***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: Background To answer the question if and to which extent acute symptoms at the end and /or several weeks after radiotherapy can predict adverse urinary and gastrointestinal long-term quality of life ( QoL ) . Methods A group of 298 patients has been surveyed prospect ively before ( time A ) , at the last day ( B ) , two months after ( C ) and > one year after ( D ) radiotherapy  using a vali date d question naire ( Exp and ed Prostate Cancer Index Composite ) . A subgroup of 10 % with the greatest urinary/bowel bother score decrease at time D was defined as patients with adverse long-term QoL. Results Subgroup and correlation analyses could demonstrate a strong dependence of urinary/bowel QoL  after radiotherapy on urinary/bowel QoL  before radiotherapy . In contrast to absolute scores , QoL score changes ( relative to baseline scores ) did not correlate with pretreatment scores . Long-term changes could be well predicted by acute changes . Patients reporting great/moderate bother with urinary/bowel problems at time C reported to have great/moderate bother at time D in ≥ 50 % , respectively . In a multivariate analysis of factors for adverse long-term urinary and bowel QoL , score changes at time C were found to be independent predictors , respectively . Additionally , QoL changes at time B were independently predictive for adverse long-term bowel QoL. Conclusions Consequential late effects play a major role after radiotherapy for prostate cancer . Patients with greater and particularly longer non-healing acute toxicity are c and i date s for closer follow-up and possible prophylactic actions to reduce a high probability of long-term problems PURPOSE To compare the toxicity between hypofractionation vs. conventional fractionation schedules in patients with high-risk prostate cancer . METHODS AND MATERIAL S Between January 2003 and December 2007 , 168 patients were r and omized to receive either hypofractionated ( 62 Gy in 20 fractions within 5 weeks , 4 fractions/wk ) or conventionally fractionated ( 80 Gy in 40 fractions within 8 weeks ) three-dimensional conformal radiotherapy to the prostate and seminal vesicles . All patients had undergone a 9-month course of total and rogen deprivation , with radiotherapy starting 2 months after initiation of the total and rogen deprivation . RESULTS The median follow-up was 32 and 35 months in the hypofractionation and conventional fractionation arms , respectively . For the patients developing acute toxicity , no difference between the two fractionation groups was found in either severity or duration of gastrointestinal or genitourinary toxicity . Also , no difference was found in the incidence and severity of late gastrointestinal and genitourinary toxicity between the two treatment schedules , with a 3-year rate of Grade 2 or greater toxicity of 17 % and 16 % for the hypofractionation arm and 14 % and 11 % for the conventional fractionation arm , respectively . A statistically significant correlation between acute and late gastrointestinal toxicity was found only in the conventional fractionation group . CONCLUSION Our findings suggest that the hypofractionation regimen used in our study is safe , with only a slight , nonsignificant increase in tolerable and temporary acute toxicity compared with the conventional fractionation schedule . The severity and frequency of late complications was equivalent between the two treatment groups PURPOSE To report toxicity and preliminary biochemical outcomes with high-dose intensity-modulated radiation therapy ( IMRT ) to a dose of 86.4 Gy for localized prostate cancer . METHODS AND MATERIAL S Between August 1997 and March 2004 , 478 patients were treated with 86.4 Gy using a 5- to 7-field IMRT technique . To adhere to normal tissue constraints , the mean D95 and V100 for the planning target volume were 83 Gy and 87 % , respectively . Toxicity data were scored according to the Common Terminology Criteria for Adverse Events Version 3.0 . Freedom from biochemical relapse was calculated . The median follow-up was 53 months . RESULTS Thirty-seven patients ( 8 % ) experienced acute Grade 2 gastrointestinal ( GI ) toxicity . There was no acute Grade 3 or 4 GI toxicity . One hundred and five patients ( 22 % ) experienced acute Grade 2 genitourinary ( GU ) toxicity and three patients ( 0.6 % ) had Grade 3 GU toxicity . There was no acute Grade 4 GU toxicity . Sixteen patients ( 3 % ) developed late Grade 2 GI toxicity and two patients ( < 1 % ) developed late Grade 3 GI toxicity . Sixty patients ( 13 % ) had late Grade 2 GU toxicity and 12 ( <3 % ) experienced late Grade 3 GU toxicity . The 5-year actuarial PSA relapse-free survival according to the nadir plus 2 ng/mL definition was 98 % , 85 % and 70 % for the low , intermediate , and high risk NCCN prognostic groups . CONCLUSION This report represents the largest data set of patients treated to ultra-high radiation dose levels of 86.4 Gy using IMRT for localized prostate cancer . Our findings indicate that this treatment is well tolerated and the early excellent biochemical control rates are encouraging Background As dose-escalation in prostate cancer radiotherapy improves cure rates , a major concern is rectal toxicity . We prospect ively assessed an innovative approach of hydrogel injection between prostate and rectum to reduce the radiation dose to the rectum and thus side effects in dose-escalated prostate radiotherapy . Methods Acute toxicity and planning parameters were prospect ively evaluated in patients with T1 - 2 N0 M0 prostate cancer receiving dose-escalated radiotherapy after injection of a hydrogel spacer .  Before and after hydrogel injection , we performed MRI scans for anatomical assessment of rectal separation . Radiotherapy was planned and administered to 78 Gy in 39 fractions . Results From eleven patients scheduled for spacer injection the procedure could be performed in ten . In one patient hydrodissection of the Denonvillier space was not possible . Radiation treatment planning showed low rectal doses despite dose-escalation to the target . In accordance with this , acute rectal toxicity was mild without grade 2 events and there was complete resolution within four to twelve weeks . Conclusions This prospect i ve study suggests that hydrogel injection is feasible and may prevent rectal toxicity in dose-escalated radiotherapy of prostate cancer . Further evaluation is necessary including the definition of patients who might benefit from this approach . Trial registration : German Clinical Trials Register DRKS00003273 Objective To determine late toxicity and quality of life ( QoL ) in patients with localized prostate cancer after high-dose intensity-modulated radiotherapy (IMRT).Patient  and methods This was a prospect i ve study in patients with localized prostate adenocarcinoma who had been treated by IMRT ( 76 Gy ) between February and November 2006 . Physicians scored acute and late toxicity using the Common Terminology Criteria for Adverse Events ( version 3.0 ) . Patients completed cancer and prostate-specific QoL question naires ( EORTC QLQ-C30 and QLQ-PR25 ) before IMRT ( baseline ) and at 2 , 6 , 18 and 54 months . Result Data were available for 38 patients ( median age , 73 years ) ( 18 % low risk ; 60 % intermediate risk ; 32 % high risk ) . The incidence of urinary and gastrointestinal toxicity was respectively : immediately post IMRT : 36.8 % and 23.7 % ( grade 1 ) , 5.3 % and 5.3 % ( grade 2 ) , 2.6 % and 0 % ( grade 3 ) ; at 18 months : 23.7 % and 10.3 % ( grade 1 ) , 26.3 % and 13.2 % ( grade 2 ) , 0 % and 2.6 % ( grade 3 ) ; at 54 months : 34.2 % and 23.7 % ( grade 1 ) , 5.3 % and 15.8 % ( grade 2 ) , 5.3 % and 0 % ( grade 3 ) . At 54 months , significant worsening was reported by patients for 11/19 QoL items but the worsening was clinical ly relevant ( > 10 points ) for 7 items only : physical , role as well as social functioning , fatigue , pain , dyspnoea and constipation . There was no significant difference between 54-month and baseline QoL scores for global health , gastrointestinal symptoms , treatment-related symptoms and sexual function . However , there was significant - but clinical ly non-relevant ( < 10 points ) - worsening of urinary symptom . Conclusion High-dose IMRT to the prostate with accurate patient positioning did not induce any clinical ly relevant worsening in late urinary and gastrointestinal QoL at 54 months . Impaired physical and role functioning may be related to age and comorbidities Purpose : To assess whether the topical use of steroids or 5-aminosalicylic acid ( 5-ASA ) is superior to sucralfate in preventing acute rectal toxicity during three-dimensional conformal radiotherapy ( 3DCRT ) to 76 Gy . Patients and Methods : Patients undergoing 3DCRT for prostate carcinoma at our institution were offered to be r and omized to sucralfate 3 g in 15 ml suspension enema ( Antepsin ® ) , mesalazine 4 g gel enema ( Enterasyn ® ) , or hydrocortisone 100 mg foam enema ( Colifoam ® ) . R and omization was blind to the treating physician but not to the patient . Sucralfate was chosen as control arm . Topical treatment had to be performed once daily , starting on day 1 of 3DCRT . Acute rectal toxicity was scored weekly according to RTOG criteria . Time to occurrence of grade 2 + acute rectal toxicity was taken as endpoint . Results : The trial was opened in August 1999 , and after the first 24 patients had been treated , arm 2 was discontinued because of eight patients receiving mesalazine , seven actually developed acute rectal toxicity ( five patients grade 3 and two patients grade 2).Until May 2001 , 134 consecutive patients were r and omly assigned to sucralfate ( 63 patients ) , mesalazine ( eight patients ) or hydrocortisone ( 63 patients ) . The cumulative incidence of acute rectal toxicity at the end of treatment by arm is 61.9 ± 6.1 % , 87.5 ± 11.7 % , and 52.4 ± 6.2 % for arms 1 , 2 , and 3 , respectively . The difference between the mesalazine group and the sucralfate group is highly significant ( hazard ratio [ HR ] 2.5 , 95 % confidence interval [ CI ] 1.1–5.7 ; p = 0.03 ) . At both uni- and multivariate analysis taking into account several patients and treatment covariates , the difference between hydrocortisone and  sucralfate  is not significant ( HR 0.7 , 95 % CI 0.5–1.2 ; p = 0.2 ) . Conclusion : Topical mesalazine is contraindicated during radiotherapy . Hydrocortisone enema is not superior to sucralfate in preventing acute rectal toxicity . Fragestellung : R and omisierter Vergleich der lokalen Anwendung von Steroiden oder 5-ASA oder Sucralfat zur Prävention einer akuten Strahlenproktitis unter 3-D-konformaler Radiotherapie ( 3DCRT ) bis 76 Gy . Patienten und Method ik : Patienten , die sich in unserer Klinik wegen eines Prostatakarzinoms einer 3DCRT unterzogen , wurde r and omisiert angeboten eine Vorbeh and lung 1 ) mit Sucralfat ( 3 g suspendiert i m 15-ml-Klysma ) , 2 ) Mesalazin als 4-g-Gelklysma ) oder 3 ) Hydrocortison : 100 mg als Schaumklysma ) . Die R and omisierung zu einem dieser drei Studienarme war dem beh and elnden Arzt unbekannt , nicht aber dem Patienten . Sucralfat wurde als Kontrollarm gewählt . Die jeweilige topische Therapie musste ab dem 1 . Tag der 3DCRT einmal täglich durchgeführt werden . Auf akute Strahlenproktitis wurde jede Woche nach RTOG-Kriterien geprüft . Als Endpunkt wurde das Auftreten einer akuten Strahlenproktitis Grad 2 festgelegt . Ergebnisse : Die Studie begann i m August 1999 . Nachdem die ersten 24 Patienten aufgenommen worden waren , wurde Arm 2 abgebrochen , da sieben Patienten unter Mesalazin eine akute Strahlenproktitis ( Grad 3 bei fünf Patienten und Grad 2 bei zwei Patienten ) entwickelten . Bis zum Mai 2001 wurden 134 Patienten der lokalen Anwendung von Sucralfat  ( 63 Patienten ) , Mesalazin ( acht Patienten ) oder Hydrocortison ( 63 Patienten ) zugeführt . Die kumulative Inzidenz akuter Strahlenproktitis betrug jeweils 61,9 ± 6,1 % , 87,5 ± 11,7 % und 52,4 ± 6,2 % . Der Unterschied zwischen Mesalazin- und Sucralfat-Gruppe  ist hoch signifikant ( HR : 2,5 ; 
    Output:
    
In this systematic review of published reports , we found that  late gastrointestinal toxicity following prostate radiotherapy  seems to be statistically and potentially causally related to acute gastrointestinal morbidity as a consequential effect .
We su bmi t that acute gastrointestinal toxicity may be used to identify at-risk patients who may benefit from additional attention for medical interventions and close follow-up to prevent late toxicity .