***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 
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    Input: PURPOSE Local failure after radiotherapy can arise with cancer extending beyond the capsule and /or involvement of seminal vesicles or positive surgical margins . METHODOLOGY After undergoing radical prostatectomy 1005 patients were r and omly assigned ( 1999 - 2001 ) to a wait and see policy  or an  immediate postoperative irradiation  ( 60 Gy delivered over 6 weeks ) ; eligible patients had pN0 M0 tumors and one or more pathological risk factors mentioned above . The main end-point was 5-year biochemical progression free survival . RESULTS After a median follow-up of 5-year biochemical progression free survival was significantly improved in the irradiated group ( 74 % , 98 % CI : 68.7 - 79.3 vs 52.6 % , 98 % CI : 46.6 - 58.5 ; P<0.0001 ) Clinical progression free survival was also significantly improved ( P<0.0009 ) . The cumulative rate of loco-regional failure was also significantly improved ( P<0.0009 ) . Grade 2 or 3 late effects were significantly more frequent in the postoperative irradiation group ( P=0.0005 ) , but severe toxicity ( grade 3 or higher ) were rare with a 5-year rate of 2.6 % in the wait- and -see group and 4.2 % in the postoperative irradiation group ( P=0.07 ) . CONCLUSION Immediate external irradiation after radical prostatectomy improves biochemical progression free survival and local control in patients with positive surgical margin or pT3 prostate cancer who are at high risk of progression . Further follow-up is needed to assess the impact on overall survival BACKGROUND Local failure after prostatectomy can arise in patients with cancer extending beyond the capsule . We did a r and omised controlled trial to compare radical prostatectomy followed by immediate external irradiation with prostatectomy alone for patients with positive surgical margin or pT3 prostate cancer . METHODS After undergoing radical retropubic prostatectomy , 503 patients were r and omly assigned to a wait- and -see policy , and 502 to  immediate postoperative radiotherapy ( 60 Gy conventional irradiation delivered over 6 weeks ) . Eligible patients had pN0M0 tumours and one or more pathological risk factors : capsule perforation , positive surgical margins , invasion of seminal vesicles . Our revised primary endpoint was biochemical progression-free survival . Analysis was by intention to treat . FINDINGS The median age was 65 years ( IQR 61 - 69 ) . After a median follow-up of 5 years , biochemical progression-free survival was significantly improved in the irradiated group ( 74.0 % , 98 % CI 68.7 - 79.3 vs 52.6 % , 46.6 - 58.5 ; p<0.0001 ) . Clinical progression-free survival was also significantly improved ( p=0.0009 ) . The cumulative rate of locoregional failure was significantly lower in the irradiated group ( p<0.0001 ) . Grade 2 or 3 late effects were significantly more frequent in the postoperative irradiation group ( p=0.0005 ) , but severe toxic toxicity ( grade 3 or higher ) were rare , with a 5-year rate of 2.6 % in the wait- and -see group and 4.2 % in the postoperative irradiation group ( p=0.0726 ) . INTERPRETATION Immediate external irradiation after radical prostatectomy improves biochemical progression-free survival and local control in patients with positive surgical margins or pT3 prostate cancer who are at high risk of progression . Further follow-up is needed to assess the effect on overall survival OBJECTIVES To define the optimal role for radiotherapy ( RT )  after radical prostatectomy ( RP ) and to characterize specific patterns of PSA failure in this setting . METHODS The records of 105 patients who underwent RT after RP ( 69 received therapeutic RT because of an elevated prostate-specific antigen [ PSA ] level , 36 received immediate adjuvant RT ) were review ed . The median follow-up was 35 months after RT and 57 months after RP . Radiation success was defined as achievement and maintenance of a PSA less than 0.2 ng/mL. Preoperative , pathologic , and postoperative characteristics were examined for their ability to predict success after RT .  Patterns of PSA recurrence after RT were also examined by determining the PSA nadir , PSA velocity , and timing of and rogen-deprivation therapy . RESULTS Of 105 patients , 47 experienced biochemical failure . Actuarial 3 and 5-year progression-free survival estimates for all patients were 55 % and 43 % , respectively . Significant favorable predictors of response to RT by multivariate analysis were preoperative PSA less than 20 ng/mL and the use of adjuvant RT . However , patients who received therapeutic RT with a pre-RT PSA less than 1.0 ng/mL demonstrated progression-free outcome equivalent to those who received adjuvant RT . Two distinct patterns of PSA failure were observed on the basis of PSA nadir after RT . Patients whose PSA failed to reach a nadir less than 0.2 ng/mL after RT had progression with a high PSA velocity ( 1.5 ng/mL/yr ) . Patients whose PSA reached a nadir less than 0.2 ng/mL but who subsequently had treatment failure progressed later with a lower PSA velocity ( 0.36 ng/ml/yr ) . CONCLUSIONS RT is effective in select patients after RP . Given the low PSA velocity consistent with persistent local disease in nearly 50 % of patients in whom RT failed , more effective local therapy is needed after RP in high-risk patients INTRODUCTION A dry run of a clinical trial ( EORTC 22911 ) is presented in which 12 centres have participated . These are the centres which have contributed the largest number of patients to the trial . MATERIAL AND METHODS Each participating centre received data from a suitable patient . Investigators were asked to plan and ' treat ' the patient according to the protocol guidelines and return the data for evaluation of compliance . RESULTS The results show that compliance to the protocol guidelines was generally good . There were a few minor deviations in the dose and fractionation schedule , in the volume reduction for the booster dose and in the dose prescription point . None of these deviations will affect the outcome of the study . The most important observation is the large inter-centre variation in target volumes . CONCLUSIONS The results of this study underlines the need for a strict definition of the target volume and the adoption of the ICRU 50 recommendations in future protocol Pathological staging and surgical margin status of  radical prostatectomy specimens are next to grading the most important prognosticators for recurrence . A central review of pathological stage and surgical margin status was performed on a series of 552 radical prostatectomy specimens of patients , participating in the European Organisation for Research and Treatment of Cancer trial 22911 . Inclusion criteria of the trial were pathological stage pT3 and /or positive surgical margin at local pathology . All specimens were totally embedded . Data of the central review were compared with those of local pathologists and related to clinical follow-up . Although a high concordance between review pathology and local pathologists existed for seminal vesicle invasion ( 94 % , κ=0.83 ) , agreement was much less for extraprostatic extension ( 57.5 % , κ=0.33 ) and for surgical margin status ( 69.4 % , κ=0.45 ) .  Review pathology of surgical margin status  was a stronger predictor of biochemical progression-free survival in univariate analysis [ hazard ratio (HR)=2.16 and p=0.0002 ] than local pathology ( HR=1.08 and p>0.1 ) . The review pathology demonstrated a significant difference between those with and without extraprostatic extension ( HR=1.83 and p=0.0017 ) , while local pathology failed to do so ( HR=1.05 and p>0.8 ) . The observations suggest that review of pathological stage and surgical margin of radical prostatectomy strongly improves their prognostic impact in multiinstitutional studies or trials PURPOSE Southwest Oncology Group ( SWOG ) trial 8794 demonstrated that adjuvant radiation reduces the risk of biochemical ( prostate-specific antigen [ PSA ] ) treatment failure by 50 % over radical prostatectomy alone . In this analysis , we stratified patients as to their preradiation PSA levels and correlated it with outcomes such as PSA treatment failure , local recurrence , and distant failure , to serve as guidelines for future research . PATIENTS AND METHODS Four hundred thirty-one subjects with pathologically advanced prostate cancer ( extraprostatic extension , positive surgical margins , or seminal vesicle invasion ) were r and omly assigned to adjuvant radiotherapy or observation . RESULTS Three hundred seventy-four eligible patients had immediate postprostatectomy and follow-up PSA data . Median follow-up was 10.2 years . For patients with a postsurgical PSA of 0.2 ng/mL , radiation was associated with reductions in the 10-year risk of biochemical treatment failure ( 72 % to 42 % ) , local failures ( 20 % to 7 % ) , and distant failures ( 12 % to 4 % ) . For patients with a postsurgical PSA between higher than 0.2 and < or = 1.0 ng/mL , reductions in the 10-year risk of biochemical failure ( 80 % to 73 % ) , local failures ( 25 % to 9 % ) , and distant failures ( 16 % to 12 % ) were realized . In patients with postsurgical PSA higher than 1.0 , the respective findings were 94 % versus 100 % , 28 % versus 9 % , and 44 % versus 18 % . CONCLUSION The pattern of treatment failure in high-risk patients is predominantly local with a surprisingly low incidence of metastatic failure . Adjuvant radiation to the prostate bed reduces the risk of metastatic disease and biochemical failure at all postsurgical PSA levels . Further improvement in reducing local treatment failure is likely to have the greatest impact on outcome in high-risk patients after prostatectomy 4504 Background : In 1992 , as radical prostatectomy was more frequently applied to clinical T1 - 2N0M0 prostate cancer , the EORTC has undertaken a r and omized trial of immediate post-operative treatment versus wait- and -see policy , for patients with high risk factors of local relapse on pathological specimen . We present the first efficacy results of this study . METHODS Eligible patients were ≤75 years old , WHO performance status ( PS ) 0 - 1 , had T0 - 3N0M0 PC preoperatively and ≥1 pathological risk factor of : capsule invasion , positive surgical margins , invasion of seminal vesicles .  P-XRT was 60Gy conventional external radiation delivered over 6 weeks . The trial was powered to detect a hazard ratio ( HR ) of 0.77 with 80 % power with two-sided α=0.05 with regard to clinical or biological progression-free survival . RESULTS 1005 pts were accrued by end 2001 ( P-XRT : 503 , Px : 502 ) . Median age was 65.4 years , PS 0 in 93.8 % , median pre- and post-operative PSA 12.3 and 0.2 ng/ml , respectively . All but 41pts on P-XRT were irradiated with median dose 60Gy ( range : 50 - 74 ) . The trial was review ed by an IDMC in December 2003 , after a median follow-up of 5 years and early disclosure of the trial results was recommended . Biochemical PFS ( time to twice confirmed PSA increase over nadir or first clinical failure or death ) at 5 years was 72.2 % ( CI : 67.7 - 76.8 ) on P-XRT and 51.8 % ( CI : 46.8 - 56.8 ) , HR=0.52 ( CI : 0.42 - 0.64 ) , P<0.0001 . Clinical PFS was improved from 74.8 % to 83.3 % at 5 years ( HR=0.68 , CI : 0.52 - 0.89 , P=0.004 ) . The incidence of loco-regional failure was significantly decreased ( P<0.0001 ) . Further follow-up is needed to assess the impact on distant metastases and overall survival . P-XRT is associated with an increased risk of immediate and late grade 1 - 2 side effects . Grade 3 side effect rates so far were less than 5 % in both groups . CONCLUSIONS Post-operative radiotherapy results in improved biochemical and clinical PFS . This benefit is to be weighed against the treatment side effects . Further follow-up is needed to assess the impact on overall survival . No significant financial relationships to disclose As professionals , we want to use the best treatments ; as patients , we want to be given them . Knowing whether an intervention works ( or does not work ) is fundamental to clinical decision making . However , clinical decision making involves more than simply taking published results of research directly to the bedside . Physicians need to consider how similar their patients are to those in the published studies , to take the values and preferences of their patients into account , and to consider their own experience with a given test or treatment . Evidence from clinical research is becoming increasingly important in medical- practice decisions as more and better 
    Output:
    
Adjuvant RT after RP improves overall survival and reduces the rate of distant metastases , but these effects are only evident with longer follow up .
At 5 and 10 years it improves local control and reduces the risk of biochemical failure , although the latter is not a clinical endpoint .
Moderate or severe acute and late toxicity is minimal .
There is an increased risk of urinary stricture and incontinence , but no detriment to quality of life , based on limited data .