***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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    Input: PURPOSE Patients with biochemical failure ( BF ) after radical prostatectomy may benefit from dose-intensified salvage radiation therapy ( SRT ) of the prostate bed . We performed a r and omized phase III trial assessing dose intensification . PATIENTS AND METHODS Patients with BF but without evidence of macroscopic disease were r and omly assigned to either  64 or 70 Gy . Three-dimensional conformal radiation therapy or intensity-modulated radiation therapy/rotational techniques were used . The primary end point was freedom from BF . Secondary end points were acute toxicity according to the National Cancer Institute Common Terminology Criteria for Adverse Events ( version 4.0 ) and quality of life ( QoL ) according to the European Organisation for Research and Treatment of Cancer Quality of Life Question naires C30 and PR25 . RESULTS Three hundred fifty patients were enrolled between February 2011 and April 2014 . Three patients withdrew informed consent , and three patients were not eligible , result ing in 344 patients age 48 to 75 years in the safety population . Thirty patients ( 8.7 % ) had grade 2 and two patients ( 0.6 % ) had grade 3 genitourinary ( GU ) baseline symptoms . Acute grade 2 and 3 GU toxicity was observed in 22 patients ( 13.0 % ) and one patient ( 0.6 % ) , respectively , with 64 Gy and in 29 patients ( 16.6 % ) and three patients ( 1.7 % ) , respectively , with 70 Gy ( P = .2 ) . Baseline grade 2 GI toxicity was observed in one patient ( 0.6 % ) . Acute grade 2 and 3 GI toxicity was observed in 27 patients ( 16.0 % ) and one patient ( 0.6 % ) , respectively , with 64 Gy , and in 27 patients ( 15.4 % ) and four patients ( 2.3 % ) , respectively , with 70 Gy ( P = .8 ) . Changes in early QoL were minor . Patients receiving 70 Gy reported a more pronounced and clinical ly relevant worsening in urinary symptoms ( mean difference in change score between arms , 3.6 ; P = .02 ) . CONCLUSION Dose-intensified SRT was associated with low rates of acute grade 2 and 3 GU and GI toxicity . The impact of dose-intensified SRT on QoL was minor , except for a significantly greater worsening in urinary symptoms BACKGROUND We report the long-term results of a trial of immediate postoperative irradiation versus a wait- and -see policy in patients with prostate cancer extending beyond the prostate , to confirm whether previously reported progression-free survival was sustained . METHODS This r and omised , phase 3 , controlled trial recruited patients aged 75 years or younger with untreated cT0 - 3 prostate cancer ( WHO performance status 0 or 1 ) from 37 institutions across Europe . Eligible patients were r and omly assigned central ly ( 1:1 ) to postoperative irradiation ( 60 Gy of conventional irradiation to the surgical bed for 6 weeks ) or to a wait- and -see policy until biochemical progression ( increase in prostate-specific antigen > 0·2 μg/L confirmed twice at least 2 weeks apart ) . We analysed the primary endpoint , biochemical progression-free survival , by intention to treat ( two-sided test for difference at α=0.05 , adjusted for one interim analysis ) and did exploratory analyses of heterogeneity of effect . This trial is registered with Clinical Trials.gov , number NCT00002511 . FINDINGS 1005 patients were r and omly assigned to a wait- and -see policy ( n=503 ) or postoperative irradiation ( n=502 ) and were followed up for a median of 10·6 years ( range 2 months to 16·6 years ) . Postoperative irradiation significantly improved biochemical progression-free survival compared with the wait- and -see policy ( 198 [ 39·4 % ] of 502 patients in postoperative irradiation group vs 311 [ 61·8 % ] of 503 patients in wait- and -see group had biochemical or clinical progression or died ; HR 0·49 [ 95 % CI 0·41 - 0·59 ] ; p<0·0001 ) . Late adverse effects ( any type of any grade ) were more frequent in the postoperative irradiation group than in the wait- and -see group ( 10 year cumulative incidence 70·8 % [ 66·6 - 75·0 ] vs 59·7 % [ 55·3 - 64·1 ] ; p=0.001 ) . INTERPRETATION Results at median follow-up of 10·6 years show that conventional postoperative irradiation  significantly improves biochemical progression-free survival and local control compared with a wait- and -see policy , supporting results at 5 year follow-up ; however , improvements in clinical progression-free survival were not maintained . Exploratory analyses suggest that postoperative irradiation might improve clinical progression-free survival in patients younger than 70 years and in those with positive surgical margins , but could have a detrimental effect in patients aged 70 years or older . FUNDING Ligue Nationale contre le Cancer ( Comité de l'Isère , Grenoble , France ) and the European Organisation for Research and Treatment of Cancer ( EORTC ) Charitable Trust Purpose To compare the impact of elective whole pelvic radiotherapy ( WPRT ) versus prostate bed-only radiotherapy ( PBRT ) on biochemical relapse-free survival ( bRFS ) in prostate cancer patients treated with salvage radiotherapy following radical prostatectomy ( RP ) . Patients and methods In our data base , 163 lymph node-negative prostate cancer patients who had undergone salvage radiotherapy ( SRT ) for biochemical relapse after RP between September 2004 and April 2012 were identified .  PBRT was administered to 134 patients ( the PBRT group ) , while the remaining 29 patients ( the WPRT group ) received WPRT . Results Median follow-up was 57 months ( range 18–122 months ) . In the propensity score-matched cohort , the 4-year bRFS of the WPRT group was significantly higher compared to the PBRT group ( 63.1 vs. 43.4 % , p = 0.034 ) . Subgroup analysis showed that the bRFS of patients who had two or more risk factors ( seminal vesicle invasion , Roach score for lymph node invasion ≥ 45 % , and number of harvested lymph nodes ≤ 5 ) and were treated with WPRT was significantly improved compared to those who received PBRT ( hazard ratio , HR 0.33 ; 95 % confidence interval , CI 0.13–0.83 ; p = 0.018 ) . Conclusion Elective WPRT for SRT may improve bRFS in patients with unfavorable risk factors . These results need to be confirmed by a prospect i ve r and omized trial . ZusammenfassungZielVergleich der Auswirkungen der gezielten Beckenstrahlentherapie ( WPRT ) gegenüber der Prostatastrahlentherapie ( PBRT ) hinsichtlich des biochemischen rezidivfreien Überlebens ( bRFS ) bei Prostatakarzinompatienten , die nach radikaler Prostatektomie ( RP ) mit einer Salvage-Strahlentherapie ( SRT ) beh and elt wurden . Patienten und Method enAus unserer Date nbank wurden 163 lymphknotennegative Patienten mit Prostatakrebs identifiziert , die sich nach RP zwischen September 2004 und April 2012 wegen einem biochemischen Rückfall einer rettenden SRT unterzogen hatten . PBRT wurde 134 Patienten verabreicht ( PBRT-Gruppe ) , während die übrigen 29 Patienten eine WPRT erhielten (WPRT-Gruppe).ErgebnisseDie mediane Nachbeobachtungszeit betrug 57 Monate ( Spanne : 18–122 Monate ) . In der auf den Propensity-Score abgestimmten Kohorte war das 4-Jahres-bRFS der WPRT-Gruppe i m Vergleich zur PBRT-Gruppe signifikant höher ( 63,1 vs. 43,4 % ; p = 0,034 ) . Eine Untergruppenanalyse zeigte , dass sich das bRFS der Patienten , die zwei oder mehr Risikofaktoren hatten ( Samenblasenbefall , Roach-Score für Lymphknotenbefall ≥ 45 % und Zahl der entfernten Lymphknoten ≤ 5 ) und mit WPRT beh and elt wurden , i m Vergleich zu diejenigen , die PBRT erhalten hatten , deutlich verbessert ( Hazard-Ratio 0,33 ; 95 % -Konfidenzintervall 0,13–0,83 ; p = 0,018).FazitEine gezielte WPRT-Strahlentherapie kann das bRFS bei Patienten mit ungünstigen Risikofaktorenverbessern . Diese Ergebnisse müssen in einer prospektiven r and omisierten Studie bestätigt werden BACKGROUND The optimum duration of and rogen deprivation combined with high-dose radiotherapy in prostate cancer remains undefined . We aim ed to determine whether long-term and rogen deprivation was superior to short-term and rogen deprivation when combined with high-dose radiotherapy . METHODS In this open-label , multicentre , phase 3 r and omised controlled trial , patients were recruited from ten university hospitals throughout Spain . Eligible patients had clinical stage T1c-T3b N0M0 prostate adenocarcinoma with intermediate-risk and high-risk factors according to 2005 National Comprehensive Cancer Network criteria . Patients were r and omly assigned ( 1:1 ) using a computer-generated r and omisation schedule to receive either 4 months of and rogen deprivation combined with three-dimensional conformal radiotherapy at a minimum dose of 76 Gy ( range 76 - 82 Gy ; short-term and rogen deprivation group ) or the same treatment followed by 24 months of adjuvant and rogen deprivation ( long-term and rogen deprivation group ) , stratified by prostate cancer risk group ( intermediate risk vs high risk ) and participating centre . Patients assigned to the short-term and rogen deprivation group received 4 months of neoadjuvant and concomitant and rogen deprivation with subcutaneous goserelin ( 2 months before and 2 months combined with high-dose radiotherapy ) . Anti- and rogen therapy ( flutamide 750 mg per day or bicalutamide 50 mg per day ) was added during the first 2 months of treatment . Patients assigned to long-term suppression continued with the same luteinising hormone-releasing hormone analogue every 3 months for another 24 months . The primary endpoint was biochemical disease-free survival . Analysis was by intention to treat . This study is registered with Clinical Trials.gov , number NCT02175212 . FINDINGS Between Nov 7 , 2005 , and Dec 20 , 2010 , 178 patients were r and omly assigned to receive short-term and rogen deprivation and 177 to receive long-term and rogen deprivation . After a median follow-up of 63 months ( IQR 50 - 82 ) , 5-year biochemical disease-free survival was significantly better among patients receiving long-term and rogen deprivation than among those receiving short-term treatment ( 90 % [ 95 % CI 87 - 92 ] vs 81 % [ 78 - 85 ] ; hazard ratio [ HR ] 1·88 [ 95 % CI 1·12 - 3·15 ] ; p=0·01 ) . 5-year overall survival ( 95 % [ 95 % CI 93 - 97 ] vs 86 % [ 83 - 89 ] ; HR 2·48 [ 95 % CI 1·31 - 4·68 ] ; p=0·009 ) and 5-year metastasis-free survival ( 94 % [ 95 % CI 92 - 96 ] vs 83 % [ 80 - 86 ] ; HR 2·31 [ 95 % CI 1·23 - 3·85 ] ; p=0·01 ) were also significantly better in the long-term and rogen deprivation group than in the short-term and rogen deprivation group . The effect of long-term and rogen deprivation  on biochemical disease-free survival , metastasis-free survival , and overall survival was more evident in patients with high-risk disease than in those with low-risk disease .  Grade 3 late rectal toxicity was noted in three ( 2 % ) of 177 patients in the  long-term and rogen deprivation group and two ( 1 % ) of 178 in the short-term and rogen deprivation  group ; grade 3 - 4 late urinary toxicity was noted in five ( 3 % ) patients in each group . No deaths related to treatment were reported . INTERPRETATION Compared with short-term and rogen deprivation , 2 years of adjuvant and rogen deprivation combined with high-dose radiotherapy  improved biochemical control and overall survival in patients with prostate cancer , particularly those with high-risk disease , with no increase in late radiation toxicity . Longer follow-up is needed to determine whether men with intermediate-ris 
    Output:
    
Three prognostic factors appeared to discriminate improvements in meaningful clinical endpoints ( eg , distant metastasis or survival ) : pre-SRT PSA , Gleason score , and margin status .
Two years of bicalutamide monotherapy result ed in higher rates of gynecomastia with a trend for worse survival when given in favorable risk patients , and 6 mo of luteinizing hormone-releasing hormone agonist therapy result ed in higher rates of hot flashes and long-term hypertension .
Similar to the selective use of HT with radiotherapy in localized prostate cancer , not all patients appear to derive a meaningful benefit from HT with SRT .
We found that the benefit of hormone therapy varied by important prognostic factors , including pre-SRT prostate-specific antigen , Gleason grade , and surgical margin status .
Our group then developed a framework on how best to utilize hormone therapy with SRT