***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 assess in a prospect i ve trial the feasibility and late toxicity of hypofractionated radiotherapy ( RT ) for prostate cancer . METHODS AND MATERIAL S Eligible patients had clinical stage T1c-2cNXM0 disease . They received 60 Gy in 20 fractions over 4 weeks with intensity-modulated radiotherapy including daily on-line image guidance with intraprostatic fiducial markers . RESULTS Between June 2001 and March 2004 , 92 patients were treated with hypofractionated RT .  The cohort had a median prostate-specific antigen value of 7.06 ng/mL. The majority had Gleason grade 5 - 6 ( 38 % ) or 7 ( 59 % ) disease , and 82 patients had T1c-T2a clinical staging . Overall , 29 patients had low-risk , 56 intermediate-risk , and 7 high-risk disease . Severe acute toxicity ( Grade 3 - 4 ) was rare , occurring in only 1 patient . Median follow-up was 38 months . According to the Phoenix definition for biochemical failure , the rate of biochemical control at 14 months was 97 % . According to the previous American Society for Therapeutic Radiology and Oncology definition , biochemical control at 3 years was 76 % . The incidence of late toxicity was low , with no severe ( Grade > or =3 ) toxicity at the most recent assessment . CONCLUSIONS Hypofractionated RT using 60 Gy in 20 fractions over 4 weeks with image guidance is feasible and is associated with low rates of late bladder and rectal toxicity . At early follow-up , biochemical outcome is comparable to that reported for conventionally fractionated controls . The findings are being tested in an ongoing , multicenter , Phase III trial OBJECTIVES To compare three hypofractionated protocol s in postmastectomy cancinoma breast in terms of local control , toxicity and work load . METHODS A total of three hundred patients suffering from cancer breast stage T2 - 4 , N any were r and omized into three arms after mastectomy . All the patients were treated with four fields on Co60 i.e. two tangential portals for chest wall , one anterior supraclavicular and axillary field and a posterior axillary boost and were r and omized into three arms i.e. 2700 CGy in 5 fractions ( one week ) arm A , 3500 CGy in 10 fractions ( 2 weeks ) arm B and 4000 CGy in 15 fractions ( 3 weeks ) arm C. Skin , cardiac , pulmonary and haematological toxicities and lymphoedema were compared in addition to local control and work load . RESULTS The locoregional relapses were 11 % , 12 % and 10 % in arms A , B and C respectively . 26 % , 24 % and 28 % patients developed metastatic disease and 17 % , 18 % and 20 % died in the three arms . G3 and G4 skin toxicities were 37 % , 28 % and 14 % . G2 and G3 lymphedoema was 21 % , 22 % and 27 % . Cardiac toxicity was 5 % , 6 % and 5 % while pulmonary toxicity was 4 % , 5 % and 5 % respectively . All the differences except skin toxicity were statistically insignificant . There were no cases of haematological depression or rib fractures . CONCLUSION All the three short protocol s were equally effective in locoregional disease control and toxicity was also comparable . They were helpful in reducing the work load and can be safely recommended for routine clinical use Purpose In men with localized prostate cancer , dose-escalated conformal radiotherapy ( CFRT ) improves efficacy outcomes at the cost of increased toxicity . We present a detailed analysis to provide further information about the incidence and prevalence of late gastrointestinal side effects . Methods and Material s The UK Medical Research Council RT01 trial included 843 men with localized prostate cancer , who were treated for 6 months with neoadjuvant radiotherapy and were r and omly assigned to either 64-Gy or 74-Gy CFRT .  Toxicity was evaluated before CFRT and during long-term follow-up using Radiation Therapy Oncology Group ( RTOG ) grading , the Late Effects on Normal Tissue : Subjective , Objective , Management ( LENT/SOM ) scale , and Royal Marsden Hospital assessment scores . Patients regularly completed Functional Assessment of Cancer Therapy -- Prostate ( FACT-P ) and University of California , Los Angeles , Prostate Cancer Index ( UCLA-PCI ) question naires . Results In the dose-escalated group , the hazard ratio ( HR ) for rectal bleeding ( LENT/SOM grade ≥2 ) was 1.55 ( 95 % CI , 1.17–2.04 ) ; for diarrhea ( LENT/SOM grade ≥2 ) , the HR was 1.79 ( 95 % CI , 1.10–2.94 ) ; and for proctitis ( RTOG grade ≥2 ) , the HR was 1.64 ( 95 % CI , 1.20–2.25 ) . Compared to baseline scores , the prevalence of moderate and severe toxicities generally increased up to 3 years and than lessened . At 5 years , the cumulative incidence of patient-reported severe bowel problems was 6 % vs. 8 % ( st and ard vs. escalated , respectively ) and severe distress was 4 % vs. 5 % , respectively . Conclusions There is a statistically significant increased risk of various adverse gastrointestinal events with dose-escalated CFRT . This remains at clinical ly acceptable levels , and overall prevalence ultimately decreases with duration of follow-up PURPOSE To compare the toxicity and efficacy of hypofractionated ( 62 Gy/20 fractions/5 weeks , 4 fractions per week ) vs. conventional fractionation radiotherapy ( 80 Gy/40 fractions/8 weeks ) in patients with high-risk prostate cancer . METHODS AND MATERIAL S From January 2003 to December 2007 , 168 patients were r and omized to receive either hypofractionated or conventional fractionated schedules of three-dimensional conformal radiotherapy to the prostate and seminal vesicles . All patients received a 9-month course of total and rogen deprivation ( TAD ) , and radiotherapy started 2 months thereafter . RESULTS The median ( range ) follow-up was 32 ( 8 - 66 ) and 35 ( 7 - 64 ) months in the hypofractionation and conventional fractionation arms , respectively . No difference was found for late toxicity between the two treatment groups , with 3-year Grade 2 rates of 17 % and 16 % for gastrointestinal and 14 % and 11 % for genitourinary in the hypofractionation and conventional fractionation groups , respectively . The 3-year freedom from biochemical failure ( FFBF ) rates were 87 % and 79 % in the hypofractionation and conventional fractionation groups , respectively ( p = 0.035 ) . The 3-year FFBF rates in patients at a very high risk ( i.e. , pretreatment prostate-specific antigen ( iPSA ) > 20 ng/mL , Gleason score > or=8 , or T > or=2c ) , were 88 % and 76 % ( p = 0.014 ) in the former and latter arm , respectively . The multivariate Cox analysis confirmed fractionation , iPSA , and Gleason score as significant prognostic factors . CONCLUSIONS Our findings suggest that late toxicity is equivalent between the two treatment groups and that the hypofractionated schedule used in this trial is superior to the conventional fractionation in terms of FFBF PURPOSE The aim of this study was to compare the toxicity and efficacy of radiation therapy ( RT ) for localized carcinoma of the prostate , using a hypofractionated ( 55 Gy/20 fractions/4 weeks ) vs. a conventionally fractionated ( 64 Gy/32 fractions/6.5 weeks ) dose schedule . METHODS AND MATERIAL S A total of 217 patients were r and omized to either the hypofractionated ( 108 patients ) or the conventional ( 109 patients ) dose schedule  , with planning with two-dimensional ( 2D ) CT scan planning methodology in the majority of cases . All patients were followed for a median of 48 ( 6 - 108 ) months . Gastrointestinal ( GI ) and genitourinary ( GU ) toxicity was evaluated before RT and after its completion using modified late effects of normal tissue-subjective , objective , management , analytic ( LENT-SOMA ) scales and the European Organization for Research and Treatment of Cancer sexual function question naire . Efficacy of RT based on clinical , radiologic , and prostate-specific antigen data were also evaluated at baseline and after RT . RESULTS Gastrointestinal and GU toxicity persisted 5 years after RT and did not differ between the two dose schedules other than in regard to urgency of defecation . However , 1-month GI toxicity was not only worse in patients with the hypofractionated RT schedule but also adversely affected daily activities . Nadir prostate-specific antigen values occurred at a median of 18.0 ( 3.0 - 54.0 ) months after RT . A total of 76 biochemical relapses , with or without clinical relapses , have occurred since ; of these , 37 were in the hypofractionated and 39 in the conventional schedule . The 5-year biochemical + /- clinical relapse-free and overall survival was 55.9 % and 85.3 % respectively for all patients , and did not differ between the two schedules . CONCLUSIONS Radiation therapy for prostate carcinoma causes persistent GI toxicity that is largely independent of the two dose schedules . The hypofractionated schedule is equivalent in efficacy to the conventional schedule OBJECTIVE This paper describes the first-year biochemical ( prostate-specific antigen [ PSA ] ) response of 91 irradiated patients enrolled in a single-institution r and omized trial comparing  hypofractionated ( HFRT ) and conventionally fractionated ( CFRT ) external beam radiotherapy . MATERIAL AND METHODS Forty-four patients in the CFRT treatment arm were irradiated with 74 Gy in 37 fractions ( 2 Gy per fraction ) , and 47 in the HFRT arm were treated with 57 Gy , given in 13 fractions of 3 Gy plus 4 fractions of 4.5 Gy . The clinical target volume includes the prostate and a base of seminal vesicles . The proportions of patients who reached PSA nadir ( nPSA ) lower than or equal to 1.0 ng/mL ( nPSA1 ) and 0.5 ng/mL ( nPSA05 ) were compared . RESULTS There were 2 non-cancer-related deaths ( 1 in the CFRT and 1 in the HFRT treatment arms ) . Biochemical relapse after irradiation was defined in five cases ( 3 in the CFRT and 2 in the HFRT treatment arms ) during a 12-month follow-up . The remaining 84 patients were analyzed . The proportions of patients reaching nPSA1 were 50 % and 54.5 % in the CFRT and HFRT treatment arms , respectively ( chi-square P=0.843 ) . The percentages of patients reaching nPSA05 were 25 % and 18.2 % , respectively ( chi-square P=0.621 ) . The trends toward increasing proportions of biochemical responders ( both nPSA1 and nPSA05 ) during 12 months after radiotherapy were observed , but the difference between trends for treatment arms did not reach a statistical significance . CONCLUSION The preliminary results presented here demonstrate that HFRT schedule induces biochemical response rates comparable to those in the CFRT schedule during the first-year follow-up PURPOSE Now that the follow-up time has exceeded 5 years , an estimate of the α/β ratio can be presented . The additional late outcomes in patients treated with three-dimensional conformal external beam radiotherapy for localized prostate cancer using a  hypofractionated vs. a st and ard fractionation regimen  are reported from this prospect i ve nonr and omized contemporary comparison . METHODS AND MATERIAL S A total of 114 nonr and omized patients chose hypofractionation delivered in 20 fractions of 3 Gy or 3.15 Gy ( mean 3.06 Gy ) for localized prostate cancer within a median overall time of 32 days ( range , 29 - 49 ) using four fractions weekly . A total of 160 comparable patients were contemporarily treated within a median of 55 days ( range 49 - 66 ) . The median follow-up was 66 months ( range , 24 - 95 ) for the hypofractionated arm and 63 months ( range , 36 - 92 ) for the st and ard arm . The percentage of patients in the low- , medium- , and high-risk groups was 36 % , 46 % , and 18 % in the hypofractionated arm and 44 % , 50 % , and 6 % in st and ard arm ( 2 Gy ) , respectively . RESULTS The 5-year actuarial biochemical absence of disease ( prostate-specific antigen nadir + 2 ng/mL ) and disease-free survival rate was the same at 89 % in both arms , making the α/β calculation unambiguous . The point ratio of α/β was 1.86 ( 95 % confidence interval , 0.7 - 5.1 Gy ) . The 95 % confidence interval was determined entirely by the binomial confidence limits in the numbers of patients . Rectal reactions 
    Output:
    
CONCLUSION Hypofractionated radiotherapy in localized prostate cancer was not superior to conventional radiotherapy and showed higher acute gastrointestinal toxicity in this meta- analysis .