***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 To perform a r and omized trial comparing 70 and 80 Gy radiotherapy for prostate cancer . PATIENTS AND METHODS A total of 306 patients with localized prostate cancer were r and omized . No and rogen deprivation was allowed . The primary endpoint was biochemical relapse according to the modified 1997-American Society for Therapeutic Radiology and Oncology and Phoenix definitions . Toxicity was grade d using the Radiation Therapy Oncology Group 1991 criteria and the late effects on normal tissues-subjective , objective , management , analytic scales ( LENT-SOMA ) scales . The patients ' quality of life was scored using the European Organization for Research and Treatment of Cancer Quality of Life Question  naire 30-item cancer-specific and 25-item prostate-specific modules . RESULTS The median follow-up was 61 months . According to the 1997-American Society for Therapeutic Radiology and Oncology definition , the 5-year biochemical relapse rate was 39 % and 28 % in the 70- and 80-Gy arms , respectively ( p = .036 ) . Using the Phoenix definition , the 5-year biochemical relapse rate was 32 % and 23.5 % , respectively ( p = .09 ) . The subgroup analysis showed a better biochemical outcome for the higher dose group with an initial prostate-specific antigen level > 15 ng/mL. At the last follow-up date , 26 patients had died , 10 of their disease and none of toxicity , with no differences between the two arms . According to the Radiation Therapy Oncology Group scale , the Grade 2 or greater rectal toxicity rate was 14 % and 19.5 % for the 70- and 80-Gy arms ( p = .22 ) , respectively . The Grade 2 or greater urinary toxicity was 10 % at 70 Gy and 17.5 % at 80 Gy ( p = .046 ) . Similar results were observed using the LENT-SOMA scale . Bladder toxicity was more frequent at 80 Gy than at 70 Gy ( p = .039 ) . The quality -of-life question naire results before and 5 years after treatment were available for 103 patients with no differences found between the 70- and 80-Gy arms . CONCLUSION High-dose radiotherapy provided a better 5-year biochemical outcome with slightly greater toxicity PURPOSE To evaluate the acute toxicities of hypofractionated accelerated radiotherapy ( RT ) using a concomitant intensity-modulated RT boost in conjunction with elective pelvic nodal irradiation for high-risk prostate cancer . METHODS AND MATERIAL S This report focused on 66 patients entered into this prospect i ve Phase I study . The eligible patients had clinical ly localized prostate cancer with at least one of the following high-risk features ( Stage T3 , Gleason score > or=8 , or prostate-specific antigen level > 20 ng/mL ) . Patients were treated with 45 Gy in 25 fractions to the pelvic lymph nodes using a conventional four-field technique . A concomitant intensity-modulated radiotherapy boost of 22.5 Gy in 25 fractions was delivered to the prostate . Thus , the prostate received 67.5 Gy in 25 fractions within 5 weeks . Next , the patients underwent 3 years of adjuvant and rogen ablative therapy .  Acute toxicities were assessed using the Common Terminology Criteria for Adverse Events , version 3.0 , weekly during treatment and at 3 months after RT . RESULTS The median patient age was 71 years . The median pretreatment prostate-specific antigen level and Gleason score was 18.7 ng/L and 8 , respectively . Grade 1 - 2 genitourinary and gastrointestinal toxicities were common during RT but most had settled at 3 months after treatment . Only 5 patients had acute Grade 3 genitourinary toxicity , in the form of urinary incontinence ( n = 1 ) , urinary frequency/urgency ( n = 3 ) , and urinary retention ( n = 1 ) . None of the patients developed Grade 3 or greater gastrointestinal or Grade 4 or greater genitourinary toxicity . CONCLUSION The results of the present study have indicated that hypofractionated accelerated RT with a concomitant intensity-modulated RT boost and pelvic nodal irradiation is feasible with acceptable acute toxicity The objectives of this study were to evaluate dosimetric quality and acute toxicity of volumetric-modulated arc therapy ( VMAT ) and daily image guidance in high-risk prostate cancer patients . A total of 100 consecutive high-risk prostate cancer patients treated with definitive VMAT with prophylactic whole-pelvic radiotherapy ( WPRT ) were enrolled . All patients were treated with a double-arc VMAT plan delivering 52 Gy to the prostate planning target volume ( PTV ) , while simultaneously delivering 46.8 Gy to the pelvic nodal PTV in 26 fractions , followed by a single-arc VMAT plan delivering 26 Gy to the prostate PTV in 13 fractions . Image-guided RT was performed with daily cone-beam computed tomography . Dose – volume parameters for the PTV and the organs at risk ( OARs ) , total number of monitor units ( MUs ) and treatment time were evaluated . Acute toxicity was assessed using the Common Terminology Criteria for Adverse Events , version 4.0 . All dosimetric parameters met the present plan acceptance criteria . Mean MU and treatment time were 471 and 146 s for double-arc VMAT , respectively , and were 520 and 76 s for single-arc VMAT , respectively . No Grade 3 or higher acute toxicity was reported . Acute Grade 2 proctitis , diarrhea , and genitourinary toxicity occurred in 12 patients ( 12 % ) , 6 patients ( 6 % ) and 13 patients ( 13 % ) , respectively . The present study demonstrated that VMAT for WPRT in prostate cancer results in favorable PTV coverage and OAR sparing with short treatment time and an acceptable rate of acute toxicity . These findings support the use of VMAT for delivering WPRT to high-risk prostate cancer patients PURPOSE To report acute toxicity result ing from radiotherapy ( RT ) dose escalation and hypofractionation using intensity-modulated RT ( IMRT ) treatment combined with and rogen suppression in high-risk prostate cancer patients . METHODS AND MATERIAL S Sixty patients with a histological diagnosis of high-risk prostatic adenocarcinoma ( having either a clinical Stage of > or = T3a or an initial prostate-specific antigen [ PSA ] level of > or = 20 ng/ml or a Gleason score of 8 to 10 or a combination of a PSA concentration of > 15 ng/ml and a Gleason score of 7 ) were enrolled . RT prescription was 68 Gy in 25 fractions ( 2.72 Gy/fraction ) over 5 weeks to the prostate and proximal seminal vesicles . The pelvic lymph nodes and distal seminal vesicles concurrently received 45 Gy in 25 fractions . The patients were treated with helical TomoTherapy-based IMRT and underwent daily megavoltage CT image-guided verification prior to each treatment . Acute toxicity scores were recorded weekly during RT and at 3 months post-RT , using Radiation Therapy Oncology Group acute toxicity scales . RESULTS All patients completed RT and follow up for 3 months . The maximum acute toxicity scores were as follows : 21 ( 35 % ) patients had Grade 2 gastrointestinal ( GI ) toxicity ; 4 ( 6.67 % ) patients had Grade 3 genitourinary ( GU ) toxicity ; and 30 ( 33.33 % ) patients had Grade 2 GU toxicity . These toxicity scores were reduced after RT ; there were only 8 ( 13.6 % ) patients with Grade 1 GI toxicity , 11 ( 18.97 % ) with Grade 1 GU toxicity , and 5 ( 8.62 % ) with Grade 2 GU toxicity at 3 months follow up . Only the V60 to the rectum correlated with the GI toxicity . CONCLUSION Dose escalation using a hypofractionated schedule to the prostate with concurrent pelvic lymph node RT and long-term and rogen suppression therapy is well tolerated acutely . Longer follow up for outcome and late toxicity is required OBJECTIVE Accuracy of biopsy scheme depends on different parameters . Prostate-specific antigen ( PSA ) level and digital rectal examination ( DRE ) influenced the detection rate and suggested the biopsy scheme to approach each patient . Another parameter is the prostate volume . Sampling accuracy tends to decrease progressively with an increasing prostate volume . We prospect ively observed detection cancer rate in suspicious prostate cancer ( PCa ) and improved by applying a protocol biopsy according to prostate volume ( PV ) . PATIENTS AND METHODS Clinical data and pathological features of these 1356 patients were analysed and included in this study . This protocol is a combined scheme that includes transrectal ( TR ) 12-core PBx ( TR12PBx ) for PV ≤ 30 cc , TR 14-core PBx ( TR14PBx ) for PV > 30 cc but < 60 cc , TR 18-core PBx ( TR18PBx ) for PV ≥ 60 cc . RESULTS Out of a total of 1356 patients , in 111 ( 8.2 % ) PCa was identified through TR12PBx scheme , in 198 ( 14.6 % ) through TR14PBx scheme and in 253 ( 18.6 % ) through TR18PBx scheme . The PCa detection rate was increased by 44 % by adding two TZ cores ( TR14PBx scheme ) . The TR18PBx scheme increased this rate by 21.7 % vs. TR14PBx scheme . The diagnostic yield offered by TR18PBx was statistically significant compared to the detection rate offered by the TR14PBx scheme ( p < 0.003 ) . The biopsy Gleason score and the percentage of core involvement were comparable between PCa detected by the TR14PBx scheme diagnostic yield and those detected by the TR18PBx scheme ( p = 0.362 ) . CONCLUSIONS The only PV parameter , in our opinion , can be significant in choosing the best biopsy scheme to approach in a first setting of biopsies increasing PCa detection rate Abstract Background A prospect i ve clinical trial was conducted to evaluate the feasibility of a novel approach to the treatment of patients with high risk prostate cancer ( HRPC ) through the use of a nomogram to tailor radiotherapy target volumes . Methods Twenty seven subjects with HRPC were treated with a mildly hypofractionated radiotherapy regimen using image-guided IMRT technique between Jun/2013-Jan/2015.A set of vali date d prognostic factors were inputted into the Memorial-Sloan-Kettering Cancer Center ( MSKCC ) prostate cancer nomogram to estimate risk of loco-regional spread ( LRS ) . The nomogram risk estimates for extra-capsular extension ( ECE ) , seminal vesicles involvement ( SVI ) , and pelvic lymph nodes involvement ( LNI ) were used to adapt radiotherapy treatment volumes based on a risk threshold of ≥15 % in all cases . A planning guide was used to delineate target volumes and organs at risk ( OAR ) . Up to three dose levels were administered over 28 fractions ; 70Gy for gross disease in the prostate + /− seminal vesicles ( 2.5Gy/fraction ) , 61.6Gy for sub clinical peri-prostatic disease ( 2.2Gy/fraction ) and 50.4Gy to pelvic nodes ( 1.8Gy/fraction ) . Data regarding protocol adherence , nomogram use , radiotherapy dose distribution , and acute toxicity were collected . Results Nomogram use 100 % of patients were treated for ECE , 88.9 % for SVI , and 70.4 % for LNI . The three areas at risk of LRS were appropriately treated according to the study protocol in 98.8 % cases . The MSKCC nomogram estimates for LRS differed significantly between the time of recruitment and analysis . Contouring protocol compliance Compliance with the trial contouring protocol for up to seven target volumes was 93.0 % ( 159/171 ) . Compliance with protocol for small bowel contouring was poor ( 59.3 % ) . Dose constraints compliance Compliance with dose constraints for target volumes was 97.4 % ( 191/196 ) . Compliance with dose constraints for OAR was 88.2 % ( 285/323 ) . Acute toxicity There were no grade 3 acute toxicities observed . 20/27 ( 74.1 % ) and 6/27 ( 22.2 % ) patients experienced a grade 2 genitourinary and gastrointestinal toxicity respectively . Conclusions We have demonstrated the feasibility of this novel risk-adapted radiation treatment protocol for HRPC . This study has identified key learning points regarding this approach , including the importance of st and ardization and updating of risk quantification tools , and the utility of an observer to verify their correct use . Trial registration ClincialTrials.gov identifier NCT01418040.Hunter New Engl and Human Research Ethics Committee ( HNEHREC ) reference number Background Definitive , percutaneous irradiation of the prostate and the pelvic lymph nodes in high- 
    Output:
    
In order to perform odds ratio we observed a decrease in late gastrointestinal toxicity for patients treated with hypofractionated schemes compared to CV treated ones .
Among patients who underwent conventional treatment , SIB seemed to decrease acute genitourinary side effects ; SIB-Hypo treated patients suffered less toxicity than patients treated with hypofractionated- sequential boost schemes .
Hypo-SIB schemes would seem less toxic in terms of acute gastrointestinal and late genitourinary side effects than CV-SIB .