Therapy Intensification for Solid Tumors: A Systematic Review of Randomized Trials.International journal of radiation oncology, biology, physics · 2015
    Pooled it
  7. Guideline
  8. Trial
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  12. The radiotherapy quality assurance gap among phase III cancer clinical trials.Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2022
    Trial
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  15. A dedicated cloud system for real-time upfront quality assurance in pediatric radiation therapy.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2019
    Trial
  16. Trial
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  20. Radiotherapy quality assurance report from children's oncology group AHOD0031.International journal of radiation oncology, biology, physics · 2015
    Trial

65 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Nitin OhriDepartment of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, New York 10467, USA. ohri.nitin@gmail.com
Xinglei Shen
Adam P Dicker
Laura A Doyle
Amy S Harrison
Timothy N Showalter

Funding

X-Ray Crystallography and Macromolecular CharacterizationP30CA056036 · NCI · THOMAS JEFFERSON UNIVERSITY · PI CHRISTINE M. EISCHEN · 1995 to 2026
$94.8M
NCI NIH HHS P30 CA056036NCI NIH HHS P30 CA56036
6 · The paper itself

Abstract

backgroundNoncompliance with radiotherapy (RT) protocol guidelines has been linked to inferior clinical outcomes. We performed a meta-analysis of cooperative group trials to examine the association between RT quality assurance (QA) deviations and disease control and overall survival (OS).

methodsWe searched MEDLINE and the Cochrane Central Register of Controlled Trials for multi-institutional trials that reported clinical outcomes in relation to RT QA results. Hazard ratios (HRs) describing the association between RT protocol noncompliance and patient outcomes were extracted directly from the original studies or calculated from survival curves. Inverse variance meta-analyses were performed to assess the association between RT QA deviations and OS. A second meta-analysis tested the association between RT QA deviations and secondary outcomes, including local or locoregional control, event-free survival, and relapse. Random-effects models were used in cases of statistically significant (P < .10) effect heterogeneity. The Egger test was used to detect publication bias. All statistical tests were two-sided.

resultsEight studies (four pediatric, four adult) met all inclusion criteria and were incorporated into this analysis. The frequency of RT QA deviations ranged from 8% to 71% (median = 32%). In a random-effects model, RT deviations were associated with a statistically significant decrease in OS (HR of death = 1.74, 95% confidence interval [CI] = 1.28 to 2.35; P < .001). A similar effect was seen for secondary outcomes (HR of treatment failure = 1.79, 95% CI = 1.15 to 2.78; P = .009). No evidence of publication bias was detected.

conclusionIn clinical trials, RT protocol deviations are associated with increased risks of treatment failure and overall mortality.

Indexed as

Patient ComplianceRadiotherapyClinical ProtocolsClinical Trials as TopicDisease-Free SurvivalHumansMulticenter Studies as TopicNeoplasmsOdds RatioPublication BiasQuality Assurance, Health CareSelection BiasTreatment Failure

Identifiers

PMID23468460
PMCPMC3601950

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.