Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
There is frequently no standard treatment for a rare cancer, so it is
even more difficult to obtain data from a well-conducted randomised trial.
There are several diseases on which randomised trials will never be
conducted or completed even if opened because of the lack of consensus as
to what the best or standard therapy should be, the strong individual bias
of the treating physician and the rarity of the condition. So despite the
sound statistical strategy for randomised trials for rare cancer, it is
unlikely that data regarding therapy for some rare cancer would be
available. There are a few ways to tackle these. Large scale, multicenter,
retrospective studies might help us obtain some useful albeit not perfect
information. The study on lymphocyte predominant Hodgkin's disease by the
European Task Force on Lymphoma Project on Lymphocyte Predominant
Hodgkin's Disease is an example (1). For even rarer diseases where such
information is not available, one would have to rely on individual case
series or case reports. Sometimes, the treating physician will have to
extrapolate data from diseases better studied and exercise best clinical
judgement based on the knowledge of the literature and basic sciences. For
example, stage I duodenal MALT (mucosa-associated lymphoid tissue)
lymphoma is a rare form of lymphoma. Only scattered case reports are
available in the literature. It is extremely unlikely that any level I
evidence would ever be available regarding the best therapy for this
disease. Our knowledge in basic anatomy tells us that the duodenum is a
retroperitoneal structure that makes it a suitable target for local
radiation therapy. The reports on gastric MALT lymphoma tell us that low
dose radiation therapy is able to achieve excellent local control of this
histological subtype of lymphoma. Patching together all the information,
the treating physician could determine that local radiation therapy would
be a feasible treatment option that could result in excellent local
control. The scientific data can enhance but cannot replace our clinical
judgement.
REFERENCES:
1) Diehl V, Sextro M, Franklin J et al (1999). Clinical Presentation,
Course, and Prognostic Factors in Lymphocyte-Predominant Hodgkin's Disease
and Lymphocyte-Rich Classical Hodgkin's Disease: Report from the European
Task Force on Lymphoma Project on Lymphocyte-Predominant Hodgkin's
Disease. Journal of Clinical Oncology 17: 776-783.
The scientific data can enhance but cannot replace our clinical judgement
There is frequently no standard treatment for a rare cancer, so it is
even more difficult to obtain data from a well-conducted randomised trial.
There are several diseases on which randomised trials will never be
conducted or completed even if opened because of the lack of consensus as
to what the best or standard therapy should be, the strong individual bias
of the treating physician and the rarity of the condition. So despite the
sound statistical strategy for randomised trials for rare cancer, it is
unlikely that data regarding therapy for some rare cancer would be
available. There are a few ways to tackle these. Large scale, multicenter,
retrospective studies might help us obtain some useful albeit not perfect
information. The study on lymphocyte predominant Hodgkin's disease by the
European Task Force on Lymphoma Project on Lymphocyte Predominant
Hodgkin's Disease is an example (1). For even rarer diseases where such
information is not available, one would have to rely on individual case
series or case reports. Sometimes, the treating physician will have to
extrapolate data from diseases better studied and exercise best clinical
judgement based on the knowledge of the literature and basic sciences. For
example, stage I duodenal MALT (mucosa-associated lymphoid tissue)
lymphoma is a rare form of lymphoma. Only scattered case reports are
available in the literature. It is extremely unlikely that any level I
evidence would ever be available regarding the best therapy for this
disease. Our knowledge in basic anatomy tells us that the duodenum is a
retroperitoneal structure that makes it a suitable target for local
radiation therapy. The reports on gastric MALT lymphoma tell us that low
dose radiation therapy is able to achieve excellent local control of this
histological subtype of lymphoma. Patching together all the information,
the treating physician could determine that local radiation therapy would
be a feasible treatment option that could result in excellent local
control. The scientific data can enhance but cannot replace our clinical
judgement.
REFERENCES:
1) Diehl V, Sextro M, Franklin J et al (1999). Clinical Presentation,
Course, and Prognostic Factors in Lymphocyte-Predominant Hodgkin's Disease
and Lymphocyte-Rich Classical Hodgkin's Disease: Report from the European
Task Force on Lymphoma Project on Lymphocyte-Predominant Hodgkin's
Disease. Journal of Clinical Oncology 17: 776-783.
Competing interests:
None declared
Competing interests: No competing interests