***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 Using real-time intraoperative inverse-planned permanent seed prostate implant ( RTIOP/PSI ) , multiple core biopsy maps , and three-dimensional ultrasound guidance , we planned a boost volume ( BV ) within the prostate to which hyperdosage was delivered selectively . The aim of this study was to investigate the potential negative effects of such a procedure . METHODS AND MATERIAL S Patients treated with RTIOP/PSI for localized prostate cancer with topographic biopsy results received an intraprostatic boost ( boost group [ BG ] ) . They were compared with patients treated with a st and ard plan ( reference group [ RG ] ) . Plans were generated using a simulated annealing inverse planning algorithm . Prospect ively recorded urinary , rectal , and sexual toxicities and dosimetric parameters were compared between groups . RESULTS The study included 120 patients treated with boost technique who were compared with 70 patients treated with a st and ard plan . Boost technique did not significantly change the number of seeds ( 55.1/RG vs. 53.6/BG ) . The intraoperative prostate V150 was slightly higher in BG ( 75.2/RG vs. 77.2/BG , p = 0.039 ) . Urethra V100 , urethra D90 , and rectal D50 were significantly lower in the BG . No significant differences were seen in acute or late urinary , rectal , or sexual toxicities . CONCLUSIONS Because there were no differences between the groups in acute and late toxicities , we believe that BV can be planned and delivered to the dominant intraprostatic lesion without increasing toxicity . It is too soon to say whether a boost technique will ultimately increase local control Purpose : Recent studies have suggested that extracapsular brachytherapy treatment margins correlate with biochemical control . It is likely that volumetric geographic dosimetric parameters will be more robust than selected radial measurements . Accordingly , we evaluated extracapsular volumetric dosimetric parameters in low-risk patients . Material s and Methods : A total of 263 low-risk prostate cancer patients r and omized to Pd-103 versus I-125 were  implanted with a brachytherapy target volume consisting of the prostate with a 5-mm periprostatic margin . The median follow-up was 4.2 years . All patients were implanted at least 3 years prior to analysis . Within 2 hours of implantation , an axial CT was obtained for postimplant dosimetry . A 5-mm three-dimensional periprostatic anulus was constructed around the prostate and evaluated in its entirety and in 90 ° segments . Prostate and anular dosimetric parameters consisted of V100/V150/V200 and D90 . Biochemical progression-free survival ( bPFS ) was defined as a PSA ≤0.50 ng/mL after nadir . Results : The Pd-103 and I-125 arms were well-matched in terms of clinical , biochemical , and pathologic presentation . Six-year bPFS was 96.8 % versus 99.2 % for I-125 versus Pd-103 ( P = 0.149 ) . The most recent median posttreatment PSA was < 0.04 ng/mL for both isotopes . No significant differences in postoperative anular doses were discerned between bPFS and failed patients . Conclusions : A postimplant 5-mm , three-dimensional periprostatic anulus provides substantial information regarding dosimetric coverage . However , with a median follow-up of 4.2 years , such volumetric and geographic parameters have not proven useful in predicting biochemical outcome in low-risk patients PURPOSE To compare treatment impact on health-related quality of life ( HRQL ) in patients with localized prostate cancer , from before treatment to 2 years after the intervention . METHODS AND MATERIAL S This was a longitudinal , prospect i ve study of 614 patients with localized prostate cancer treated with radical prostatectomy ( 134 ) , three-dimensional external conformal radiotherapy ( 205 ) , and brachytherapy ( 275 ) . The HRQL question naires administered before and after treatment ( months 1 , 3 , 6 , 12 , and 24 ) were the Medical Outcomes Study 36-Item Short Form , the Functional Assessment of Cancer Therapy ( General and Prostate Specific ) , the Exp and ed Prostate Cancer Index Composite ( EPIC ) , and the American Urological Association Symptom Index . Differences between groups were tested by analysis of variance and within-group changes by univariate repeated- measures analysis of variance . Generalized estimating equations ( GEE ) models were constructed to assess between-group differences in HRQL at 2 years of follow-up after adjusting for clinical variables . RESULTS In each treatment group , HRQL initially deteriorated after treatment with subsequent partial recovery . However , some dimension scores were still significantly lower after 2 years of treatment . The GEE models showed that , compared with the brachytherapy group , radical prostatectomy patients had worse EPIC sexual summary and urinary incontinence scores ( -20.4 and -14.1 ; p < 0.001 ) , and external radiotherapy patients had worse EPIC bowel , sexual , and hormonal summary scores ( -3.55 , -5.24 , and -1.94 ; p < 0.05 ) . Prostatectomy patients had significantly better EPIC urinary irritation scores than brachytherapy patients ( + 4.16 ; p < 0.001 ) . CONCLUSIONS Relevant differences between treatment groups persisted after 2 years of follow-up . Radical prostatectomy had a considerable negative effect on sexual functioning and urinary continence .  Three-dimensional conformal radiotherapy had a moderate negative impact on bowel functioning , and brachytherapy caused moderate urinary irritation . These results provide relevant information for clinical decision making PURPOSE To compare prostate cancer control rates in patients who received (125)I vs. (103)Pd .  MATERIAL S AND METHODS Of a planned total of 600 patients with 1997 American Joint Committee on Cancer clinical Stage T1c-T2a prostate carcinoma ( Gleason score 5 - 6 , prostate-specific antigen [ PSA ] 4 - 10 ng/mL ) , 126 were r and omized to implantation with  (125)I ( 144 Gy ) vs. (103)Pd ( 125 Gy ) . The prostate biopsies were review ed for Gleason score by one of us ( L.T. ) . A single manufacturer of (125)I sources ( Model 6711 , Amersham , Chicago , IL ) and (103)Pd sources ( Theraseed , Theragenics , Buford , Georgia ) was used . Isotope implantation was performed with st and ard techniques , using a modified peripheral loading pattern . Of a total of 126 patients r and omized , 11 were excluded , leaving 115 r and omized patients for this analysis . Twenty patients received a short course of preimplant hormonal therapy , none of whom continued hormonal therapy after their implant procedure . Postimplant CT was obtained 2 - 4 hours after implantation . The dosimetric parameters analyzed included the percentage of the postimplant prostate or rectal volume covered by the prescription dose ( V(100 ) ) and the dose that covered 90 % of the postimplant prostate volume ( D(90 ) ) . Freedom from biochemical failure was defined as a serum PSA level < or = 0.5 ng/mL at last follow-up . Patients were censored at last follow-up if their serum PSA level was still decreasing . Patients whose serum PSA had reached a nadir at a value > 0.5 ng/mL were scored as having failure at the time at which their PSA had reached a nadir . The follow-up period for patients without failure ranged from 2.0 to 4.9 years ( median 2.9 ) . Freedom-from-failure curves were calculated by the Kaplan-Meier method . Differences between groups were determined by the log-rank method . RESULTS The actuarial biochemical freedom-from-failure rate at 3 years was 89 % for (125)I patients vs. 91 % for (103)Pd patients ( p = 0.76 ) . The 3-year biochemical freedom-from-failure rate for patients with a D(90 ) < 100 % of the prescription dose was 82 % vs. 97 % for patients with a D(90 ) > or = 100 % of the prescription dose ( p = 0.01 ) . Similarly , the 3-year biochemical freedom-from-failure rate for patients with a V(100 ) < 90 % of the prescription dose was 87 % vs. 97 % for patients with a V(100 ) > or = 90 % of the prescription dose ( p = 0.01 ) . The effect of the dosimetric parameters on biochemical control was most pronounced for (125)I , but also apparent for (103)Pd . CONCLUSIONS The 3-year actuarial biochemical control rates for low early-stage prostate cancer are similar after (125)I and (103)Pd PURPOSE The aim of this study was to compare the toxicity and efficacy of radiation therapy ( RT ) for localized carcinoma of the prostate , using a hypofractionated ( 55 Gy/20 fractions/4 weeks ) vs. a conventionally fractionated ( 64 Gy/32 fractions/6.5 weeks ) dose schedule . METHODS AND MATERIAL S A total of 217 patients were r and omized to either the hypofractionated ( 108 patients ) or the conventional ( 109 patients ) dose schedule  , with planning with two-dimensional ( 2D ) CT scan planning methodology in the majority of cases . All patients were followed for a median of 48 ( 6 - 108 ) months . Gastrointestinal ( GI ) and genitourinary ( GU ) toxicity was evaluated before RT and after its completion using modified late effects of normal tissue-subjective , objective , management , analytic ( LENT-SOMA ) scales and the European Organization for Research and Treatment of Cancer sexual function question naire . Efficacy of RT based on clinical , radiologic , and prostate-specific antigen data were also evaluated at baseline and after RT . RESULTS Gastrointestinal and GU toxicity persisted 5 years after RT and did not differ between the two dose schedules other than in regard to urgency of defecation . However , 1-month GI toxicity was not only worse in patients with the hypofractionated RT schedule but also adversely affected daily activities . Nadir prostate-specific antigen values occurred at a median of 18.0 ( 3.0 - 54.0 ) months after RT . A total of 76 biochemical relapses , with or without clinical relapses , have occurred since ; of these , 37 were in the hypofractionated and 39 in the conventional schedule . The 5-year biochemical + /- clinical relapse-free and overall survival was 55.9 % and 85.3 % respectively for all patients , and did not differ between the two schedules . CONCLUSIONS Radiation therapy for prostate carcinoma causes persistent GI toxicity that is largely independent of the two dose schedules . The hypofractionated schedule is equivalent in efficacy to the conventional schedule OBJECTIVE This paper describes the first-year biochemical ( prostate-specific antigen [ PSA ] ) response of 91 irradiated patients enrolled in a single-institution r and omized trial comparing  hypofractionated ( HFRT ) and conventionally fractionated ( CFRT ) external beam radiotherapy . MATERIAL AND METHODS Forty-four patients in the CFRT treatment arm were irradiated with 74 Gy in 37 fractions ( 2 Gy per fraction ) , and 47 in the HFRT arm were treated with 57 Gy , given in 13 fractions of 3 Gy plus 4 fractions of 4.5 Gy . The clinical target volume includes the prostate and a base of seminal vesicles . The proportions of patients who reached PSA nadir ( nPSA ) lower than or equal to 1.0 ng/mL ( nPSA1 ) and 0.5 ng/mL ( nPSA05 ) were compared . RESULTS There were 2 non-cancer-related deaths ( 1 in the CFRT and 1 in the HFRT treatment arms ) . Biochemical relapse after irradiation was defined in five cases ( 3 in the CFRT and 2 in the HFRT treatment arms ) during a 12-month follow-up . The remaining 84 patients were analyzed . The proportions of patients reaching nPSA1 were 50 % and 54.5 % in the CFRT and HFRT treatment arms , respectively ( chi-square P=0.843 ) . The percentages of patients reaching nPSA05 were 25 % and 18.2 % , respectively ( chi-square P=0.621 ) . The trends toward increasing proportions of biochemical responders ( both nPSA1 and nPSA05 ) during 12 months after radiotherapy were observed , but the difference between trends for treatment arms did not reach a statistical significance . CONCLUSION The preliminary results presented here demonstrate that HFRT schedule induces biochemical response rates comparable to those in the CFRT schedule during the first-year follow-up Purpose : Evaluation of late side effects and biochemical control ( bNED ) 5 years after three-dimensional radiotherapy with moderate , risk-adapted dose escalation . Patients and Methods : From 03/1999 to 07/2002 , 486 patients have been registered in the prospect i ve Austrian-German multicenter phase II trial ( AUGE ) . 39 
    Output:
    
Overall , moderate-strength evidence consistently showed that a higher EBRT dose was associated with increased rates of long-term biochemical control compared with lower EBRT dose .
A lack of high- quality comparative evidence precludes conclusions about the efficacy of radiation treatments compared with no treatments for localized prostate cancer .