***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 The American College of Surgeons Oncology Group trial Z0011 was a prospect i ve , r and omized , multicenter trial comparing overall survival between patients with positive sentinel lymph nodes ( SLNs ) who did and did not undergo axillary lymph node dissection ( ALND ) .  The current study compares complications associated with SLN dissection ( SLND ) plus ALND , versus SLND alone . PATIENTS AND METHODS From May 1999 to December 2004 , 891 patients were r and omly assigned to  SLND + ALND ( n = 445 ) or SLND alone ( n = 446 ) . Information on wound infection , axillary seroma , paresthesia , brachial plexus injury ( BPI ) , and lymphedema was available for 821 patients . RESULTS Adverse surgical effects were reported in 70 % ( 278 of 399 ) of patients after SLND + ALND and 25 % ( 103 of 411 ) after SLND alone ( P < or= .001 ) . Patients in the SLND + ALND group had more wound infections ( P < or= .0016 ) , seromas ( P < or= .0001 ) , and paresthesias ( P < or= .0001 ) than those in the SLND-alone group . At 1 year , lymphedema was reported subjectively by 13 % ( 37 of 288 ) of patients after SLND + ALND and 2 % ( six of 268 ) after SLND alone ( P < or= .0001 ) . The difference between the two groups ' lymphedema , assessed by arm measurements at 30 days ( P = .36 ) , 6 months ( P = .22 ) , and 1 year ( P = .078 ) , although close to the cutoff for significance at 1 year , was not significant . BPIs occurred in less than 1 % of patients . CONCLUSION In trial Z0011 , the use of SLND + ALND result ed in more wound infections , axillary seromas , and paresthesias than SLND alone . Lymphedema was more common after SLND + ALND but was significantly different only by subjective report . The use of SLND alone result ed in fewer complications Purpose To evaluate toxicity of radiochemotherapy schedule using daily-low-dose-cisplatin in radiochemotherapy of locally-advanced head- and -neck-cancer ( HNSCC ) . Methods and patients From October 2003 to October 2006 , 50 patients with HNSCC ( stage III/IVA/IVB ) were treated . In 32 patients , surgery and adjuvant radiotherapy(64 Gy ) , in 18 patients definitive radiotherapy(70 Gy ) was performed . Low-dose-cisplatin was applied concomitantly ( 6 mg/m2/every radiotherapy-day ) . Results Acute toxicity ≥ grade 3 was observed in 22 patients ( 11 patients mucositis/dysphagia , 7 hematologic toxicity , 4 mucositis/dysphagia/hematologic toxicity ) . 90 % of our patients received > 80 % of the planned cumulative chemotherapy dose , 94 % the intended dose of radiotherapy . After median follow-up of 24.2 months , 3-year overall survival and loco-regional control rates were 67.1 and 78 % . During follow-up , chronic toxicity ≥ grade 3 ( xerostomia , subcutaneous fibrosis , or lymphedema ) was observed in nine patients . Conclusion We found chemoradiation with daily-low-dose-cisplatin to be feasible with advantage of low acute and chronic toxicity . Therefore , use of low-dose-cisplatin should be evaluated in future clinical trials PURPOSE To investigate the safety and clinical utility of the sentinel node procedure in early-stage vulvar cancer patients . PATIENTS AND METHODS A multicenter observational study on sentinel node detection using radioactive tracer and blue dye was performed in patients with T1/2 ( < 4 cm ) squamous cell cancer of the vulva . When the sentinel node was found to be negative at pathologic ultrastaging , inguinofemoral lymphadenectomy was omitted , and the patient was observed with follow-up for 2 years at intervals of every 2 months . Stopping rules were defined for the occurrence of groin recurrences . RESULTS From March 2000 until June 2006 , a sentinel node procedure was performed in 623 groins of 403 assessable patients . In 259 patients with unifocal vulvar disease and a negative sentinel node ( median follow-up time , 35 months ) , six groin recurrences were diagnosed ( 2.3 % ; 95 % CI , 0.6 % to 5 % ) , and 3-year survival rate was 97 % ( 95 % CI , 91 % to 99 % ) . Short-term morbidity was decreased in patients after sentinel node dissection only when compared with patients with a positive sentinel node who underwent inguinofemoral lymphadenectomy ( wound breakdown in groin : 11.7 % v 34.0 % , respectively ; P < .0001 ; and cellulitis : 4.5 % v 21.3 % , respectively ; P < .0001 ) . Long-term morbidity also was less frequently observed after removal of only the sentinel node compared with sentinel node removal and inguinofemoral lymphadenectomy ( recurrent erysipelas : 0.4 % v 16.2 % , respectively ; P < .0001 ; and lymphedema of the legs : 1.9 % v 25.2 % , respectively ; P < .0001 ) . CONCLUSION In early-stage vulvar cancer patients with a negative sentinel node , the groin recurrence rate is low , survival is excellent , and treatment-related morbidity is minimal . We suggest that sentinel node dissection , performed by a quality -controlled multidisciplinary team , should be part of the st and ard treatment in selected patients with early-stage vulvar cancer BACKGROUND Radical radiotherapy for muscle-invasive urinary bladder cancer can sterilize the tumour with preserved organ function . Here we studied symptoms , symptom distress and trade-off among long-term survivors and compared figures to those of population controls and patients who had undergone cystectomy .  MATERIAL S AND METHODS We identified 71 patients who had had urinary bladder cancer treated with radical radiotherapy before 1995 . For comparison , 325 patients treated with radical cystectomy and urostomy , continent or non-continent , during the same period and 460 individuals r and omly selected from the general population were included . Information was collected by means of an anonymously answered postal question naire to avoid investigator-related bias . RESULTS Answers were obtained from 58 ( 82 % ) radiated patients , 251 ( 85 % ) cystectomized patients and 310 ( 71 % ) population controls . Of the radiated patients , 74 % reported little or no distress from symptoms from the urinary tract , 38 % had had intercourse the previous month and 57 % ( men ) reported they had ejaculated . Among the cystectomized patients , 13 % had had intercourse and 0 % ( men ) had ejaculated . Moderate or much distress from symptoms from the gastrointestinal tract was reported by 32 % of the radiated patients , 24 % of the cystectomized patients and 9 % of the population controls . After radical radiotherapy , 46 % of the patients were willing to accept some risk of decreased survival to become symptom-free . CONCLUSIONS About 3/4 of these long-term survivors after radical radiotherapy for bladder cancer had a functioning urinary bladder with little or no distress from the urinary tract . The prevalence of sexual dysfunction was lower than after cystectomy and the prevalence of distress from the gastrointestinal tract was comparable PURPOSE The objective was to investigate the effect of pathologic parameters and other variables on treatment outcome for patients with International Federation of Gynecology and Obstetrics ( FIGO ) stage IB , IIA cervical carcinoma , as well as to assess the morbidities attributable to radical surgery combined with postoperative radiotherapy . MATERIAL S AND METHODS Between January 1980 and June 1994 , 179 women with FIGO stage IB , IIA carcinoma of the uterine cervix were treated with radical hysterectomy and postoperative irradiation .  The median follow-up of alive patients was 6.8 years . All patients received 44 - 60 Gy external irradiation .  One hundred fifty-nine patients received  3 - 10 Gy intracavitary brachytherapy . The data were analyzed for overall survival , disease-free survival , pelvic control , and treatment-related complications . RESULTS The 5-year overall survival rate , disease-free survival rate , and pelvic control rate for the 179 patients were 72 , 74 , and 90 % , respectively . The 5-year overall survival rate was 81 % for patients without pelvic lymphadenopathy and 53 % for those with pelvic lymphadenopathy ( P = 0.0000 ) . Other independent prognostic factors for overall survival included tumor differentiation and the interval between operation and initiation of radiotherapy . For the endpoint of disease-free survival , pelvic lymph node status , tumor differentiation , the duration of interruption of radiotherapy , and the interval between operation and radiotherapy were of independent prognostic significance . As pelvic control was concerned , the 5-year pelvic control rate was 90 % and only the duration of interruption of radiotherapy was noted as an independent predictor of pelvic control . Distant metastases were noted in 43 patients ( 24 % ) ; the most common sites were lung ( 10 % ) , liver ( 6 % ) , and bone ( 6 % ) . The overall 5-year intestinal and urinary complication-free rate was 66 and 82 % , respectively . The overall incidence of grade 3 or above late rectal and urinary sequelae was 10 % . For patients sustaining leg lymphedema after radiotherapy , there was higher incidence of severe leg cellulitis which warranted antibiotics treatment . CONCLUSION These prognostic factors should be considered in patient counseling and treatment planning . Based on these factors , a more aggressive treatment to improve survival in these subsets of high-risk patients might be justified . New therapeutic regimens and modalities aim ed to overcome treatment failure should be investigated OBJECTIVES To evaluate VH fibrin sealant 's influence on lower extremity lymphedema after inguinal lymphadenectomy in vulvar cancer patients . METHODS Patients undergoing an inguinal lymphadenectomy during the management of vulvar malignancy were r and omized to receive sutured closure ( SC ) vs VH fibrin sealant sprayed into the groin followed by sutured closure ( FS ) . Leg measurements were taken preoperatively and during postoperative encounters when surgical outcomes were assessed . Grade 2 or 3 lymphedema was defined as circumferential measurement increases of 3 - 5 cm and > 5 cm , respectively . RESULTS 150 patients were enrolled . 137 patients were evaluable for lymphedema analysis with 67 and 70 patients in the SC arm and FS arm , respectively . The incidence of grade 2 and 3 lymphedema was 67%(45/67 ) in the SC arm , and 60 % ( 42/70 ) FS arm ( p=0.4779 ) . The incidence of lymphedema was strongly associated with inguinal infection ( p=0.0165 ) . Lymphedema was not statistically increased in those who received adjuvant radiation . 139 patients remained evaluable for a descriptive analysis of their surgical complications . The overall incidence of complications was 61%(43/70 ) and 59 % ( 41/69 ) for SC and FS arms , respectively . There was no statistically significant difference in duration of drains , drain output or incidence of inguinal infections , wound breakdowns or seromas . There was an increased incidence of vulvar infections in the FS arm ( 23/69 ) vs ( 10/70 ) ( p=0.0098 ) . The utilization of a Blake drain was associated with an increase in vulvar ( p=0.0157 ) and inguinal wound breakdown ( p=0.0456 ) . CONCLUSION VH fibrin sealant in inguinal lymphadenectomies does not reduce leg lymphedema and may increase the risk for complications in the vulvar wound In a preliminary report of a prospect i ve controlled study treatment results and therapy morbidity of 60 patients with stage pT1bNoMo carcinoma of the uterine cervix treated by radical surgery only ( Wertheim-Meigs ) were compared with those of 60 patients treated by radical surgery followed by a postoperative external radiotherapy .  The median duration of follow-up was 44 ( 24 - -72 ) months . Comparing the survival probability analyzed by life-table- method up to 18 months there was a significant better result for patients treated with surgery only . However , after that the study demonstrated comparable therapeutic results with the two therapeutic regimens . There was no difference of tumor size in patients who died after surgery alone and those who died after combined therapy . The therapy morbidity was slightly greater in patients 
    Output:
    
Objective measurement methods and longer follow-up were both associated with increased lymphedema incidence .
CONCLUSIONS Lymphedema is a common condition affecting cancer survivors with various malignancies .
The incidence of lymphedema is related to the type and extent of treatment , anatomic location , heterogeneity of assessment methods , and length of follow-up