***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 Limits for sphincter preservation in rectal cancer have been exp and ed under the assumption that patients with a permanent colostomy have worse quality of life ( QoL ) . Incontinence and painful defecation are common problems ; therefore , this study compares functional outcome and QoL after sphincter-sparing intersphincteric resection ( ISR ) , low anterior resection ( LAR ) , and abdominoperineal resection ( APR ) for rectal cancer . Methods From a prospect i ve data base , three matched groups of patients after surgery for rectal cancer between 1999 and 2009 were extracted . Median follow-up was 59 months . Of 131 patients receiving a question naire , 95 % could be analyzed further . Generic and disease-specific vali date d QoL ( European Organization for Research and Treatment in Cancer QLQ-C30 , CR38 ) and Wexner incontinence score were used . Results Global QoL was comparable between the groups . Physical functioning was significantly better after sphincter preservation surgery than APR ( p < 0.05 ) . Symptom scores for diarrhea ( DIA ) and constipation ( CON ) were higher after sphincter-preserving surgery ( ISR : DIA 45.4 , CON 20.2 ; LAR : DIA 34.1 , CON 25.2 ) compared to APR ( DIA 16.6 , CON 12.0 ) ( p < 0.05 and < 0.01 , respectively ) . Disease-specific QoL assessment showed significantly worse QoL regarding to male sexual function after APR ( 80.8 ) than after ISR ( 53.6 ) ( p < 0.005 ) . Regarding defecation , the ISR group showed significantly higher symptom scores than patients after LAR ( p < 0.05 ) . Wexner scores were significantly higher after ISR ( 12.9 ) than after LAR ( 9.5 ) ( p < 0.005 ) PURPOSE To evaluate the toxicity and efficacy of the combination of external beam radiation therapy ( EBRT ) followed by high-dose-rate endorectal brachytherapy ( HDREBT ) boost in elderly and medically inoperable patients with rectal cancer . METHODS AND MATERIAL S A phase 1 dose-escalation study was performed . Treatment consisted of EBRT ( 13 × 3 Gy ) followed by 3 weekly brachytherapy applications 6 weeks later . The HDREBT dose started at 5 Gy per fraction , increasing with 1 Gy per fraction if dose-limiting toxicity ( DLT , defined as grade ≥3 proctitis < 6 weeks after HDREBT ) occurred in ≤2 patients per dose level . The primary endpoint was the maximum tolerated dose , defined as 1 dose level below the dose at which 3 patients experienced DLT . Secondary endpoints were toxicity , clinical tumor response , freedom from local progression , and local progression-free and overall survival ( L-PFS and OS ) . RESULTS Thirty-eight patients with a median age of 83 years were included in the study . Thirty-two were evaluable for DLT and late toxicity and 33 for response evaluation . Maximum delivered dose was 8 Gy per fraction , result ing in a recommended dose of 7 Gy per fraction . Response occurred in 29 of 33 patients ( 87.9 % ) , with 60.6 % complete response ( CR ) . The L-PFS and OS rates were 42 % and 63 % , respectively , at 2 years . Patients with CR showed a significantly improved L-PFS ( 60 % at 2 years , P=.006 ) and a trend in improved OS ( 80 % at 2 years , P=.11 ) . Severe late toxicity occurred in 10 of 32 patients . CONCLUSION We found that HDREBT after EBRT results in a high overall response rate , with improved L-PFS for patients with a CR . The high observed rate of severe late toxicity requires further evaluation of the risks and benefits of an HDREBT boost BACKGROUND Postoperative chemoradiotherapy is the recommended st and ard therapy for patients with locally advanced rectal cancer . In recent years , encouraging results with preoperative radiotherapy have been reported . We compared preoperative chemoradiotherapy with postoperative chemoradiotherapy for locally advanced rectal cancer . METHODS We r and omly assigned patients with clinical stage T3 or T4 or node-positive disease to receive either  preoperative or postoperative chemoradiotherapy . The preoperative treatment consisted of 5040 cGy delivered in fractions of 180 cGy per day , five days per week , and fluorouracil , given in a 120-hour continuous intravenous infusion at a dose of 1000 mg per square meter of body-surface area per day during the first and fifth weeks of radiotherapy . Surgery was performed six weeks after the completion of chemoradiotherapy . One month after surgery , four five-day cycles of fluorouracil ( 500 mg per square meter per day ) were given . Chemoradiotherapy was identical in the postoperative-treatment group , except for the delivery of a boost of 540 cGy . The primary end point was overall survival . RESULTS Four hundred twenty-one patients were r and omly assigned to receive preoperative chemoradiotherapy  and 402 patients to receive postoperative chemoradiotherapy . The overall five-year survival rates were 76 percent and 74 percent , respectively ( P=0.80 ) . The five-year cumulative incidence of local relapse was 6 percent for patients assigned to preoperative chemoradiotherapy and 13 percent in the postoperative-treatment group ( P=0.006 ) . Grade 3 or 4 acute toxic effects occurred in 27 percent of the patients in the preoperative-treatment group , as compared with 40 percent of the patients in the postoperative-treatment group ( P=0.001 ) ; the corresponding rates of long-term toxic effects were 14 percent and 24 percent , respectively ( P=0.01 ) . CONCLUSIONS Preoperative chemoradiotherapy , as compared with postoperative chemoradiotherapy , improved local control and was associated with reduced toxicity but did not improve overall survival PURPOSE This analysis was performed to evaluate the results of endocavitary radiotherapy ( RT ) administered for early rectal cancer at our institution . METHODS AND MATERIAL S Patient charts were retrospectively review ed to determine the results of endocavitary RT regarding survival , local control , and complications .  Between 1987 and 1994 , 25 patients were treated with endocavitary RT for early rectal cancer . Twenty had early , low grade tumors and met the criteria for treatment with curative intent . Five had more advanced , high grade , or multiple recurrent tumors and were treated with palliative intent . The tumors were treated to between 20 and 155 Gy in one to four fractions with 50 KV x-rays given through a specialized proctoscope . Patients were followed for 5 to 84 months ( median = 55 months ) after therapy . Local control and survival were determined using the Kaplan-Meier method . RESULTS Local control was achieved in 18 of the 20 patients treated with curative intent and 4 of 5 treated with palliative intent . For those patients treated with curative intent , the 5-year local control rate was 89 % and the 5-year survival rate was 76 % . The most significant toxicity was ulceration that occurred in 5 of the 25 patients . The ulcers were asymptomatic in three cases and associated with bleeding in one case . The fifth patient had pain . One ulcer was biopsied , result ing in perforation that was treated with an abdominal perineal resection ( APR ) . There was no tumor found upon pathologic evaluation . CONCLUSIONS Endocavitary RT can be used to treat patients with early , low- grade rectal cancers and will yield a high level of disease control and a low risk of serious complications . Major advantages of this treatment technique are that it requires neither general anesthesia nor hospitalization In the era of total mesorectal surgery , the issue of radiation toxicity is raised . A novel endocavitary brachytherapy technique was tested as a neoadjuvant treatment for patients with resectable rectal cancer . The objectives of the study were to evaluate the treatment-related toxicity and effects on local recurrence . A dose of 26 Gy was prescribed to the gross tumour volume and intramesorectal deposits seen on magnetic resonance imaging and given over four daily treatments , using the high dose rate delivery system followed by surgery 6 - 8 weeks later . The study included 93 T3 , four T4 and three T2 tumours .  Acute proctitis of grade 2 was observed in all patients , but one required transfusion . At a median follow-up time of 60 months , the 5-year actual local recurrence rate was 5 % , disease-free survival was 65 % , and overall survival was 70 % . High dose rate endorectal brachytherapy seems to prevent local recurrence and has a favourable toxicity pattern compared with external beam radiotherapy Introduction : Colonic pouches have been used for 20 years to provide reservoir function after reconstructive proctectomy for rectal cancer . More recently coloplasty has been advocated as an alternative to a colonic pouch . However there have been no long-term r and omized , controlled trials to compare functional outcomes of coloplasty , colonic J-Pouch ( JP ) , or a straight anastomosis ( SA ) after the treatment of low rectal cancer . Aim : To compare the complications , long-term functional outcome , and quality of life ( QOL ) of patients undergoing a coloplasty , JP , or an SA in reconstruction of the lower gastrointestinal tract after proctectomy for low rectal cancer . Methods : A multicenter study enrolled patients with low rectal cancer , who were r and omized intraoperatively to coloplasty ( CP-1 ) or SA if JP was not feasible , or JP or coloplasty ( CP-2 ) if a JP was feasible . Patients were followed for 24 months with SF-36 surveys to evaluate the QOL . Bowel function was measured quantitatively and using Fecal Incontinence Severity Index ( FISI ) . Urinary function and sexual function were also assessed . Results : Three hundred sixty-four patients were r and omized . All patients were evaluated for complications and recurrence . Mean age was 60 ±12 years , 71 % were male . Twenty-three ( 7.4 % ) died within 24 months of surgery . No significant difference was observed in the complications among the 4 groups . Two hundred ninety-seven of 364 were evaluated for functional outcome at 24 months . There was no difference in bowel function between the CP-1 and SA groups . JP patients had fewer bowel movements , less clustering , used fewer pads and had a lower FISI than the CP-2 group . Other parameters were not statistically different . QOL scores at 24 months were similar for each of the 4 groups . Conclusions : In patients undergoing a restorative resection for low rectal cancer , a colonic JP offers significant advantages in function over an SA or a coloplasty . In patients who can not have a pouch , coloplasty seems not to improve the bowel function of patients over that with an SA Purpose To examine the complications , local effects , survival , and prognostic factors of preoperative high-dose radiation therapy in patients with advanced carcinomas of the distal rectum . Methods Forty-one patients with tethered or fixed rectal cancer located a median distance of 3.0 cm from the anal verge were treated with extracorporeal and endocavitary radiation therapy ( 70 Gy ) , followed 2 weeks later by abdominoperineal resection ( APR ) . Results This combined radiotherapy achieved acceptable results . Postoperative complications developed in 18 patients ( 43.9 % ) , 10 ( 24.3 % ) of which involved perineal dehiscence . Two patients ( 4.8 % ) suffered more than grade 3 toxicity . Destructive changes were histologically confirmed in all specimens , and there were four ( 9.8 % ) sterile specimens . Recurrence developed in 11 patients and there were 6 cancer-related deaths . Among six cases of local recurrence , three were found just outside of the radiation field . The 5-year survival and disease-free survival rates were 82.9 % and 71.8 % , respectively . Multivariate analysis revealed that nodal involvement was the sole independent prognostic factor for survival . Sexual function was maintained in the most recent patients who underwent APR with autonomic nerve-preserving surgery . Conclusion Although the original aim of our treatment focused on curability , this combination therapy may be an option for selected patients , because of potential prevention of local recurrence , relatively low morbidity , and promising autonomic nerve function Purpose . To assess for differences in clinical , radiologic , and pathologic outcomes between patients with stage II-III rectal adenocarcinoma treated neoadjuvantly with conventional external beam radiotherapy ( 3D conformal radiotherapy ( 3DRT ) or intensity-modulated radiotherapy ( IMRT ) )  versus high-dose-rate endorectal brachytherapy ( EBT ) . Methods . Patients undergoing neoadjuvant EBT  received 4 consecutive daily 6.5 Gy fractions without chemotherapy , while those undergoing 3DRT or IMRT  received 28 daily 1.8 Gy fractions with concurrent 5-fluorouracil . Data was collected prospect ively for 7 EBT patients and retrospectively for 25 historical 3DRT/IMRT controls . Results . Time to surgery was less for EBT compared to 3DRT and IMRT ( P < 0.001 ) . There was a trend towards higher rate of pathologic 
    Output:
    
Direct comparison of toxicity by the different radiation modes was hampered by various combinations of endorectal techniques , a lack of clear reporting of toxicity scores , dose prescription , technique used , and treated volumes .
All techniques reported some ≥ Grade 3 toxicity .
Toxicity after CXT was confined to the rectum , whereas after BT  , urogenital toxicity and skin toxicity were seen as well .
Unfortunately , few specific conclusions could be drawn regarding the dose-related risk of toxicity for the various techniques due to nonuniform reporting strategies and missing information .