***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: OBJECTIVE This study evaluated the safety and objective response of combining 131I-labeled-metuximab ( Licartin ) with transarterial chemoembolization ( TACE ) in the treatment of unresectable hepatocellular carcinoma ( HCC ) . MATERIAL S AND METHODS In a multicenter open-label clinical trial , 341 enrolled patients with stage III/IV HCC according to TNM criteria were nonr and omly assigned to a trial group ( n=167 ) and a control group ( n=174 ) , undergoing TACE following hepatic intra-arterial injection of licartin or TACE alone from July 2007 to July 2009 . Radiopharmaceutical distribution was evaluated . The primary endpoint was overall survival ; secondary endpoints included time-to-progression ( TTP ) , toxicity and adverse events ( AEs ) . RESULTS The radiobiological distribution demonstrated better localization of licartin in liver tumors than other tissues ( P<0.01 ) . The organ absorbed doses to liver and red marrow were 3.19 ± 1.01 Gy and 0.55 ± 0.22 Gy , respectively . The 1-year survival rate was significantly higher [ 79.47 % vs. 65.59 % , hazard ratio ( HR ) , 0.598 , P=0.041 ] and TTP significantly improved ( 6.82 ± 1.28 vs. 4.7 ± 1.14 months , P=0.037 ) compared with the control group . Patients at stage III achieved more benefit of one year survival than stage IV in the trial group ( 86.9 % vs. 53.8 % , P<0.001 ) . There were significant different toxicities in leukocytopenia , thrombocytopenia and increased total bilirubin level [ P<0.001 , P=0.013 , P<0.01 , relative risk ( RR ) 1.63 , 1.33 , 1.43 ] , but no differences in severe AEs of upper GI hemorrhage and severe liver dysfunction between the groups ( 5.39 % vs. 2.3 % , P=0.136 ) . CONCLUSIONS Owing to excellent tumor-targeting , promised efficacy and favourable toxicity profile , the novel combination therapy of licartin and TACE could be applied in patients with unresectable HCC BACKGROUND In Japan and South Korea , transarterial chemoembolisation ( TACE ) is an important locoregional treatment for patients with unresectable hepatocellular carcinoma ( HCC ) .  Sorafenib , a multikinase inhibitor , has been shown effective and safe in patients with advanced HCC . This phase III trial assessed the efficacy and safety of sorafenib in Japanese and Korean patients with unresectable HCC who responded to TACE . METHODS Patients ( n=458 ) with unresectable HCC , Child-Pugh class A cirrhosis and ≥25 % tumour necrosis/shrinkage 1 - 3 months after 1 or 2 TACE sessions were r and omised 1:1 to sorafenib 400 mg bid or placebo and treated until progression/recurrence or unacceptable toxicity . Primary end-point was time to progression/recurrence ( TTP ) . Secondary end-point was overall survival ( OS ) . FINDINGS Baseline characteristics in the two groups were similar ; > 50 % of patients started sorafenib>9 weeks after TACE . Median TTP in the sorafenib and placebo groups was 5.4 and 3.7 months , respectively ( hazard ratio ( HR ) , 0.87 ; 95 % confidence interval ( CI ) , 0.70 - 1.09 ; P=0.252 ) .  HR ( sorafenib/placebo ) for OS was 1.06 ( 95 % CI , 0.69 - 1.64 ; P=0.790 ) . Median daily dose of sorafenib was 386 mg , with 73 % of patients having dose reductions and 91 % having dose interruptions . Median administration of sorafenib and placebo was 17.1 and 20.1 weeks , respectively . No unexpected adverse events were observed . INTERPRETATION This trial , conducted prior to the reporting of registration al phase III trials , found that sorafenib did not significantly prolong TTP in patients who responded to TACE . This may have been due to delays in starting sorafenib after TACE and /or low daily sorafenib doses Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND AND OBJECTIVES To compare the impact of concurrent TACE + sorafenib versus TACE alone on overall survival ( OS ) and time to progression ( TTP ) in patients with unresectable hepatocellular carcinoma ( uHCC ) . A secondary goal was to determine if sorafenib use increases the interval between courses of TACE . METHODS This study enrolled 150 patients with uHCC from June 2011 to June 2014 , including 50 treated with TACE + sorafenib and 100 treated with TACE alone .  Factors associated with OS and TTP were identified by univariate and multivariate Cox-regression model analyses . Average TACE interval was defined as TTP/TACE frequency . RESULTS The median OS ( 21.7 vs. 11.5 months ) and TTP ( 10.2 vs. 6.7 months ) were longer in the TACE + sorafenib group compared to the TACE group . Patients receiving combination therapy had higher survival rate ( P < 0.032 ) and longer average interval to TACE  ( P < 0.001 ) , but lower progression rate ( P < 0.001 ) . TACE + sorafenib therapy was associated with improved OS ( P ≤ 0.009 ) and TTP ( P ≤ 0.021 ) . The majority of AEs identified in patients receiving the combination therapy were classified as Grade s 1 and 2 , and skin-related reactions and fatigue were the most common . CONCLUSION Concurrent sorafenib with TACE provides survival benefits  over TACE monotherapy , which may be related to a prolonged interval between subsequent TACE courses . J. Surg . Oncol . 2016;113:672 - 677 . © 2016 Wiley Periodicals , This prospect i ve non‐r and omized controlled trial aim ed to compare the efficacy of sorafenib in combination with transarterial chemoembolization ( TACE ) vs TACE alone for the treatment of patients with unresectable intermediate or advanced hepatocellular carcinoma As a result of demographic evolution , oncologists will treat more and more elderly patients with prostate cancer . Aging is frequently associated with the coexistence of several medical complications that can increase the complexity of cancer treatment decision-making . Unfortunately , clinical oncologists need to be more familiar with the multidimensional assessment of elderly patients . To acquire this skill , we implemented a multidimensional geriatric assessment program at our cancer center . This instrument prospect ively assessed 60 elderly patients with prostate cancer . Herein , we describe geriatric aspects detected in our patient sample and report treatment options proposed to elderly patients with prostate cancer at different disease stages . The minimal comprehensive geriatric assessment ( mini-CGA ) procedure revealed that 66 % of our patient population was dependent in one or more of the Katz Activities of Daily Living and 87 % were dependent in 1 or more of the Lawton Instrumental Activities of Daily Living ; all patients had significant comorbidity according to the Cumulative Illness Rating Scale-Geriatrics  , 75 % having at least one severe comorbidity . We identified 19 cases of drug interaction . We also observed that half of these patients had a risk of falling and some physical disability ; 45 % had cognitive disorders requiring more investigation ; one third had depressive symptoms . Finally , 65 % of the patients were either malnourished or at risk of malnutrition . Many of these problems were unknown before the mini-CGA processing and may interfere with cancer and cancer treatment . Thus , the correct management of elderly patients with cancer requires comprehensive geriatric assessment as well as relevant disease staging at diagnosis . This approach will help us to propose the most appropriate treatment with the main aim of preserving quality of life This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence BACKGROUND & AIMS To eluci date the survival of the patients with unresectable hepatocellular carcinoma ( HCC ) who underwent transcatheter arterial lipiodol chemoembolization ( TACE )  and to analyze the factors affecting the survivals . METHODS During the last 8 years , a nationwide prospect i ve cohort study was performed in 8510 patients with unresectable HCC who underwent TACE using emulsion of lipiodol and anticancer agents followed by gelatin sponge particles as an initial treatment . Exclusion criteria were extrahepatic metastases and /or any previous treatment prior to the present TACE . The primary end point was survival . The survival rates were calculated by the Kaplan-Meier method . The multivariate analyses for the factors affecting survival were evaluated by the Cox proportional hazard model . The mean follow-up period was 1.77 years . RESULTS For overall survival rates by TACE , median and 1- , 3- , 5- , and 7-year survivals were 34 months , 82 % , 47 % , 26 % , and 16 % , respectively . Both the degree of liver damage and the tumor-node-metastasis ( TNM ) system proposed by the Liver Cancer Study Group of Japan demonstrated good stratification of survivals ( P = .0001 ) . The multivariate analyses showed significant difference in degree of liver damage ( P = .0001 ) , alpha-fetoprotein value ( P = .0001 ) , maximum tumor size ( P = .0001 ) , number of lesions ( P = .0001 ) , and portal vein invasion ( P = .0001 ) . The last 3 factors could be replaced by TNM stage . The  TACE-related mortality rate after the initial therapy was .5 % . CONCLUSIONS TACE showed safe therapeutic modality with a 5-year survival of 26 % for unresectable HCC patients . The degrees of liver damage , TNM stage , and alpha-fetoprotein values were independent risk factors for patient survival UNLABELLED Transarterial chemoembolization ( TACE ) is the current st and ard of treatment for unresectable intermediate-stage hepatocellular carcinoma ( HCC ) . Brivanib , a selective dual inhibitor of vascular endothelial growth factor and fibroblast growth factor signaling , may improve the effectiveness of TACE when given as an adjuvant to TACE . In this multinational , r and omized , double-blind , placebo-controlled , phase III study , 870 patients with TACE-eligible HCC were planned to be r and omly assigned ( 1:1 ) after the first TACE to receive either brivanib 800 mg or placebo orally once-daily . The primary endpoint was overall survival ( OS ) . Secondary endpoints included time to disease progression ( TTDP ; a composite endpoint based on development of extrahepatic spread or vascular invasion , deterioration of liver function or performance status , or death ) , time to extrahepatic spread or vascular invasion ( TTES/VI ) , rate of TACE , and safety . Time to radiographic progression ( TTP ) and objective response rate were exploratory endpoints . The trial was terminated after r and omization of 502 patients  ( brivanib , 249 ; placebo , 253 ) when two other phase III studies of brivanib in advanced HCC patients failed to meet OS objectives . At termination , median follow-up was approximately 16 months . Intention-to-treat analysis showed no improvement in OS with brivanib versus placebo ( median , 26.4 [ 95 % confidence interval { CI } : 19.1 to not reached ] vs. 26.1 months [ 19.0 - 30.9 ] ; hazard ratio [ HR ] : 0.90 [ 95 % CI : 0.66 - 1.23 ] ; log-rank P=0.5280 ) . Brivanib improved TTES/VI ( HR , 0.64 [ 95 % CI : 0.45 - 0.90 ] ) , TTP ( 0.61 [ 0.48 - 0.77 ] ) , and rate of TACE ( 0.72 [ 0.61 - 0.86 ] ) , but not TTDP ( 0.94 [ 0.72 - 
    Output:
    
Significant efficacy was observed in most subgroups .
Conclusions Regarding efficacy , TACE+CKI offers clear advantages for patients with advanced HCC .