***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE This phase II study of sorafenib , an oral multikinase inhibitor that targets Raf kinase and receptor tyrosine kinases , assessed efficacy , toxicity , pharmacokinetics , and biomarkers in advanced hepatocellular carcinoma ( HCC ) patients . METHODS Patients with inoperable HCC , no prior systemic treatment , and Child-Pugh ( CP ) A or B , received continuous , oral sorafenib 400 mg bid in 4-week cycles . Tumor response was assessed every two cycles using modified WHO criteria . Sorafenib pharmacokinetics were measured in plasma sample s. Biomarker analysis included phosphorylated extracellular signal regulated kinase ( pERK ) in pretreatment biopsies ( immunohistochemistry ) and blood-cell RNA expression patterns in selected patients . RESULTS Of 137 patients treated ( male , 71 % ; median age , 69 years ) , 72 % had CP A , and 28 % had CP B. On the basis of independent assessment , three ( 2.2 % ) patients achieved a partial response , eight ( 5.8 % ) had a minor response , and 46 ( 33.6 % ) had stable disease for at least 16 weeks . Investigator-assessed median time to progression ( TTP ) was 4.2 months , and median overall survival was 9.2 months . Grade 3/4 drug-related toxicities included fatigue ( 9.5 % ) , diarrhea ( 8.0 % ) , and h and -foot skin reaction ( 5.1 % ) . There were no significant pharmacokinetic differences between CP A and B patients . Pretreatment tumor pERK levels correlated with TTP . A panel of 18 expressed genes was identified that distinguished " nonprogressors " from " progressors " with an estimated 100 % accuracy . CONCLUSION Although single-agent sorafenib has modest efficacy in HCC , the manageable toxicity and mechanisms of action support a role for combination regimens with other anticancer agents BACKGROUND Assessment of the change in tumour burden is an important feature of the clinical evaluation of cancer therapeutics : both tumour shrinkage ( objective response ) and disease progression are useful endpoints in clinical trials . Since RECIST was published in 2000 , many investigators , cooperative groups , industry and government authorities have adopted these criteria in the assessment of treatment outcomes . However , a number of questions and issues have arisen which have led to the development of a revised RECIST guideline ( version 1.1 ) . Evidence for changes , summarised in separate papers in this special issue , has come from assessment of a large data warehouse ( > 6500 patients ) , simulation studies and literature review s. HIGHLIGHTS OF REVISED RECIST 1.1 : Major changes include : Number of lesions to be assessed : based on evidence from numerous trial data bases merged into a data warehouse for analysis purpose s , the number of lesions required to assess tumour burden for response determination has been reduced from a maximum of 10 to a maximum of five total ( and from five to two per organ , maximum ) . Assessment of pathological lymph nodes is now incorporated : nodes with a short axis of 15 mm are considered measurable and assessable as target lesions . The short axis measurement should be included in the sum of lesions in calculation of tumour response . Nodes that shrink to < 10 mm short axis are considered normal . Confirmation of response is required for trials with response primary endpoint but is no longer required in r and omised studies since the control arm serves as appropriate means of interpretation of data . Disease progression is clarified in several aspects : in addition to the previous definition of progression in target disease of 20 % increase in sum , a 5 mm absolute increase is now required as well to guard against over calling PD when the total sum is very small . Furthermore , there is guidance offered on what constitutes ' unequivocal progression ' of non-measurable/non-target disease , a source of confusion in the original RECIST guideline . Finally , a section on detection of new lesions , including the interpretation of FDG-PET scan assessment is included . Imaging guidance : the revised RECIST includes a new imaging appendix with up date d recommendations on the optimal anatomical assessment of lesions . FUTURE WORK A key question considered by the RECIST Working Group in developing RECIST 1.1 was whether it was appropriate to move from anatomic unidimensional assessment of tumour burden to either volumetric anatomical assessment or to functional assessment with PET or MRI . It was concluded that , at present , there is not sufficient st and ardisation or evidence to ab and on anatomical assessment of tumour burden . The only exception to this is in the use of FDG-PET imaging as an adjunct to determination of progression . As is detailed in the final paper in this special issue , the use of these promising newer approaches requires appropriate clinical validation studies Objectives The aim of this single , r and omized study was to explore the efficacy of postoperative transarterial chemoembolization ( TACE ) and portal vein chemotherapy ( PVC ) for patients with hepatocellular carcinoma ( HCC ) complicated by portal vein tumor thrombosis ( PVTT ) and to evaluate prognostic factors . Methods The study cohort consisted of 112 patients with HCC and PVTT r and omly divided into three groups : Group A ( 37 patients ) , operation only ; Group B ( 35 patients ) , operation plus TACE ; Group C ( 40 patients ) , operation plus TACE and PVC .  Disease-free survival rates and prognostic factors were analyzed . Results Most of the side effects and complications were related to the operation , catheters , and local chemotherapy and included liver decompensation ( 15.0 % ) , catheter obstruction ( 11.6 % ) , and nausea and loss of appetite ( 22.1 % ) . The disease-free survival curve was significantly different among the three groups , as estimated by the Kaplan-Meier method ( both P < 0.05 ) . Group C showed a significantly higher disease-free survival rate than Group A ( P < 0.05 ) , but no statistical differences were found between group A and group B , and group B and group C ( both P > 0.05 ) . Tumor size , tumor number , PVTT location , and treatment modalities were independent prognostic factors ( P < 0.05 ) . Conclusion Postoperative TACE combined with PVC may benefit the survival of patients with HCC complicated by PVTT in the short-term ( less than 60 months ) , but long-term efficacy is not yet certain and needs to be confirmed by further studies Sorafenib , an oral multikinase inhibitor , shows efficacy in renal cell and hepatocellular carcinoma ( HCC ) and is well tolerated when combined with doxorubicin in other solid tumours . Eighteen patients with inoperable HCC received doxorubicin 60 mg/m(2 ) IV for up to six 3-week cycles . Sorafenib 400 mg bid was administered continuously starting day 4 . Patients discontinuing doxorubicin were eligible for sorafenib monotherapy . The most frequent grade 3 - 4 drug-related adverse events were neutropaenia ( 61 % ) , leukopaenia ( 45 % ) and diarrhoea ( 17 % , grade 3 ) . Seven of eight patients who completed six cycles of doxorubicin continued treatment with sorafenib for at least 3 months . Doxorubicin  moderately increased AUC ( 21 % ) and C(max ) ( 33 % ) when administered with sorafenib .  The disease control rate for 16 evaluable patients was 69 % . Sorafenib plus doxorubicin appears to be well tolerated and more effective in the treatment of HCC than doxorubicin alone . Follow-up with single-agent sorafenib in these patients also appears to be well tolerated Purpose The BCLC staging classification has been widely endorsed to predict the prognosis of patients with HCC . However , its validity as a means of therapeutic instructions needs to be challenged . This study aim ed to evaluate perioperative and long-term outcomes of surgical resection in patients with advanced hepatocellular carcinoma ( HCC ) according to the Barcelona Clinic Liver Cancer ( BCLC ) staging . Methods This study used a prospect ively maintained data base consisting of a consecutive series of 511 Chinese patients with advanced HCC who underwent surgical resection in a hepatobiliary surgical center from 2001 to 2007 .  Mortality , morbidity , long-term overall survival ( OS ) and disease-free survival ( DFS ) were evaluated . Results Hospital mortality was 2.3 % , and overall morbidity was 31.3 % . After a median follow-up period of 27.8 months ( range , 0–112 months ) , the 1- , 3- and 5-year OS rate was 69.9 , 41.2 and 30.5 % , and the 1- , 3- and 5-year DFS rate was 48.2 , 30.3 and 24.0 % , respectively . The 1- , 3- and 5-year OS and DFS rates were significantly poorer in patients with vascular invasion and /or extrahepatic spread than those in patients without ( both P < 0.001 ) , and also poorer in patients with biliary invasion than those in patients without ( both P < 0.05 ) . Conclusions Surgical resection could be considered in part of patients with advanced HCC ( BCLC stage C ) , with low mortality , acceptable morbidity and favorable survival benefits . These results imply that BCLC recommendations for treatment schedules of advanced HCC need to be re-evaluated PURPOSE To determine the safety and efficacy of transarterial chemoembolization ( TACE ) combined with sorafenib ( hereafter , TACE-sorafenib ) in patients with hepatocellular carcinoma ( HCC ) and portal vein tumor thrombus ( PVTT ) . MATERIAL S AND METHODS This study was approved by the institutional review board , and the requirement for informed consent was waived . The medical records of consecutive patients with HCC and PVTT who underwent TACE-sorafenib or TACE alone from January 2010 to December 2012 were retrospectively evaluated .  Sorafenib ( 400 mg ) was administered twice daily . Outcomes of patients who underwent TACE-sorafenib were compared with outcomes of patients who underwent TACE by using the Kaplan-Meier method according to types of PVTT : PVTT in the main portal vein ( type A ) , PVTT in the first-order portal vein branch ( type B ) , and PVTT in second- or lower-order portal vein branches ( type C ) . RESULTS Ninety-one patients were included in the analysis ; 46 patients underwent TACE-sorafenib and 45 underwent TACE . TACE-sorafenib showed significant survival benefits compared with TACE in patients with type B ( median survival , 13 months vs 6 months ; P = .002 ) or type C ( median survival , 15 months vs 10 months ; P = .003 ) PVTT . TACE-sorafenib and main PVTT were the independent prognostic factors for survival at uni- and multivariate analysis . Liver function after TACE-sorafenib worsened only in patients with main PVTT . Sorafenib-related adverse events of grade 3 or higher occurred in 16 patients ( 35 % ) . CONCLUSION TACE-sorafenib side effects were acceptable , and this treatment may improve overall survival in patients with HCC with first-order or lower-branch PVTT when compared with patients who underwent TACE alone BACKGROUND The survival benefit of combining sorafenib and transarterial chemoembolization ( TACE ) therapy compared with sorafenib monotherapy for patients with advanced hepatocellular carcinoma ( HCC ) and main portal vein tumor thrombosis ( MPVTT ) is unclear . METHODS Between January 2009 and June 2013 , 183 consecutive patients with advanced HCC ( Barcelona Clinic Liver Cancer stage C ) and MPVTT were retrospectively review ed . Of these , 89 patients with advanced HCC and MPVTT were enrolled in this study : 45 were treated with combination therapy ( sorafenib-TACE group ) , and the other 44 treated with sorafenib monotherapy ( sorafenib group ) . RESULTS The mean number of TACE sessions per patient was 2.6 ( range : 1 - 5 ) . The median duration of sorafenib in the sorafenib-TACE group and sorafenib group was 5.6 months and 5.4 months , respectively . The disease control rate was similar between the two groups . Median time to progression was 3.0 months ( 95 % confidence interval [ CI ] : 2.2 , 3.7 ) in the sorafenib-TACE group , and 3.0 months ( 95 % CI : 2.1 , 3.8 ) in the sorafenib group ( p = .924 ) . Median overall survival was 7.0 months ( 95 % CI : 6.1 , 7.8 ) and 6.0 months ( 95 % CI : 4.7 , 7.3 ) in the sorafenib-TACE group and the sorafenib group , respectively ( p = .544 ) . The adverse events related to sorafenib were comparable between the two groups . Twenty-one adverse events of grade 3 - 4 related to TACE occurred in 12 patients ( 26.7 % ) , and 2 of them died ( 4.4 % ) . CONCLUSION This study demonstrated no advantage of combination therapy over sorafenib monotherapy . Considering the patients ' morbidity after TACE , sorafenib monotherapy is appropriate for managing patients with advanced HCC and MPVTT 
    Output:
    
TACE-S with PVTT had better outcomes in the first-order portal vein branch and lower-order portal vein branches than in the main portal vein and upper branches to superior mesenteric vein .
CONCLUSIONS TACE-S may improve OS , ORR , TTP and DCR for HCC patients with PVTT compared to TACE