This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bentzen, S. M. Articles by Trotti, A. Search for Related Content PubMed PubMed Citation Articles by Bentzen, S. M. Articles by Trotti, A.

Evaluation of Early and Late Toxicities in Chemoradiation Trials

Søren M. Bentzen, Andrea Trotti

From the University of Wisconsin School of Medicine and Public Health, Department of Human Oncology, Madison, WI; H. Lee Moffitt Cancer Center at The University of South Florida, Tampa, FL

Address reprint requests to Andrea M. Trotti, MD, Interdisciplinary Oncology, H. Lee Moffitt Cancer Center at The University of South Florida, 12902 Magnolia Dr, Mod 9 RT, Tampa, FL 33612-9416; e-mail: andy.trotti{at}moffitt.org

Combined chemoradiotherapy is increasingly becoming a standard of care for the nonoperative management of a variety of solid malignancies. A string of randomized controlled phase III trials have shown statistically significant and clinically relevant improvements in outcome, ostensibly without any apparent increase in late toxicity. However, the reliability and the sensitivity of toxicity reporting in most trials are questionable. Audits and phase IV studies suggest that the chemoradiotherapy success comes at a price in terms of late toxicity. This review presents some of the challenges in recording, analyzing, and reporting toxicity data. Methods for summarizing toxicity are reviewed, and a new investigational metric, the TAME reporting system, is discussed. The need for special vigilance in the era of molecular-targeted agents is emphasized because of the possibility that unexpected serious adverse events with a low incidence may occur. Finally, we discuss how progress in molecular pathology and radiation biology may provide novel opportunities for stratifying patients according to risk of adverse effects, interventional targets for reducing or treating adverse effects, and surrogate markers of normal-tissue injury.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

This article has been cited by other articles:

				N. Choong and E. Vokes Expanding Role of the Medical Oncologist in the Management of Head and Neck Cancer CA Cancer J Clin, January 1, 2008; 58(1): 32 - 53. [Abstract] [Full Text] [PDF]