***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 AND AIMS There is currently no proven chemotherapy regimen for hepatocellular carcinoma ( HCC ) . The principal chemotherapeutic approach in most cases is infusion therapy into the hepatic arteries feeding the tumors . However , the clinical effects of chemotherapy are extremely poor . Therefore , in the present study , we conducted a prospect i ve r and omized trial of the efficacy of oral administration of enteric-coated tegafur/uracil for advanced HCC . METHODS From 1994 to 1999 , a total of 56 consecutive patients with unresectable stage IV-A HCC were studied prospect ively to examine the efficacy of enteric-coated tegafur/uracil in HCC and to determine the significant prognostic factors . Twenty-eight patients were treated only with enteric-coated tegafur/uracil without other anticancer treatment .  Another 20 patients were given conservative management only . The remaining eight patients withdrew from the study . RESULTS In the group treated only with enteric-coated tegafur/uracil , the median survival time and 1 and 2 year survival rates were 12.13 months and 55.3 and 36.9 % , respectively . In the control group , the median survival time and 1 year survival rate were 6.20 months and 5.5 % , respectively . By both univariate analysis and multivariate analysis using Cox 's proportional hazards model , treatment with enteric-coated tegafur/uracil was shown to be the factor most significantly favoring a better prognosis . CONCLUSIONS Although the prognosis of most patients with stage IV-A HCC is poor , administration of enteric-coated tegafur/uracil induces long-term survival and is an effective treatment for stage IV-A HCC We conducted a prospect i ve r and omized trial to evaluate the efficacy of Lipiodol in intrahepatic arterial infusion chemotherapy for patients with hepatocellular carcinoma ( HCC ) . A total of 38 patients with unresectable HCCs and underlying cirrhosis were entered in this trial , and 36 of them were evaluable . Every 4 weeks , 17 patients received 70 mg of 4′-epidoxorubicin ( epirubicin ) alone ( group A ) , whereas 19 patients received a Lipiodol emulsion containing the same dose of epirubicin ( group B ) through the hepatic artery . A tumor response ( CR+PR ) was observed in 12 % of group A patients and in 42 % of group B patients . The group B patients showed a significantly higher response rate than the group A patients . There was a tendency for an increased duration of survival ( P=0.09 ) in the group B patients . These results suggested that the infusion of the Lipiodol emulsion with epirubicin was more effective than epirubicin alone for the treatment of these patients with HCC Variant liver oestrogen receptor transcripts in hepatocellular carcinoma are associated with aggressive clinical course and unresponsiveness to tamoxifen . To evaluate the impact on survival and on tumour growth of megestrol ( progestin drug acting at post-receptorial level ) we enrolled 45 patients with HCC characterized by variant liver oestrogen receptors in a prospect i ve , r and omized study with megestrol vs. placebo .  Presence of variant oestrogen receptors was determined by RT/PCR . 24 patients were r and omized to no treatment and 21 to therapy with megestrol 160 mg day–1 . Results were analysed by Kaplan-Meier and Cox methods . Survival of hepatocellular carcinoma characterized by variant oestrogen receptors was extremely poor ( median survival 7 months ) ; megestrol significantly improved survival ( 18 months ) ( P = 0.0090 ) . Tumour growth at one year was significantly slowed down in megestrol-treated patients ( P = 0.0212 ) . Bilirubin levels , presence of portal thrombosis , HBV aetiology and treatment were identified at univariate analysis as factors significantly associated with survival ; at multivariate analysis , only megestrol therapy ( P = 0.0003 ) , presence of HBV infection ( P = 0.0009 ) and presence of portal vein thrombosis ( P = 0.0051 ) were factors independently related with survival . ( 1 ) Megestrol slows down the aggressive tumour growth of patients with hepatocellular carcinoma characterized by variant estrogen receptors and ( 2 ) is also able to favourably influence the course of disease , more than doubling median survival . © 2001 Cancer Research One hundred ninety‐two patients with unresectable primary liver cancer studied by members of the Eastern Cooperative Oncology Group ( ECOG ) were evaluable in a prospect ively r and omized clinical trial . Patient discriminants such as performance status were carefully evaluated to assess their influence on prognosis and to evaluate the importance of patient status on response and survival . Patients who were totally bedridden or with signs of overt liver failure were not entered on study .  The median survival time for all evaluable previously untreated patients was 17 weeks ( 19 weeks for North American and European , and 10 weeks for South African black patients ) . Among the South African patients , however , there was a significantly larger proportion with an initially poor performance status . Prognostic variables ( performance status , jaundice , and reduced appetite ) dominate any differences among the treatments studied . Among North American and European patients on intravenous ( IV ) 5‐fluorouracil ( 5‐FU ) + Methyl‐CCNU ( MeCCNU ) + Adriamycin ( ADM , doxorubicin ) , the 19 % response rate is offset by 63 % with severe toxicity and a median survival time of only 17 weeks , making this treatment unacceptable clinical ly . The median survival time of North American and European patients treated with IV 5‐FU + MeCCNU was 28 weeks in contrast to a median survival time of 12 weeks with ADM ( P ≤ 0.01 ) . EST 2273 was the ECOG study of patients with primary liver cancer . The results of the first part of the trial were published in 1978 . This report up date s those findings and reports the results of patients entered subsequently on the second part of that study after it was amended in 1979 . With more than 300 evaluable patients in EST 2273 , this duet of studies is the largest ever conducted in patients with primary liver cancer , and draws a new baseline from which to measure the disease and its response to treatment A r and omized controlled trial of tamoxifen ( 60 mg/die ) versus placebo was performed in patients with cirrhosis and advanced inoperable hepatocellular carcinoma . Twenty-two patients were matched and coupled for sex , age , Child-Pugh class and tumour mass and then r and omized to tamoxifen or placebo .  Median survival was 74 weeks in the tamoxifen group ( range 27 to 144 weeks ) and 52 weeks in the placebo group ( range 4 to 112 weeks ) . The survival of patients treated with tamoxifen improved significantly compared to the controls ( Logrank-test , p = 0.04 ) . These findings suggest that the effect of the antiestrogen tamoxifen is both statistically and clinical ly significant in increasing survival in patients with advanced hepatocellular carcinoma OBJECTIVES : A prospect i ve r and omized study was performed to test the hypothesis that tamoxifen might improve the survival of patients with advanced hepatocellular carcinoma ( HCC ) and to correlate the response of treatment with the expression of hormone receptors . METHODS : One hundred nineteen patients with advanced and otherwise untreatable HCC were included in a placebo-controlled , single-blind trial . The patients were r and omized to tamoxifen group ( 61 patients ) and control group ( 58 patients ) and were prescribed with a daily dose of 30 mg of tamoxifen and placebo , respectively . Immunohistochemical tests for estrogen and progesterone receptors were performed on the tumor tissues obtained from 66 patients . All patients were closely monitored and the survival outcome of the two groups of patients was compared and stratified according to the hormonal receptor status . RESULTS : There was no difference in the 1-month mortality rates ( 32.8 % vs 43.1 % , p = 0.246 ) and the median survival ( 44 days vs 41 days , p = 0.703 ) between the tamoxifen group and the control group . Furthermore , the expression of hormone receptors in the tumors did not affect the survival outcome of the patients treated with tamoxifen . None of the patients who survived longer than 3 months had tumor that had partial response to tamoxifen treatment on follow-up imaging study . CONCLUSIONS : Tamoxifen has no efficacy in the treatment of patients with advanced HCC and response to treatment was not affected by the expression of hormone receptors Lipiodol injected into the hepatic artery is selectively retained in hepatomas so has been used as a vehicle for cytotoxic drugs . This study compared treatment with 5-epidoxorubicin emulsified in lipiodol and infused into the hepatic artery with symptomatic treatment alone in a r and omised trial . Of 136 patients with hepatoma 78 ( 57 % ) were not eligible , eight ( 6 % ) refused to take part , and 50 entered the trial  ( chemotherapy : n = 25 , symptomatic treatment : n = 25 ) . The two groups had similar prognostic indices . Seven of 25 patients allocated to chemotherapy were unable to receive it . The slight survival disadvantage associated with chemotherapy was not significant ( median survival 48 days compared with 51 days , log rank chi 2 = 0.07 , p > 0.05 ) . Patients given  chemotherapy  spent significantly longer in hospital , however ( median three days compared with one , p = 0.0008 ) . Changes in symptoms and indices of tumour growth did not differ significantly between the two groups . It is concluded that infusion of 5-epidoxorubicin emulsified in lipiodol for hepatoma increased morbidity but did not affect survival . In addition , most patients were unsuitable for this treatment because of advanced disease . The patients in the trial had a short median survival time so the conclusions may not be valid for other patients with hepatoma Thirty-six consecutive patients with advanced hepatocellular carcinoma and chronic liver disease were r and omly allocated to two groups : group I included 20 patients who were treated with 10 mg bid . tamoxifen  and group II with 16 non-treated patients . The two groups were homogeneous according to clinical and analytical data . Survival curves in the tamoxifen-treated patients improved significantly when compared with the non-treated group ( p = 0.01 ) . Cumulative survival at the end of the first year was 48.5 % in the treated patients and 9.1 % in controls . Median survival was 261 days in the treated group vs. 172 in the non-treated group ( p < 0.05 ) . Complications of cirrhosis and worsening of the performance status test occurred less in the treated patients than in the controls , but not significantly so . Tamoxifen was well tolerated and no marked side effects were observed . In this series , tamoxifen improved survival in patients with advanced hepatocellular carcinoma BACKGROUND / AIMS Lipiodol chemoembolization is a widely used method of treatment in patients with unresectable hepatocellular carcinoma , but its efficacy is still debated . The aim of our study was to assess the efficacy of lipiodol chemoembolization in patients with unresectable hepatocellular carcinoma . METHODS Seventy-three patients with unresectable hepatocellular carcinoma , but without severe liver disease or portal vein occlusion , were r and omly assigned to receive either repeated lipiodol chemoembolization ( lipiodol , cisplatin ( 2 mg/kg ) , lecithin , and gelatin sponge injected into the hepatic artery ) plus tamoxifen ( 40 mg ) or tamoxifen alone . The main end-point was survival . RESULTS The 37 patients in the lipiodol chemoembolization group received 104 courses ( median 3 per patient ) . By 1 September 1996 , 58 patients had died : 30 in the lipiodol chemoembolization group and 28 in the tamoxifen group . There was no difference in survival between the two groups ( p=0.77 ) . The relative risk of death in the lipiodol chemoembolization plus tamoxifen group as compared to the tamoxifen group was 0.92 ( 95 % confidence interval 0.55 to 1.56 ) . At 1 year , survival was 51 % and 55 % , respectively . An objective tumoral response was more frequently observed in the lipiodol chemoembolization group than in the tamoxifen group ( 24 versus 5.5 % , respectively , p=0.046 ) . Lipiodol chemoembolization caused two deaths and induced signs of liver failure in 51 % of the patients assigned to this treatment . CONCLUSION In our r and omized study , lipiodol chemoembolization did not improve the survival of patients with unresectable hepatocellular carcinoma treated with tamoxifen A r and omized trial of hepatic arterial chemoembolization was conducted in 42 patients with unresectable hepatocellular carcinoma . These patients represented 41 % of patients with hepatocellular carcinoma seen during the inclusion period . In the remaining 59 % , 9 % had resectable tumours and 50 % had unresectable tumours with contraindication 
    Output:
    
In conclusion , chemoembolization improves survival of patients with unresectable HCC and may become the st and ard treatment .
Treatment with tamoxifen does not modify the survival of patients with advanced disease