***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 
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    ***EXAMPLES*** 
    Input: To evaluate the best method of palliation for obstructing nonresectable squamous cell carcinoma of the mid or distal esophagus , 27 patients were prospect ively r and omized to one of three treatment arms : ( 1 ) esophageal intubation with an Atkinson tube ( AT , 10 patients ) , ( 2 ) esophageal intubation followed by radiation therapy ( AT/RT , 8 patients ) , and ( 3 ) endoscopic laser therapy followed by irradiation ( L/RT , 9 patients ) . Pretreatment characteristics were similar in the three groups . There was no procedure-related mortality . There were eight total complications related to the tube and none related to laser treatment ( p = 0.02 ) . Mean survival was 119 days in the AT group , 72 days in the AT/RT group , and 169 days in the L/RT arm ( p = not significant ) . Quality of survival was most dependent on swallowing ability , and the swallowing score increased by 2.3 units in the AT group , 1.8 units in the AT/RT group , and 1.4 units in the L/RT group ( p = not significant ) . Adding RT to  laser therapy significantly increased time in treatment ( mean , 38.7 days ) when compared with the AT group ( mean , 12.5 days ) ( p less than 0.001 ) . However , only 1 patient required repeat laser ablation .  It is concluded that AT and L/RT result in good palliation as measured by relief of dysphagia and survival time . However , morbidity of AT is significantly greater than that of L/RT . Laser and radiation therapy with a reduced total dosage of RT or with a change in fractionation schedule to limit treatment time is the preferred method of palliation In all , 144 patients with advanced cardiac cancers have been treated by photodynamic therapy ( PDT ) , combined chemotherapy and chemotherapy alone  from September 1982 to July 1990 . A total of 5 mg kg-1 haematoporphyrin derivative ( HpD ) was intravenously given 48 - 72 h prior to PDT . The light source was an argon dye laser with an output beam of 630 nm . The irradiation time varied between 12 and 25 min with a fluence of 100 - 350 mW cm-2 . The entire tumour was irradiated with a light dose of 100 - 250 J cm-2 . The combination of UFT and mitomycin C was used as st and ard chemotherapy . There were 26 responders out of 55 patients ( 47.3 % ) in the group treated with PDT alone , 24 out of 41 ( 58.5 % ) in the PDT+chemotherapy group , and 24 out of 48 ( 50.0 % ) in the chemotherapy alone group . In the PDT+chemotherapy group 19.5 % patients had complete remission , which was better than the other two groups ( 5.5 % , 8.3 % , p less than 0.05 ) . The following survey of all patients lasted from six months to seven years . The results suggest that a combination of PDT and chemotherapy may prove effective BACKGROUND & AIMS Light dosimetry analysis to achieve predictable tumor necrosis has not been performed for photodynamic therapy ( PDT ) in the gastrointestinal tract . We evaluated dihematoporphyrin ethers for sensitizing esophageal carcinomas to 630 nm light and compared PDT with neodymium : yttrium-aluminum-garnet ( Nd : YAG ) laser therapy in a r and omized trial . METHODS Of 52 patients with dysphagia , 32 received palliative PDT . Ten patients treated with PDT  participated in a preliminary trial using various doses of 630-nm light , and 22 patients treated with PDT  participated in a r and omized trial using a derived st and ardized light dose for comparison with 20 patients treated with the Nd : YAG laser . RESULTS Light dosimetry correlated with depth of tumor necrosis ( r = 0.664 ; P < 0.001 ) .  PDT activity was similar for squamous cell and adenocarcinoma . Among r and omized patients , both PDT and Nd : YAG therapy relieved dysphagia , but PDT result ed in improved Karnofsky performance status at 1 month ( + 7 vs. -7 ; P < 0.001 ) and longer duration of response ( 84 vs. 57 days ; P = 0.008 ) . Skin photoreactions were unique to PDT . CONCLUSIONS The extent of PDT tumor ablation correlates with light dosimetry , enabling selection of a st and ardized light dose . PDT can relieve esophageal obstruction from squamous cell and adenocarcinoma and is an alternative to Nd : YAG thermal necrosis with a longer duration of response . However , PDT requires patient pre caution s to minimize skin photoreactions BACKGROUND Photodynamic therapy ( PDT ) is a different type of laser treatment from Nd : YAG thermal ablation for palliation of dysphagia from esophageal cancer . METHODS In this prospect i ve , multicenter study , patients with advanced esophageal cancer were r and omized to receive PDT with porfimer sodium and argon-pumped dye laser or Nd : YAG laser therapy . RESULTS Two hundred thirty-six patients were r and omized and 218 treated ( PDT 110 , Nd : YAG 108 ) at 24 centers . Improvement in dysphagia was equivalent between the two treatment groups . Objective tumor response was also equivalent at week 1 , but at month 1 was 32 % after PDT and 20 % after Nd : YAG ( p < 0.05 ) . Nine complete tumor responses occurred after PDT and two after Nd : YAG . Trends for improved responses for PDT were seen in tumors located in the upper and lower third of the esophagus , in long tumors , and in patients who had prior therapy . More mild to moderate complications followed PDT , including sunburn in 19 % of patients . Perforations from laser treatments or associated dilations occurred after PDT in 1 % , Nd : YAG 7 % ( p < 0.05 ) . Termination of laser sessions due to adverse events occurred in 3 % with PDT and in 19 % with Nd : YAG ( p < 0.05 ) . CONCLUSIONS Photodynamic therapy with porfimer sodium has overall equal efficacy to Nd : YAG laser thermal ablation for palliation of dysphagia in esophageal cancer , and equal or better objective tumor response rate . Temporary photosensitivity is a limitation , but PDT is carried out with greater ease and is associated with fewer acute perforations than Nd : YAG laser therapy BACKGROUND The aim of therapy for advanced esophageal cancer is relief of dysphagia with minimal treatment-related morbidity . This study assessed the efficacy of endoscopic intratumoral injection of cisplatin/epinephrine gel to relieve obstruction and improve swallowing . The gel is design ed to minimize diffusion of active drug away from the tumor injection site . METHODS Patients with inoperable esophageal cancer and dysphagia caused by exophytic esophageal tumor underwent up to 6 weekly endoscopic injections of the gel . Response was documented objective ly ( exophytic tumor volume , lumen size , dysphagia grade ) and subjectively ( achievement of treatment goal ) . RESULTS Twenty-four patients were treated . Primary evaluation criteria for 18 evaluable patients were as follows : dysphagia grade improved in 4 ( duration 30 to 45 days ) and stabilized in 11 ; lumen patency improved in 6 ( duration 29 to 56 days ) and stabilized in 10 ; exophytic tumor volume decreased in 8 ( duration 29 to 114 days ) . Eight patients felt that their ability to swallow improved . One patient with intramural and exophytic tumor developed a tracheoesophageal fistula , possibly related to treatment . Other complications were tolerable and self-limited . No nephrotoxicty or severe nausea/vomiting typical of systemic administration of cisplatin occurred . CONCLUSIONS Endoscopic injection of cisplatin/epinephrine gel is a straightforward procedure with st and ard equipment and techniques , which can provide palliation for patients with exophytic malignant tumors of the esophagus . Assessment of this method in conjunction with other therapeutic options such as brachytherapy is warranted Abstract Background . The DBCG-IMN is a nationwide population -based cohort study on the effect of internal mammary node radiotherapy ( IMN-RT ) in patients with node positive early breast cancer . Due to the risk of RT-induced heart disease , only patients with right-sided breast cancer received IMN-RT , whereas patients with left-sided breast cancer did not . At seven-year median follow-up , a 3 % gain in overall survival with IMN-RT has been reported . This study estimates  IMN  doses and doses to organs at risk ( OAR ) in patients from the DBCG-IMN . Numbers needed to harm ( NNH ) if patients with left-sided breast cancer had received IMN-RT are compared to the number needed to treat ( NNT ) . Material and methods . Ten percent of CT-guided treatment plans from the DBCG-IMN patients were selected r and omly . IMNs and OAR were contoured in 68 planning CT scans . Dose distributions were re-calculated . IMNs and OAR dose estimates were compared in right-sided versus left-sided breast cancer patients . In six left-sided patients , IMN-RT was simulated , and OAR doses were compared to those in the original plan . The NNH result ing from the change in mean heart dose ( MHD ) was calculated using a published model for risk of RT-related ischemic heart death . Results . In original plans , the absolute difference between right- and left-sided V90 % to the IMNs was 38.0 % [ 95 % confidence interval ( 5.5 % ; 70.5 % ) , p < 0.05 ] . Heart doses were higher in left-sided plans . With IMN-RT simulation without regard to OAR constraints , MHD increased 4.8 Gy ( 0.9 Gy ; 8.7 Gy ) , p < 0.05 . Result ing NNHs from ischemic heart death were consistently larger than the NNT with IMN-RT . Conclusion . Refraining from IMN-RT on the left side may have spared some ischemic heart deaths . Assuming left-sided patients benefit as much from IMN-RT as right-sided patients , the benefits from IMN-RT outweigh the costs in terms of ischemic heart death The aim of this paper is to present the up date d experience of the Yorkshire Laser Centre in PDT for esophageal cancer and to identify its role in specific subsets of patients . Also , in the light of this experience , to compare and contrast the results of PDT with appropriate subsets of patients treated in my esophageal surgery practice . 102 consecutive patients ; 84 with advanced ( Group A ) and 18 with early ( Group E ) stage esophageal cancer undergoing endoscopic PDT  were entered into a prospect i ve study . Every patient had st and ard work up including clinical staging . PDT protocol was intravenous administration of Photofrin 2mg/kg body weight followed 24–72 hours later by endoscopic illumination using 630 nm laser light . Assessment of results was made on the basis of mortality , morbidity , patient satisfaction to treatment , symptom relief and survival . For comparison of PDT role with non PDT treated patients , reference is made to 3 previous publications comprising over 1100 patients [ Moghissi , K. , Br . J. Surg . 79 , 935–937 ( 1992 ) ( ref . 1 ) ; Sawant , D. , Moghissi , K. Eur . J. Cardio-Thorac . Surg . 8 , 113–117 ( 1994 ) ( ref . 2 ) ; Sharpe , D. A. C. , Moghissi , K. Eur . J. Cardiothorac . Surg . 10 , 359–364 ( 1996 ) ( ref . 3 ) ] . There was no mortality associated with PDT . All patients expressed satisfaction to treatment . Post PDT complications consisted of photosensitivity skin reaction ( sunburn ) in 5 patients ( 5 % ) and esophageal stricture in 8 ( 8 % ) patients . Group A : There was significant symptom and dysphegia grade improvement . Mean survival was 9.5 months . Group E : There were no significant symptoms pre or post PDT and mean survival was 60.5 months . Comparison of PDT results in Group A with results of other palliative treatment methods , indicates that palliation can be achieved in all intraluminal cancer using PDT which is at least as good as other treatments . There is , in addition , advantage over other methods in patients with cervical esophageal cancer and in cases with re-growth of tumor obstructing previously placed stents . In early cases PDT appears capable of replicating surgical results in selected cases . PDT is an effective and safe treatment method in esophageal cancer . In advance disease it improves swallowing . In early stage disease it offers long survival and the prospect of cure in some patients . At present the role of PDT in early stage cancer should be limited to patients who are unsuitable for surgical resection . Therefore , PDT should be considered as a valid oncological option to be applied in selected cases 
    Output:
    
CONCLUSION PDT is a useful method for the treatment of middle-advanced stage upper gastrointestinal carcinomas .
PDT combined with chemotherapy or radiotherapy can enhance its efficacy and prolong survival time