***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: In a prospect i ve multicenter study , 186 patients with squamous cell esophageal carcinoma , who after evaluation were considered suitable for surgery , were r and omized to 4 treatment groups : Group 1 , surgery alone ; Group 2 , pre-operative chemotherapy ( cisplatin and bleomycin ) and surgery ; Group 3 , pre-operative irradiation ( 35 Gy ) and surgery ; Group 4 , pre-operative chemotherapy , radiotherapy , and surgery .  Three-year survival was significantly higher in the pooled groups receiving radiotherapy as compared with the pooled groups not receiving radiotherapy . Comparison of the groups having pre-operative chemotherapy with those not having chemotherapy showed no significant difference in survival .  Female patients had a significantly better survival than males . The results indicate that pre-operative irradiation had a beneficial effect on intermediate term survival , whereas the chemotherapy regime used did not influence survival . RésuméDans une étude prospect i ve , multicentrique , 186 patients ayant un cancer épidermoïde de l'oesophage ont été r and omisée dans quatre groupes : le groupe 1 a eu la chirurgie seule ; le groupe 2 , une chimiothérapie préopératoire ( cis-platine et bléomycine ) ; le groupe 3 , une radiothérapie préopératoire suivie de chirurgie ; et le groupe 4 , une chimiothérapie et une radiothérapie préopératoires suivies de chirurgie . La survie à trois ans a été supérieure chez l'ensemble des patients ayant reçu la radiothérapie préopératoire par rapport à ceux qui n'en ont pas eu . Aucune différence de survie n'a pu être mise en évidence dans les groupes ayant eu ou pas de chimiothérapie . La survie des femmes a été significativement supérieure à celle des hommes . Ces résultats indiquent que la radiothérapie préopératoire apporte un plus en ce qui concerne la survie à moyen terme , alors que la chimiothérapie n'influence pas la survie . ResumenEn un estudio prospect ivo multicéntrico sobre 186 pacientes con carcinoma escamocelular del esófago c and idatos para cirugía , se constituyeron cuatro grupos para r and omización : Grupo 1 , cirugía solamente ; Grupo 2 , quimioterapia preoperatoria ( cisplatino y bleomicina ) y cirugía ; Grupo 3 , irradiación preoperatoria ( 35 Gy ) y cirugía ; Grupo 4 , quimioterapia preoperatoria , radioterapia y cirugía . La comparación entre el grupo que recibió quimioterapia y el que no la recibió no demostró diferencia significativa en cuanto a supervivencia . Las pacientes femeninas exhibieron una mejor supervivencia que los pacientes masculinos . Los result ados indican que la irradiación preoperatoria tuvo un efecto benéfico sobre la sobrevida a término medio , en tanto que la quimioterapia , en el regimen utilizado , no tuvo influencia sobre la supervivencia Between January 1986 and December 1992 , sixty-nine patients with squamous esophageal cancer were r and omized to one or the other of two treatment groups . Group 1 ( 35 patients ) were scheduled to receive chemotherapy ( cisplatinum and 5-fluorouracil ) and radiation , followed by resection , while group 2 ( 34 patients ) received resection alone . Of the 35 patients entering combined treatment , 26 completed the protocol and 9 received only chemoradiation . A complete response to preoperative therapy was shown by 7 patients , and a partial response by the other 7 patients . Survival rates at one year and five years were slightly better among patients receiving combined treatment than among those undergoing surgery alone , but overall survival did not differ statistically between the two groups . Nor were operative mortality and complications statistical different between the two groups Background . Despite well‐established surgical approaches , the prognosis for patients with squamous cell carcinoma of the esophagus remains dismal . To assess the benefit of adjuvant chemotherapy and radiation therapy ( CRT ) , a r and omized trial with and without sequential preoperative CRT was undertaken ; CRT combined 20 Gy and two courses of 5‐FU and cisplatin OBJECTIVE This study investigated the role of preoperative chemotherapy in squamous cell cancer of the esophagus . METHODS A prospect i ve r and omized trial was undertaken in 147 patients : 74 received preoperative chemotherapy comprising cisplatin and 5-fluorouracil  and 73 had surgical therapy alone . End points were cancer and therapy-related deaths . RESULTS Sixty-six patients ( 89 % ) in the chemotherapy group underwent resection compared with 69 ( 95 % ) in the control group ( p = not significant ) . Of the 60 patients who had resection after completing the chemotherapy program , 35 ( 58 % ) had a significant response , of whom four ( 6.7 % ) had a complete pathologic response . Postoperative mortality rates were 8.3 % and 8.7 % in the chemotherapy and control groups , respectively ( p = not significant ) . Significant downstaging was evident with chemotherapy ; curative resections were possible in 67 % of these patients compared with 35 % in the control group ( p = 0.0003 ) . T3 and T4 tumors were found in 67 % and 91 % of the chemotherapy and control groups , respectively ( p = 0.0002 ) . The respective figures for N1 disease were 70 % and 88 % ( p = 0.009 ) . An intent-to-treat analysis of survival showed no significant difference between the two groups . Median survivals were 16.8 and 13 months , respectively ( p = 0.17 ) . Of those who completed the chemotherapy and resection , responders fared better than control patients . Median survivals were 42.2 months and 13.8 months , respectively ( p = 0.003 ) . Median survival ( 8.3 months ) was worse for nonresponders than for control patients ( p = 0.03 ) . The recurrence pattern suggested a significant reduction in locoregional disease with chemotherapy . CONCLUSIONS Preoperative chemotherapy was safe and result ed in significant downstaging and an increased likelihood of curative resection . Survival was not better than that in the surgery-alone group , but responders did fare better than nonresponders BACKGROUND We conducted a multicenter , r and omized trial to compare preoperative chemoradiotherapy followed by surgery with surgery alone in patients with stage I and II squamous-cell cancer of the esophagus . METHODS The preoperative combined therapy consisted of two one-week courses ; each involved radiotherapy , in a dose of 18.5 Gy delivered in five fractions of 3.7 Gy each , and 80 mg of cisplatin per square meter of body-surface area , administered 0 to 2 days before the first day of radiotherapy . The surgical plan included one-stage en bloc esophagectomy and proximal gastrectomy by the abdominal and right thoracic routes , to be performed immediately after r and omization in the group assigned to surgery alone and two to four weeks after the completion of preoperative chemoradiotherapy in the group assigned to combined therapy . RESULTS A total of 297 patients entered the study ; 11 were found to be ineligible , and 4 were lost to follow-up . Of the remaining 282 , 139 were assigned to surgery alone and 143 to combined therapy . After a median follow-up of 55.2 months , no significant difference in overall survival was observed ; the median survival was 18.6 months for both groups . As compared with the group treated with surgery alone , the group treated preoperatively had longer disease-free survival ( P=0.003 ) , a longer interval free of local disease ( P=0.01 ) , a lower rate of cancer-related deaths ( P=0.002 ) , and a higher frequency of curative resection ( P=0.017 ) . However , there were more postoperative deaths ( P=0.012 ) in the group treated preoperatively with chemoradiotherapy . Three prognostic factors were found to influence survival in a multivariate analysis : the disease stage , based on computed tomography ; the location of the tumor ; and whether the surgical resection was curative . CONCLUSIONS In patients with squamous-cell esophageal cancer , preoperative chemoradiotherapy did not improve overall survival , but it did prolong disease-free survival and survival free of local disease BACKGROUND Uncontrolled studies suggest that a combination of chemotherapy and radiotherapy improves the survival of patients with esophageal adenocarcinoma . We conducted a prospect i ve , r and omized trial comparing surgery alone with combined chemotherapy , radiotherapy , and surgery . METHODS Patients assigned to multimodal therapy received two courses of chemotherapy in weeks 1 and 6 ( fluorouracil , 15 mg per kilogram of body weight daily for five days , and cisplatin , 75 mg per square meter of body-surface area on day 7 ) and a course of radiotherapy ( 40 Gy , administered in 15 fractions over a three-week period , beginning concurrently with the first course of chemotherapy ) , followed by surgery . The patients assigned to surgery had no preoperative therapy . RESULTS Of the 58 patients assigned to multimodal therapy and the 55 assigned to surgery  , 10 and 1 , respectively , were withdrawn for protocol violations . At the time of surgery , 23 of 55 patients ( 42 percent ) treated with preoperative multimodal therapy who could be evaluated had positive nodes or metastases , as compared with 45 of the 55 patients ( 82 percent ) who underwent surgery alone ( P<0.001 ) . Thirteen of the 52 patients ( 25 percent ) who underwent surgery after multimodal therapy had complete responses as determined pathologically . The median survival of patients assigned to multimodal therapy was 16 months , as compared with 11 months for those assigned to surgery alone ( P=0.01 ) . At one , two , and three years , 52 , 37 , and 32 percent , respectively , of patients assigned to multimodal therapy were alive , as compared with 44 , 26 , and 6 percent of those assigned to surgery , with the survival advantage favoring multimodal therapy reaching significance at three years ( P=0.01 ) . CONCLUSIONS Multimodal treatment is superior to surgery alone for patients with resectable adenocarcinoma of the esophagus BACKGROUND Controversy exists about the best surgical treatment for esophageal carcinoma . METHODS We r and omly assigned 220 patients with adenocarcinoma of the mid-to-distal esophagus or adenocarcinoma of the gastric cardia involving the distal esophagus either to transhiatal esophagectomy or to transthoracic esophagectomy with extended en bloc lymphadenectomy . Principal end points were overall survival and disease-free survival . Early morbidity and mortality , the number of quality -adjusted life-years gained , and cost effectiveness were also determined . RESULTS A total of 106 patients were assigned to undergo transhiatal esophagectomy , and 114 to undergo transthoracic esophagectomy .  Demographic characteristics and characteristics of the tumor were similar in the two groups . Perioperative morbidity was higher after transthoracic esophagectomy , but there was no significant difference in in-hospital mortality ( P=0.45 ) . After a median follow-up of 4.7 years , 142 patients had died--74 ( 70 percent ) after transhiatal resection and 68 ( 60 percent ) after transthoracic resection ( P=0.12 ) . Although the difference in survival was not statistically significant , there was a trend toward a survival benefit with the extended approach at five years : disease-free survival was 27 percent in the transhiatal-esophagectomy group , as compared with 39 percent in the transthoracic-esophagectomy group ( 95 percent confidence interval for the difference , -1 to 24 percent [ the negative value indicates better survival with transhiatal resection ] ) , whereas overall survival was 29 percent as compared with 39 percent ( 95 percent confidence interval for the difference , -3 to 23 percent ) . CONCLUSIONS Transhiatal esophagectomy was associated with lower morbidity than transthoracic esophagectomy with extended en bloc lymphadenectomy . Although median overall , disease-free , and quality -adjusted survival did not differ statistically between the groups , there was a trend toward improved long-term survival at five years with the extended transthoracic approach PURPOSE A pilot study of 43 patients with potentially resectable esophageal carcinoma treated with an intensive regimen of preoperative chemoradiation with cisplatin , fluorouracil , and vinblastine before surgery showed a median survival of 29 months in comparison with the 12-month median survival of 100 historical controls treated with surgery alone at the same institution . We design ed a r and omized trial to compare survival for patients treated with this preoperative chemoradiation regimen versus surgery alone . MATERIAL S AND METHODS One hundred patients with esophageal carcinoma were r and omized to receive either surgery alone ( arm I ) or preoperative chemoradiation ( arm II ) with cisplatin 20 mg/m2/d on days 1 through 5 and 1 
    Output:
    
In patients with resectable oesophageal cancer , chemoradiotherapy plus surgery significantly reduces three year mortality compared with surgery alone .
However , postoperative mortality was significantly increased by neoadjuvant chemoradiotherapy .