***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 Abstract The urinary bladder shows considerable individual variation in shape and position during a course of radiotherapy ( RT ) . In this study we have developed and compared three different adaptive RT ( ART ) strategies for bladder cancer involving daily cone beam CT ( CBCT ) imaging and plan selection . Material and methods . Ten patients treated for bladder cancer had daily CBCTs acquired that were registered online using bony anatomy registration . Seven patients received intensity modulated RT ( IMRT ) with a simultaneous integrated boost ( SIB ) technique to the bladder and pelvic lymph nodes . Three patients received treatment to the bladder only . Retrospectively , we compared three ART strategies that were all based on daily selection of the most suitable plan from a library consisting of three IMRT-plans corresponding to a small , medium and large target volume . ART method A utilised population -based margins while methods B and C used the bladder as seen on CBCT-scans from the first week of treatment ; method B without delineation of the bladder on CBCT and method C with delineation of the bladder . Total dose distributions were calculated using the planning CT . For each patient , we calculated ratios of the dose volume histograms ( DVHs ) for the three ART strategies relative to non-adaptive therapy . Results . The inter-patient variation was large for all three ART strategies . The mean ratios of the volumes receiving 57 Gy or more ( corresponding to 95 % of prescribed dose ) for methods A , B and C were 0.66 ( SD : 0.11 ) , 0.67 ( SD : 0.13 ) and 0.67 ( SD : 0.16 ) respectively when compared to the non-adaptive plan . Conclusion . When using any of the ART strategies , it is possible to reduce significantly the volumes receiving high doses compared to the use of a st and ard non-adaptive plan . The differences in dose volume parameters between the three methods were small compared with the differences from the st and ard plan Background To analyse the overall clinical outcome and benefits by applying protocol based image guided adaptive brachytherapy combined with 3D conformal external beam radiotherapy ( EBRT ) ± chemotherapy ( ChT ) . Methods Treatment schedule was EBRT with 45–50.4 Gy ± concomitant cisplatin chemotherapy plus 4 × 7 Gy High Dose Rate ( HDR ) brachytherapy .  Patients were treated in the “ protocol period ” ( 2001–2008 ) with the prospect i ve application of the High Risk CTV concept ( D90 ) and dose volume constraints for organs at risk including biological modelling . Dose volume adaptation was performed with the aim of dose escalation in large tumours ( prescribed D90 > 85 Gy ) , often with inserting additional interstitial needles . Dose volume constraints ( D2cc ) were 70–75 Gy for rectum and sigmoid and 90 Gy for bladder . Late morbidity was prospect ively scored , using LENT/SOMA Score . Disease outcome and treatment related late morbidity were evaluated and compared using actuarial analysis . Findings One hundred and fifty-six consecutive patients ( median age 58 years ) with cervix cancer FIGO stages IB – IVA were treated with definitive radiotherapy in curative intent . Histology was squamous cell cancer in 134 patients ( 86 % ) , tumour size was > 5 cm in 103 patients ( 66 % ) , lymph node involvement in 75 patients ( 48 % ) . Median follow-up was 42 months for all patients . Interstitial techniques were used in addition to intracavitary brachytherapy in 69/156 ( 44 % ) patients . Total prescribed mean dose ( D90 ) was 93 ± 13 Gy , D2cc 86 ± 17 Gy for bladder , 65 ± 9 Gy for rectum and 64 ± 9 Gy for sigmoid . Complete remission was achieved in 151/156 patients ( 97 % ) . Overall local control at 3 years was 95 % ; 98 % for tumours 2–5 cm , and 92 % for tumours > 5 cm ( p = 0.04 ) , 100 % for IB , 96 % for IIB , 86 % for IIIB . Cancer specific survival at 3 years was overall 74 % , 83 % for tumours 2–5 cm , 70 % for tumours > 5 cm , 83 % for IB , 84 % for IIB , 52 % for IIIB . Overall survival at 3 years was in total 68 % , 72 % for tumours 2–5 cm , 65 % for tumours > 5 cm , 74 % for IB , 78 % for IIB , 45 % for IIIB . In regard to late morbidity in total 188 grade 1 + 2 and 11 grade 3 + 4 late events were observed in 143 patients . G1 + 2/G3 + 4 events for bladder were n = 32/3 , for rectum n = 14/5 , for bowel ( including sigmoid ) n = 3/0 , for vagina n = 128/2 , respectively . Interpretation 3D conformal radiotherapy ± chemotherapy plus image ( MRI ) guided adaptive intracavitary brachytherapy including needle insertion in advanced disease results in local control rates of 95–100 % at 3 years in limited/favourable ( IB/IIB ) and 85–90 % in large/poor response ( IIB/III/IV ) cervix cancer patients associated with a moderate rate of treatment related morbidity . Compared to the historical Vienna series there is relative reduction in pelvic recurrence by 65–70 % and reduction in major morbidity . The local control improvement seems to have impact on CSS and OS . Prospect i ve clinical multi-centre studies are m and atory to evaluate these challenging mono-institutional findings Abstract Background . The first Nordic protocol for three-dimensional ( 3D ) planned radiotherapy in locally advanced cervical cancer was the prospect i ve NOCECA study ( 1994–2000 ) . NOCECA consisted of computed tomography (CT)-based 3D conformal external beam radiotherapy ( EBRT ) with a simultaneous integrated boost ( SIB ) to the primary tumour combined with brachytherapy ( BT ) based on x-ray imaging . In NOCECA the planning aim was to achieve 80 Gy at point A from EBRT and BT combined . However , the balance of dose between EBRT and BT was determined by tumour size at diagnosis with more EBRT dose given to point A and less by BT in more advanced stages . In 2005 image-guided adaptive brachytherapy ( IGABT ) based on magnetic resonance imaging ( MRI ) and optimisation of the BT dose distribution to the remaining tumour and cervix at time of BT ( HR CTV ) was introduced in Aarhus . EBRT remained like in NOCECA until 2008 when the SIB to the primary tumour was ab and oned and IMRT was introduced as routine technique . In this study , we report outcome of our first five-year experience with IGABT  using our NOCECA cohort as reference . Material and methods . The NOCECA cohort comprising 99 patients was compared with 140 consecutive patients treated by IGABT . Patients with para-aortic nodes were excluded in NOCECA but were present in 9 % of the patients treated with IGABT .  No patient in NOCECA received chemotherapy whereas concomitant cisplatin was given to 79 % of the IGABT patients . Results . With IGABT  actuarial local control was 91 % at three years . When comparing NOCECA with IGABT  overall survival was significantly improved from 63 % to 79 % ( p = 0.005 ) . In parallel , both moderate and severe late morbidity were reduced by about 50 % ( p = 0.02 ) . Conclusion . Introduction of IGABT  reduced morbidity and generated a very high rate of local control , which likely has improved survival by at least as much as concomitant chemotherapy PURPOSE Report of clinical cancer control outcomes on Radiation Therapy Oncology Group ( RTOG ) 9406 , a three-dimensional conformal radiation therapy ( 3D-CRT ) dose escalation trial for localized adenocarcinoma of the prostate . METHODS AND MATERIAL S RTOG 9406 is a Phase I/II multi-institutional dose escalation study of  3D-CRT for men with localized prostate cancer . Patients were registered on five sequential dose levels : 68.4 Gy , 73.8 Gy , 79.2 Gy , 74 Gy , and 78 Gy with 1.8 Gy/day ( levels I-III ) or 2.0 Gy/day ( levels IV and V ) . Neoadjuvant hormone therapy ( NHT ) from 2 to 6 months was allowed . Protocol -specific , American Society for Therapeutic Radiation Oncology ( ASTRO ) , and Phoenix biochemical failure definitions are reported . RESULTS Thirty-four institutions enrolled 1,084 patients and 1,051 patients are analyzable . Median follow-up for levels I , II , III , IV , and V was 11.7 , 10.4 , 11.8 , 10.4 , and 9.2 years , respectively . Thirty-six percent of patients received NHT . The 5-year overall survival was 90 % , 87 % , 88 % , 89 % , and 88 % for dose levels I-V , respectively . The 5-year clinical disease-free survival ( excluding protocol prostate-specific antigen definition ) for levels I-V is 84 % , 78 % , 81 % , 82 % , and 82 % , respectively . By ASTRO definition , the 5-year disease-free survivals were 57 % , 59 % , 52 % , 64 % and 75 % ( low risk ) ; 46 % , 52 % , 54 % , 56 % , and 63 % ( intermediate risk ) ; and 50 % , 34 % , 46 % , 34 % , and 61 % ( high risk ) for levels I-V , respectively . By the Phoenix definition , the 5-year disease-free survivals were 68 % , 73 % , 67 % , 84 % , and 80 % ( low risk ) ; 70 % , 62 % , 70 % , 74 % , and 69 % ( intermediate risk ) ; and 42 % , 62 % , 68 % , 54 % , and 67 % ( high risk ) for levels I-V , respectively . CONCLUSION Dose-escalated 3D-CRT yields favorable outcomes for localized prostate cancer . This multi-institutional experience allows comparison to other experiences with modern radiation therapy This study compares three online image guidance techniques ( IGRT ) for prostate IMRT treatment : bony-anatomy matching , soft-tissue matching , and online replanning . Six prostate IMRT patients were studied . Five daily CBCT scans from the first week were acquired for each patient to provide representative " snapshots " of anatomical variations during the course of treatment . Initial IMRT plans were design ed for each patient with seven coplanar 15 MV beams on a 
    Output:
    
Advantageous dosimetric and outcome patterns using ART was documented by the studies of this review .
Despite this , clinical implementations were scarce due to challenges in target/organ re-contouring and suboptimal patient selection in the ART workflows