***TASK***
the task is to simplify the input abstract of a biomedical literature

***INPUT***
the input is the abstract of a biomedical literature

***OUTPUT***
the output is the simplified abstract for the input abstract of a biomedical literature

***DOCUMENTATION***

***EXAMPLES***

Input: A total of 12 randomised trials were identified, totaling 843 patients. The size of the randomised clinical trials ranged from 30 to 155 patients. Both preoperative (neoadjuvant) and postoperative (adjuvant), systemic and locoregional (+/- embolisation), chemo- and immunotherapy interventions were tested. Treatment regimens and patients selected were not comparable, so no pooling was done. Only one regimen using preoperative transcatheter arterial chemoembolisation with doxorubicin was similar in two trials. Four of the twelve trials reported survival benefit at five years when given adjuvant or neoadjuvant therapy. Disease-free survival was reported in nine trials, and the estimated hazard ratios show that disease-free survival was significant in two trials at five years. These two trials had not shown a survival advantage, but the recurrence was significantly lower in patients given adjuvant or neoadjuvant therapy. The highest toxicity rate was in a trial using oral 1-hexylcarbamoyl 5-fluorouracil which resulted in 12 out of 38 patients being withdrawn from the trial because of adverse events. There is no clear evidence for efficacy of any of the adjuvant and neo-adjuvant protocols reviewed, but there is some evidence to suggest that adjuvant therapy may be beneficial offering prolonged disease-free survival. In order to detect a realistic treatment advantage, larger trials with lower risk of systematic error will have to be conducted.
Output:

This review sets on to determine the efficacy and adverse events of different neoadjuvant therapies (drug given before) versus adjuvant therapies (drug given after) compared to surgery alone, or surgery and placebo or supportive therapy when given to improve relapse and survival rates for operable hepatocellular carcinoma. A total of 12 randomised trials were identified, totaling 843 patients. The size of the randomised clinical trials ranged from 30 to 155 patients. Nine of the twelve trials reported no survival benefit from adjuvant therapy. Two trials reported a significant difference for survival and four studies for disease-free survival for the treatment group, but the results of one of the trials on both its groups were very poor when compared to other trials. Two of the trials that did not report any absolute survival advantage reported statistically significant differences in disease-free survival. The highest toxicity rate was in a trial using oral 1-hexylcarbamoyl 5- fluorouracil which resulted in 12 out of 38 patients being withdrawn from the trial because of adverse events. In conclusion, this review found insufficient evidence to show that adjuvant and neo-adjuvant therapy increase survival from hepatocellular carcinoma, but there is limited evidence to suggest that neoadjuvant or adjuvant therapy may be useful for disease-free survival.