***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: Surgical therapy for stage III non-small cell lung cancer ( NSCLC ) has not result ed in substantial long-term survival . Neoadjuvant treatment programs that could down-stage the tumor and achieve increased long-term survival would be of obvious benefit . We have used preoperative simultaneous chemotherapy and irradiation in 85 patients with clinical stage III non-small cell lung cancer considered c and i date s for surgical resection . One group of 56 patients was treated with cisplatin , 5-fluorouracil , and simultaneous irradiation for five days every other week for a total of four cycles . After treatment , 39 patients underwent resection , and the operative mortality was 2 ( 5 % ) of 39 . A second trial was undertaken in which etoposide ( VP-16 ) was added because of its synergism with cisplatin . In this group , 29 patients were considered to have potentially resectable disease , and 23 underwent thoracotomy with 1 operative death ( 4 % ) . Of the total of 62 patients having thoracotomy , 60 underwent resection ( 97 % ) . Complications were major , and there were four bronchopleural fistulas . For the 85 patients eligible for surgical intervention in these two groups of patients , the Kaplan-Meier median survival estimate is 40 % at 3 years . The median survival of the 62 patients having thoracotomy is 36.6 months . Combination preoperative chemotherapy and irradiation is feasible with acceptable toxicity and operative mortality in patients with clinical stage III non-small cell lung cancer . Prospect i ve r and omized studies are suggested for further evaluation of this treatment program OBJECTIVES Surgical resection after preoperative chemotherapy in patients with non-small cell lung cancer might only be best for patients who are responders . We compared positron emission tomographic scanning with 2-fluoro-2-deoxy-d-glucose ( FDP-PET scanning ) with computed tomographic scanning to evaluate their ability to predict this response for the primary tumor , N1 and N2 lymph nodes . METHODS All patients with non-small cell lung cancer who had an initial FDP-PET scan staging with tissue biopsy , neoadjuvant chemotherapy , repeat FDP-PET scanning , and repeat biopsies were prospect ively studied . RESULTS There were 34 patients ( 24 men ; median age , 64 years ) . Eleven patients had N2 disease , and 7 had N1 disease . Twenty-seven patients received chemotherapy , and 7 patients received chemotherapy and radiation . All but 9 patients underwent resection . Statistical analysis showed FDP-PET scanning to be more specific ( P < .0001 ) , to have a higher positive predictive value ( P = .0018 ) , and to have a higher negative predictive value ( P < .0001 ) than computed tomographic scanning for predicting residual tumor at the primary site . FDP-PET scanning was more sensitive ( P < .0001 ) and more accurate ( P < .0001 ) , had a higher positive predictive value ( P < .0001 ) , and had a higher negative predictive value ( P = .0002 ) than computed tomographic scanning for paratracheal nodes ( number 2 and 4 lymph nodes ) . FDP-PET scanning had a higher positive predictive value ( P < .0001 ) than computed tomographic scanning for the other N2 ( numbers 5 , 6 , 7 , 8 , and 9 ) lymph nodes . CONCLUSIONS Repeat FDP-PET scanning is more specific and has a higher positive predictive value and negative predictive value than computed tomographic scanning for detecting residual tumor in the lung in patients with non-small cell lung cancer who have received preoperative chemotherapy . It is more sensitive and accurate for paratracheal N2 nodes as well . However , there is no significant difference in its detection of N1 lymph nodes PURPOSE A number of studies have demonstrated that 18F-fluorodeoxyglucose positron emission tomography ( FDG-PET ) is effective for staging of lung cancer . However , the efficacy of FDG-PET for staging lung cancer after neoadjuvant treatment is still controversial . This study compared FDG-PET and computed tomography ( CT ) for lung cancer staging , and evaluated the ability of the two methods to predict the pathologic response of the primary tumor to neoadjuvant treatment . PATIENTS AND METHODS Twenty-two patients who underwent neoadjuvant treatment followed by surgery were investigated . Eighteen patients received chemoradiotherapy and four patients received chemotherapy only .  One hundred and three lymph node stations in the 22 patients were evaluated by FDG-PET and CT . The pathologic responses of the tumors were compared by FDG-uptake and tumor size on CT for the 15 patients who underwent  FDG-PET and CT both before and after neoadjuvant treatment . RESULTS There was no significant difference in the ability of FDG-PET or  CT  to predict residual viable tumor . Although positive predictive value by FDG-PET ( 0.29 ) was lower than that by CT ( 0.64 ) ( p=0.04 ) in the mediastinal lymph nodes , there were no statistically significant differences in the other results of lymph nodes by FDG-PET and CT . Both decrease in FDG-uptake and decrease in tumor size by CT after neoadjuvant treatment correlated significantly with pathologic response in the 15 patients ( p=0.003 and 0.009 , respectively ) . CONCLUSION FDG-PET did not appear to offer any advantages over CT for lymph node staging or for predicting the pathologic response after neoadjuvant treatment of non-small cell lung cancer PURPOSE This phase II trial was design ed to evaluate the feasibility , toxicity , response rates , and survival for neoadjuvant chemotherapy and radiotherapy ( RT ) followed by surgical resection in newly diagnosed patients with surgically staged IIIA non-small-cell lung carcinoma ( NSCLC ) . PATIENTS AND METHODS Previously untreated patients with NSCLC underwent bronchoscopy , chest and abdominal computed tomography ( CT ) , bone scan , and surgical staging of the mediastinum .  Neoadjuvant treatment consisted of concurrent chemotherapy and RT . Patients then underwent surgical resection , which was followed in turn by additional chemotherapy and RT . Chemotherapy included cisplatin 100 mg/m2 on days 1 and 29 , vinblastine 3 mg/m2 on days 1 and 3 and 29 and 31 , and fluorouracil ( 5-FU ) 30 mg/kg/d by infusion on days 1 to 3 and 29 to 31 ( FVP ) . RT began on day 1 and included 3,000 cGy in 15 fractions . Surgery took place on day 55 , and one more cycle of chemotherapy and an additional 3,000 cGy of RT began on day 85 . RESULTS Forty-one eligible patients ( median follow-up , 53 months ) were studied .  N2 disease was present in 80 % , whereas 20 % had T3N0 or T3N1 lesions . Response to neoadjuvant chemotherapy and RT included no complete responses ( CR ) , 21 ( 51 % ) partial responses ( PR ) or regressions , 19 ( 46 % ) stable disease ( SD ) , and one ( 2 % ) progressive disease ( PD ) . Thirty-one patients underwent surgery , and 25 were resected . In four of the 25 resection specimens , no viable tumor was present , whereas in three of the six unresectable patients , extensive biopsy results demonstrated only necrotic tumor . The maximum response achieved using all protocol treatment was 27 ( 66 % ) CRs , seven ( 17 % ) PRs or regression , six ( 15 % ) SDs , and one ( 2 % ) PD . Toxicity was substantial and primarily hematologic . There were six ( 15 % ) treatment-related deaths , which included three perioperative deaths and three chemotherapy-related toxicity deaths . The Kaplan-Meier curve indicated a 1-year survival of 58 % and a median survival of 15.5 months . Nine patients ( 22 % ) remain disease-free . CONCLUSIONS There was a reasonably high rate of PR associated with concurrent neoadjuvant chemotherapy and RT , and a high percentage of patients who ultimately were rendered completely disease-free . However , treatment-related morbidity and mortality was common . Median survival seemed to be only modestly improved beyond that achieved with less intensive means of treatment . However , a group has emerged of patients who enjoy prolonged disease-free survival and possible cure To evaluate the usefulness of transbronchial needle aspiration biopsy ( TBNA ) for the diagnosis of mediastinal involvement , we have prospect ively examined 316 patients with morphologically verified bronchogenic carcinoma . The percentage of positive aspirations ( 149 of 316 ) from the three basic lymph node groups in the mediastinum was not significantly different . Tumor cells were aspirated from the mediastinum in 75 of 112 patients with radiologically positive findings and in patients with 74 of 204 radiologically negative findings . Mediastinal involvement was verified even in 61 of 196 patients with a normal endoscopic picture . Metastases were proved in 14 of 39 patients with peripheral versus 135 of 277 patients with central carcinoma . Tumor cells were aspirated in 47 of 76 patients with undifferentiated small cell carcinoma , 92 of 227 patients with squamous cell carcinoma , and 10 of 13 patients with adenocarcinoma . Our results suggest that TBNA being a highly diagnostic and less invasive method , will prove its clinical importance BACKGROUND Results from phase II studies in patients with stage IIIA non-small-cell lung cancer with ipsilateral mediastinal nodal metastases ( N2 ) have shown the feasibility of resection after concurrent chemotherapy and radiotherapy with promising rates of survival . We therefore did this phase III trial to compare concurrent chemotherapy and radiotherapy followed by resection with st and ard concurrent chemotherapy and definitive radiotherapy without resection . METHODS Patients with stage T1 - 3pN2M0 non-small-cell lung cancer were r and omly assigned in a 1:1 ratio to  concurrent induction chemotherapy  ( two cycles of cisplatin [ 50 mg/m(2 ) on days 1 , 8 , 29 , and 36 ] and etoposide [ 50 mg/m(2 ) on days 1 - 5 and 29 - 33 ] ) plus radiotherapy ( 45 Gy ) in multiple academic and community hospitals . If no progression , patients in group 1 underwent resection and those in group 2 continued radiotherapy uninterrupted up to 61 Gy . Two additional cycles of cisplatin and etoposide were given in both groups . The primary endpoint was overall survival ( OS ) . Analysis was by intention to treat . This study is registered with Clinical Trials.gov , number NCT00002550 . FINDINGS 202 patients ( median age 59 years , range 31 - 77 ) were assigned to group 1 and 194 ( 61 years , 32 - 78 ) to group 2 .  Median OS was 23.6 months ( IQR 9.0-not reached ) in group 1 versus 22.2 months ( 9.4 - 52.7 ) in group 2 ( hazard ratio [ HR ] 0.87 [ 0.70 - 1.10 ] ; p=0.24 ) . Number of patients alive at 5 years was 37 ( point estimate 27 % ) in group 1 and 24 ( point estimate 20 % ) in group 2 ( odds ratio 0.63 [ 0.36 - 1.10 ] ; p=0.10 ) . With N0 status at thoracotomy , the median OS was 34.4 months ( IQR 15.7-not reached ; 19 [ point estimate 41 % ] patients alive at 5 years ) . Progression-free survival ( PFS ) was better in group 1 than in group 2 , median 12.8 months ( 5.3 - 42.2 ) vs 10.5 months ( 4.8 - 20.6 ) , HR 0.77 [ 0.62 - 0.96 ] ; p=0.017 ) ; the number of patients without disease progression at 5 years was 32 ( point estimate 22 % ) versus 13 ( point estimate 11 % ) , respectively . Neutropenia and oesophagitis were the main grade 3 or 4 toxicities associated with chemotherapy plus radiotherapy in group 1 ( 77 [ 38 % ] and 20 [ 10 % ] , respectively ) and group 2 ( 80 [ 41 % ] and 44 [ 23 % ] , respectively ) . In group 1 , 16 ( 8 % ) deaths were treatment related versus four ( 2 % ) in group 2 . In an exploratory analysis , OS was improved for patients who underwent lobectomy , but not pneumonectomy , versus chemotherapy plus radiotherapy . INTERPRETATION Chemotherapy plus radiotherapy with or without resection ( preferably lobectomy ) are options for patients with stage IIIA(N2 ) non-small-cell lung cancer . FUNDING National Cancer Institute , Canadian Cancer Society , and National Cancer Institute of Canada Thirty-three patients with T3,N2,M0 or T4,N 
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These results are not significantly affected by the type of induction therapy or the timing of restaging .
The ability to identify patients who have achieved mediastinal downstaging  other than by a careful primary mediastinoscopy is poor