***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 report long-term outcomes in terms of health-related quality of life ( HRQoL ) and survival of a dose-escalating radiotherapy protocol and to vali date a new disease-specific HRQoL instrument . Patients and Methods : 189 consecutive men with prostate cancer were analyzed ; 127 patients had T1–2 ( 1 % T1 , 66 % T2 ) and 62 patients ( 33 % ) T3 tumors . The pelvic lymphatics were treated to a dose of 50 Gy by external-beam irradiation . The prostate dose was limited to 40 Gy using compensators . The prostate was treated to the total nominal dose of 70 Gy using high-dose-rate ( HDR ) brachytherapy . The fraction dose was 15 Gy in the McNeal zone ( planning target volume [ PTV ] 1 ) , while 8–9 Gy were applied in the entire prostate ( PTV 2 ) . The HRQoL of the 145 long-term survivors was assessed using the EORTC QLQ-C30 and a new prostate-specific instrument ( PSM-G 1.0 ) . The reliability of the instruments used and HRQoL scale scores were calculated . Uni-/multivariate analyses of variance were performed . Results : At a mean follow-up of 6.5 years 86.3 % of the patients were disease-free , and 78 % were biochemically controlled . The mean Cronbach ’s α-values were 0.81 for the QLQ-C30 , and 0.74 for the prostate-specific module . Univariate analyses of variance by T-stage , grading , prostata-specific antigen ( PSA ) status after therapy and adjuvant and rogen suppression ( AS ) revealed that PSA elevation after irradiation and AS were associated with significantly diminished HRQoL. In multivariate analyses AS significantly lowered the HRQoL without survival benefit . Conclusion : The described radiotherapy regimen represents a curative and well-tolerated treatment for localized prostate cancer . The HRQoL assessment with both instruments used was reliable . Adjuvant AS and PSA elevation were associated with diminished HRQoL.Ziel : Bericht von Langzeitergebnissen in Bezug auf gesundheitsorientierte Lebensqualität ( LQ ) und Überleben nach dosiseskalierter Strahlentherapie und Validierung eines neuen krankheitsspezifischen LQ-Instruments . Patienten und Method ik:189 konsekutive Patienten mit Prostatakarzinom wurden analysiert : 127 Patienten hatten einen T1–2- ( 1 % T1 , 66 % T2 ) und 62 Patienten ( 33 % ) einen T3-Tumor . Die pelvinen Lymphabflusswege wurden bis zur Dosis von 50 Gy perkutan beh and elt . Mittels Kompensatoren wurde die Dosis in der Prostataregion auf 40 Gy limitiert . Diese wurde mit Hilfe der High-Dose-Rate-(HDR-)Brachytherapie bis zur kumulativen Dosis von 70 Gy bestrahlt . Die Fraktionsdosis betrug 15 Gy in der McNeal-Zone ( Planungszielvolumen [ PTV ] 1 ) . In der Gesamtprostata wurden pro Fraktion 8–9 Gy appliziert ( PTV 2 ) . Die LQ der 145 Langzeitüberlebenden wurde mittels EORTC QLQ-C30 und eines neuen prostataspezifischen Instrumentes ( PSM-G 1.0 ) gemessen . Die Reliabilität der verwendeten Instrumente und die LQ-Skalenmittelwerte wurden berechnet . Uni-/multivariate Varianzanalysen wurden durchgeführt . Ergebnisse : Nach einem mittleren Nachbeobachtungszeitraum von 6,5 Jahren waren 86,3 % der Patienten krankheitsfrei sowie 78 % klinisch und biochemisch rezidivfrei . Die mittleren Cronbach-α-Werte betrugen 0,81 für den QLQ-C30-Fragebogen und 0,74 für das prostataspezifische LQ-Modul . Univariate Varianzanalysen in Bezug auf T-Stadium , Grading , posttherapeutischen Status Indes prostataspezifischen Antigens ( PSA ) und adjuvante And rogensuppression ( AS ) ergaben , dass posttherapeutische PSA-Erhöhung und AS mit einer signifikant reduzierten LQ assoziiert waren . In multivariaten Analysen reduzierte allein die AS signifikant die LQ der Patienten ohne einen Überlebensvorteil . Schlussfolgerung : Das beschriebene Radiotherapieprotokoll stellt eine kurative und schonende Beh and lungs method e beim lokalisierten Prostatakarzinom dar . Die LQ-Messung war mit beiden Instrumenten reliabel . Adjuvante AS und posttherapeutische PSA-Erhöhung waren mit einer reduzierten gesundheitsorientierten LQ assoziiert 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 Purpose To evaluate gold marker displacement due to needle insertion during HDR-brachytherapy for therapy of prostate cancer . Patients and methods 18 patients entered into this prospect i ve evaluation .  Three gold markers were implanted into the prostate during the first HDR-brachytherapy procedure after the irradiation was administered . Three days after marker implantation all patients had a CT-scan for planning purpose of the percutaneous irradiation . Marker localization was defined on the digitally-reconstructed-radiographs ( DRR ) for daily ( VMAT technique ) or weekly ( IMRT ) set-up error correction . Percutaneous therapy started one week after first HDR-brachytherapy . After the second HDR-brachytherapy , two weeks after first HDR-brachtherapy , a cone-beam CT-scan was done to evaluate marker displacement due to needle insertion . In case of marker displacement , the actual positions of the gold markers were adjusted on the DRR . Results The value of the gold marker displacement due to the second HDR-brachytherapy was analyzed in all patients and for each gold marker by comparison of the marker positions in the prostate after soft tissue registration of the prostate of the CT-scans prior the first and second HDR-brachytherapy . The maximum deviation was 5 mm , 7 mm and 12 mm for the anterior-posterior , lateral and superior-inferior direction . At least one marker in each patient showed a significant displacement and therefore new marker positions were adjusted on the DRRs for the ongoing percutaneous therapy . Conclusions Needle insertion in the prostate due to HDR-brachytherapy can lead to gold marker displacements . Therefore , it is necessary to verify the actual position of markers after the second HDR-brachytherapy . In case of significant deviations , a new DRR with the adjusted marker positions should be generated for precise positioning during the ongoing percutaneous irradiation The combination of external‐beam radiotherapy and brachytherapy is used commonly to treat men with prostate cancer . In this analysis , the authors examined the rate of biochemical recurrence ( BR ) and late grade ≥3 genitourinary ( GU ) and gastrointestinal ( GI ) toxicity after treatment with external‐beam radiotherapy and brachytherapy in a multiinstitutional , cooperative group setting PURPOSE To evaluate the treatment outcome after radical radiotherapy of localized prostate cancer in 50 patients ( 38 patients with stage T1 - 2 and 12 patients with stage T3 ) after a median follow-up time of 45 months ( range 18 - 92 months ) . METHODS The treatment was given by combination of external beam radiotherapy ( 50 Gy ) and brachytherapy ( 2 x 10 Gy ) . The brachytherapy was given using TRUS-guided percutaneously inserted temporary needles with a high dose rate remote afterloading technique with Ir-192 as the radionuclide source . Three target definitions and dose levels inside the prostate gl and were used . Local control was evaluated by digital rectal examination , TRUS-guided biopsies and serum PSA evaluations . RESULTS Clinical and biopsy verified local control was achieved in 48 of the 50 ( 96 % ) patients ; for stage T1 - 2 in 37 of 38 ( 97 % ) patients and for stage T3 in 11 of 12 ( 92 % ) patients . A posttreatment serum PSA level < or = 1.0 ng/ml was seen in 42 ( 84 % ) patients , values from > 1.0 to < or = 2.0 ng/ml were seen in four ( 8 % ) patients and values exceeding 2.0 were seen in four ( 8 % ) patients . The late toxicity was minimal . CONCLUSION The local control results and the minimal toxicity after the combined radiotherapy treatment are promising . However , long term results are necessary before general use PURPOSE A Phase I/II protocol was conducted to examine the toxicity and efficacy of the combination of intensity-modulated radiation therapy ( IMRT ) with a single-fraction high-dose-rate ( HDR ) brachytherapy implant . METHODS AND MATERIAL S From 2001 through 2006 , 26 consecutive patients were treated on the trial . The primary objective was to demonstrate a high rate of completion without experiencing a treatment-limiting toxicity . Eligibility was limited to patients with T stage ≤2b , prostate-specific antigen ( PSA ) ≤20 , and Gleason score ≤7 . Treatment began with a single HDR fraction of 6Gy to the entire prostate and 9Gy to the peripheral zone , followed by IMRT optimized to deliver in 28 fractions with a normalized total dose of 70Gy . Patients received 50.4Gy to the pelvic lymph node . The prostate dose ( IMRT and HDR ) result ed in an average biologic equivalent dose > 128Gy ( α/β=3 ) . Patients whose pretreatment PSA was ≥10ng/mL , Gleason score 7 , or stage ≥T2b received short-term and rogen ablation . RESULTS Median followup was 53 months ( 9 - 68 months ) . There were no biochemical failures by either the American Society of Therapeutic Radiology and Oncology or the Phoenix definitions . The median nadir PSA was 0.32ng/mL. All the 26 patients completed the treatment as prescribed . The rate of Grade 3 late genitourinary toxicity was 3.8 % consisting of a urethral stricture . There was no other Grade 3 or 4 genitourinary or gastrointestinal toxicities . CONCLUSIONS Single-fraction HDR-boosted IMRT is a safe effective method of dose escalation for localized prostate cancer BACKGROUND We sought to identify determinants of health-related quality of life after primary treatment of prostate cancer and to measure the effects of such determinants on satisfaction with the outcome of treatment in patients and their spouses or partners . METHODS We prospect ively measured outcomes reported by 1201 patients and 625 spouses or partners at multiple centers before and after radical prostatectomy , brachytherapy , or external-beam radiotherapy .  We evaluated factors that were associated with changes in quality of life within study groups and determined the effects on satisfaction with the treatment outcome . RESULTS Adjuvant hormone therapy was associated with worse outcomes across multiple quality -of-life domains among patients receiving  brachytherapy or radiotherapy . Patients in the brachytherapy group reported having long-lasting urinary irritation , bowel and sexual symptoms , and transient problems with vitality or hormonal function . Adverse effects of prostatectomy on sexual function were mitigated by nerve-sparing procedures . After prostatectomy , urinary incontinence was observed , but urinary irritation and obstruction improved , particularly in patients with large prostates . No treatment-related deaths occurred ; serious 
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Boost from HDR-BT has theoretical advantages over LDR-BT , including improved cancer cell death and better dose distribution from customization of catheter dwell times , locations , and inverse dose optimization .
Late Radiation Therapy Oncology Group grade 3 - 4 toxicities have also been encouraging with < 6 % of patients experiencing any toxicity .