***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 For assessment of the advantages and side effects of para-aortic lymph nodes irradiation under the evaluation by computer tomography , a prospect i ve r and omized study was started in 1986 . The results for survival , local control and late complications are presented in the following . PATIENTS AND METHODS From November 1986 to October 1990 , 93 patients with cervical carcinoma were r and omly allocated for treatment with either  pelvic irradiation  ( pelvic group ) or pelvic plus para-aortic lymph nodes irradiation ( para-aortic group ) . Thirty-six patients underwent external irradiation and intracavitary therapy ( RT arm ) and 57 patients , extended radical hysterectomy and external irradiation ( OP-RT arm ) . Para-aortic lymph nodes irradiation delivered 45 Gy in 1.8 Gy per day for 5 days per week through anterior-posterior fields . RESULTS The 3-year cause specific survival rates were para-aortic group : 57 % and pelvic group : 89 % in RT arm group , and para-aortic group : 70 % and pelvic group : 86 % in OP-RT arm group . Differences for the 2 groups in each treatment arm were not significant . In pelvic failure , para-aortic lymph nodes metastases and distant metastases showed no statistically significant differences for the 2 groups in each treatment arm . In the para-aortic group , complications were more frequent than in the pelvic group ( 13/45 vs. 2/48 , p < 0.025 ) . As an enteric complication ileus was found in 7 % ( 3/45 ) of the para-aortic group while 2 % ( 1/48 ) in the pelvic group . Compression fractures of the lumber vertebral body were apparent in 9 % ( 4/45 ) and 0 % , respectively . CONCLUSION Routine para-aortic lymph nodes irradiation delivered through anterior-posterior fields for high risk patients with cervical carcinoma is of limited value occurring to the high incidence of late complications and this treatment fails to improve no survival rates From November 1977 to July 1981 , 441 patients with cervical carcinoma were r and omized between pelvic irradiation and pelvic and para-aortic irradiation .  Included were patients with stage I and IIB with proximal vaginal and /or parametrial involvement with positive pelvic lymph nodes either on lymphangiogram or at surgery , and stage IIB with distal vaginal and /or parametrial involvement and III regardless of pelvic node status on lymphangiogram . Patients with clinical ly or surgically involved para-aortic nodes were not included . The external beam dose to the para-aortic area was fixed at 45 Gy . There was no statistically significant difference between the two treatment arms in terms of local control , overall distant metastases and survival with no evidence of disease ( NED ) , although the incidence of para-aortic metastases and distant metastases without tumor at pelvic sites was significantly higher in patients receiving pelvic irradiation alone ( pelvic group ) . The 4-year NED survival rate was 51 % . The incidence of severe digestive complications was significantly higher in patients receiving para-aortic irradiation ( para-aortic group ) . Routine para-aortic irradiation for all high risk patients with cervical carcinoma is of limited value , but patients with a high probability of local control can benefit from extended field irradiation , despite an increase in severe digestive complications PURPOSE To test the hypothesis that cisplatin ( CDDP ) administered concurrently with st and ard radiotherapy ( RT ) would improve pelvic control and survival in patients with advanced squamous cell cancer of the cervix . PATIENTS AND METHODS A total of 259 patients with International Federation of Gynecology and Obstetrics stage IB to IVA squamous cell cervical cancer with central disease greater-than-or-equal 5 cm or histologically confirmed pelvic lymph node involvement were r and omized to receive RT ( external-beam RT plus brachytherapy ) plus weekly CDDP chemotherapy ( 40 mg/m(2 ) ) ( arm 1 ) or the same RT without chemotherapy ( arm 2 ) . RESULTS A total of 253 patients were available for analysis . Median follow-up was 82 months . No significant difference was found in progression-free survival ( P = .33 ) . No significant difference in 3- and 5-year survival rates was found ( 69 % v 66 % and 62 % v 58 % , respectively ; P = .42 ) . The hazard ratio for survival ( arm 2 to arm 1 ) was 1.10 ( 95 % confidence interval , 0.75 to 1.62 ) . CONCLUSION This study did not show a benefit to either pelvic control or survival by adding concurrent weekly CDDP chemotherapy in a dose of 40 mg/m(2 ) to radical RT as given in this trial . Careful attention to RT details is important for achieving optimum outcome for patients with this disease Background The aim was to evaluate whether extended-field concurrent chemoradiation ( EF-CCRT ) leads to results better than those obtained by st and ard whole-pelvis concurrent chemoradiation ( WP-CCRT ) in locally advanced cervical cancer with radiologic negative paraaortic lymph nodes ( PALNs ) . Patients and methods A total of 102 patients with histopathologically proven squamous cell carcinoma , adenocarcinoma , or adenosquamous cell carcinoma , and radiologic negative PALN locally advanced cervical cancer , stage IIB-IVA , were accrued between July 2007 and April 2008 and were r and omly assigned to WP-CCRT ( 50 patients ) or EF-CCRT ( 52 patients ) , followed by high-dose rate brachytherapy . Data regarding the safety profile , response rates , and occurrence of local , PALN , or distant failure were recorded . Results During a median follow-up time of 60 months ( 18–66 ) , 74/102 patients completed the treatment protocol and were analyzed . Overall PALN , distant-metastasis control , disease-free survival , and overall survival rates were 97.1 % , 86.9 % , 80.3 % , and 72.4 % in EF-CCRT respectively in comparison with WP-CCRT ( 82.1%,74.7 % , 69.1 % , and 60.4 % ) , with P-values of 0.02 , 0.03 , 0.03 and 0.04 respectively . No difference in acute toxicity profile was seen between the groups , and late toxicities were mild and minimal . Conclusion Prophylactic EF-CCRT can be a reasonable option in patients with locally advanced cervical cancer with radiologic positive pelvic lymph nodes and radiologic negative PALN BACKGROUND AND PURPOSE The efficacy of prophylactic extended-field irradiation ( EFI ) plus concomitant cisplatin in patients with locally advanced uterine cervical cancer ( LAUCC ) is unknown , nor is it known whether tumor carbonic anhydrase IX ( CA9 ) expression level , a hypoxia marker , influences survival outcome . MATERIAL AND METHODS We recruited patients with UCC , FIGO stage IB1 with pelvic lymph node ( LN ) metastases to IVA with negative para-aortic LN on PET/CT . CA9 expression was examined and patients were r and omized to either EFI or pelvic only radiotherapy ( PRT ) in each CA9 group . The primary outcomes were para-aortic recurrence-free survival ( PARFS ) and disease-free survival ( DFS ) . RESULTS Between 2006 and 2011 , 79 patients with CA9-positive and 37 with CA9-negative tumors were enrolled , respectively . The median follow-up period was 69.2months ( range 6.8 - 102.1 ) . For CA9-positive patients , 5-year PARFS was 100 % and 81.7 % for those receiving EFI and PRT ( p=0.007 ) , respectively . DFS was 78.6 % for EFI and 71.3 % for PRT patients ( p=0.353 ) . For CA9-negative patients , 5y PARFS was 100 % and 94.1 % for EFI and PRT ( p=0.317 ) , respectively . DFS was 100 % for EFI and 70.7 % for PRT ( p=0.018 ) . CONCLUSION EFI significantly reduced recurrences in PAN in patients with CA9-positive tumors , but survival outcome was not improved , due to high local recurrence and high distant metastases rates . This study indicates the necessity for new therapeutic strategies for LAUCC patients whose tumors show high CA9 expression PURPOSE To determine whether the addition of cisplatin-based chemotherapy ( CT ) to pelvic radiation therapy ( RT ) will improve the survival of early-stage , high-risk patients with cervical carcinoma . PATIENTS AND METHODS Patients with clinical stage IA(2 ) , IB , and IIA carcinoma of the cervix , initially treated with radical hysterectomy and pelvic lymphadenectomy , and who had positive pelvic lymph nodes and /or positive margins and /or microscopic involvement of the parametrium were eligible for this study . Patients were r and omized to receive RT or RT + CT . Patients in each group received 49.3 GY RT in 29 fractions to a st and ard pelvic field . Chemotherapy consisted of bolus cisplatin 70 mg/m(2 ) and a 96-hour infusion of fluorouracil 1,000 mg/m(2)/d every 3 weeks for four cycles , with the first and second cycles given concurrent to RT . RESULTS Between 1991 and 1996 , 268 patients were entered onto the study . Two hundred forty-three patients were assessable ( 127 RT + CT patients and 116 RT patients ) .  Progression-free and overall survival are significantly improved in the patients receiving CT . The hazard ratios for progression-free survival and overall survival in the RT only arm versus the RT + CT arm are 2.01 ( P = .003 ) and 1.96 ( P = . 007 ) , respectively . The projected progression-free survivals at 4 years is 63 % with RT and 80 % with RT + CT . The projected overall survival rate at 4 years is 71 % with RT and 81 % with RT + CT . Grade s 3 and 4 hematologic and gastrointestinal toxicity were more frequent in the RT + CT group . CONCLUSION The addition of concurrent cisplatin-based CT to RT significantly improves progression-free and overall survival for high-risk , early-stage patients who undergo radical hysterectomy and pelvic lymphadenectomy for carcinoma of the cervix BACKGROUND Stage Ib and IIa cervical carcinoma can be cured by radical surgery or radiotherapy . These two procedures are equally effective , but differ in associated morbidity and type of complications . In this prospect i ve r and omised trial of radiotherapy versus surgery , our aim was to assess the 5-year survival and the rate and pattern of complications and recurrences associated with each treatment . METHODS Between September , 1986 , and December , 1991 , 469 women with newly diagnosed stage Ib and IIa cervical carcinoma were referred to our institute . 343 eligible patients were r and omised : 172 to surgery and 171 to radical radiotherapy . Adjuvant radiotherapy was delivered after surgery for women with surgical stage pT2b or greater , less than 3 mm of safe cervical stroma , cut-through , or positive nodes . The primary outcome measures were 5-year survival and the rate of complications . The analysis of survival and recurrence was by intention to treat and analysis of complications was by treatment delivered . FINDINGS 170 patients in the surgery group and 167 in the radiotherapy group were included in the intention-to-treat analysis ; scheduled treatment was delivered to 169 and 158 women , respectively , 62 of 114 women with cervical diameters of 4 cm or smaller and 46 of 55 with diameters larger than 4 cm received adjuvant therapy . After a median follow-up of 87 ( range 57 - 120 ) months , 5-year overall and disease-free survival were identical in the surgery and radiotherapy groups ( 83 % and 74 % , respectively , for both groups ) , 86 women developed recurrent disease : 42 ( 25 % ) in the surgery group and 44 ( 26 % ) in the radiotherapy group . Significant factors for survival in univariate and multivariate analyses were : cervical diameter , positive lymphangiography , and adeno-carcinomatous histotype . 48 ( 28 % ) surgery-group patients had severe morbidity compared with 19 ( 12 % ) radiotherapy-group patients ( p = 0.0004 ) . INTERPRETATION There is no treatment of choice for early-stage cervical carcinoma in terms of overall or disease-free survival . The combination of surgery and radiotherapy has the worst morbidity , especially urological complications . The optimum therapy for each patient should take account of clinical factors such as menopausal status , age , medical illness , histological type 
    Output:
    
Studies of pelvic chemoradiotherapy ( CRT ) demonstrated improved survival rates compared to pelvic RT alone .
Moderate-certainty evidence shows that , compared with pelvic RT alone , extended-field RT probably improves overall survival and reduces risk of para-aortic lymph node recurrence .
Low- to moderate-certainty evidence suggests that pelvic CRT may increase overall and progression-free survival compared to extended-field RT , although there may or may not be a higher rate of para-aortic recurrence and acute adverse events .