***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: The purpose of this study was to report the outcomes of high-dose-rate ( HDR ) brachytherapy and hypofractionated external beam radiotherapy ( EBRT ) combined with long-term and rogen deprivation therapy ( ADT ) for National Comprehensive Cancer Network ( NCCN ) criteria -defined high-risk ( HR ) and very high-risk ( VHR ) prostate cancer . Data from 178 HR ( n = 96 , 54 % ) and VHR ( n = 82 , 46 % ) prostate cancer patients who underwent 192Ir-HDR brachytherapy and hypofractionated EBRT with long-term ADT between 2003 and 2008 were retrospectively analyzed . The mean dose to 90 % of the planning target volume was 6.3 Gy/fraction of HDR brachytherapy . After five fractions of HDR treatment , EBRT with 10 fractions of 3 Gy was administered . All patients initially underwent ≥6 months of neoadjuvant ADT , and adjuvant ADT was continued for 36 months after EBRT . The median follow-up was 61 months ( range , 25–94 months ) from the start of radiotherapy . The 5-year biochemical non- evidence of disease , freedom from clinical failure and overall survival rates were 90.6 % ( HR , 97.8 % ; VHR , 81.9 % ) , 95.2 % ( HR , 97.7 % ; VHR , 92.1 % ) , and 96.9 % ( HR , 100 % ; VHR , 93.3 % ) , respectively . The highest Radiation Therapy Oncology Group-defined late genitourinary toxicities were Grade 2 in 7.3 % of patients and Grade 3 in 9.6 % . The highest late gastrointestinal toxicities were Grade 2 in 2.8 % of patients and Grade 3 in 0 % . Although the 5-year outcome of this tri-modality approach seems favorable , further follow-up is necessary to vali date clinical and survival advantages of this intensive approach compared with the st and ard EBRT approach 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 PURPOSE We compared acute and late genitourinary ( GU ) and gastrointestinal ( GI ) toxicities in prostate cancer patients treated with three different high-dose radiation techniques .  METHODS AND MATERIAL S A total of 1,903 patients with localized prostate cancer were treated with definitive RT at William Beaumont Hospital from 1992 to 2006 : 22 % with brachytherapy alone ( BT ) , 55 % with image-guided external beam ( EB-IGRT ) , and 23 % external beam with high-dose-rate brachytherapy boost ( EBRT+HDR ) . Median dose with BT was 120 Gy for LDR and 38 Gy for HDR ( 9.5 Gy × 4 ) . Median dose with EB-IGRT was 75.6 Gy ( PTV ) to prostate with or without seminal vesicles . For EBRT+HDR , the pelvis was treated to 46 Gy with an additional 19 Gy ( 9.5 Gy × 2 ) delivered via HDR . GI and GU toxicity was evaluated utilizing the NCI-CTC criteria ( v.3.0 ) . Median follow-up was 4.8 years . RESULTS The incidences of any acute ≥ Grade 2 GI or GU toxicities were 35 % , 49 % , and 55 % for BT , EB-IGRT , and EBRT+HDR ( p < 0.001 ) . Any late GU toxicities ≥ Grade 2 were present in 22 % , 21 % , and 28 % for BT , EB-IGRT , and EBRT+HDR ( p = 0.01 ) , respectively . Patients receiving EBRT+HDR had a higher incidence of urethral stricture and retention , whereas dysuria was most common in patients receiving BT . Any Grade ≥ 2 late GI toxicities were 2 % , 20 % , and 9 % for BT , EB-IGRT , and EBRT+HDR ( p < 0.001 ) . Differences were most pronounced for rectal bleeding , with 3-year rates of 0.9 % , 20 % , and 6 % ( p < 0.001 ) for BT , EB-IGRT , and EBRT+HDR respectively . CONCLUSIONS Each of the three modern high-dose radiation techniques for localized prostate cancer offers a different toxicity profile . These data can help patients and physicians to make informed decisions regarding radiotherapy for prostate and enocarcinoma PURPOSE To report the genitourinary ( GU ) and gastrointestinal ( GI ) morbidity and erectile dysfunction in a r and omized trial comparing 2 methods of dose escalation for high- and intermediate-risk prostate cancer . METHODS AND MATERIAL S ASCENDE-RT ( And rogen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy ) enrolled 398 men , median age 68 years , who were then r and omized to either a st and ard arm that included 12 months of and rogen deprivation therapy and pelvic irradiation to 46 Gy followed by a dose-escalated external beam radiation therapy ( DE-EBRT ) boost to 78 Gy , or an experimental arm that substituted a low-dose-rate prostate brachytherapy ( LDR-PB ) boost . At clinic visits , investigators recorded GU and GI morbidity and information on urinary continence , catheter use , and erectile function . Exclusion of 15 who received non protocol treatment and correction of 14 crossover events left 195 men who actually received a DE-EBRT boost and 188 , an LDR-PB boost .  Median follow-up was 6.5 years . RESULTS The LDR-PB boost increased the risk of needing temporary catheterization and /or requiring incontinence pads . At 5 years the cumulative incidence of grade 3 GU events was 18.4 % for LDR-PB , versus 5.2 % for DE-EBRT ( P<.001 ) . Compared with the cumulative incidence , the 5-year prevalence of grade 3 GU morbidity was substantially lower for both arms ( 8.6 % vs 2.2 % , P=.058 ) . The 5-year cumulative incidence of grade 3 GI events was 8.1 % for LDR-PB , versus 3.2 % for DE-EBRT ( P=.124 ) . The 5-year prevalence of grade 3 GI toxicity was lower than the cumulative incidence for both arms ( 1.0 % vs 2.2 % , respectively ) . Among men reporting adequate baseline erections , 45 % of LDR-PB patients reported similar erectile function at 5 years , versus 37 % after DE-EBRT ( P=.30 ) . CONCLUSIONS The incidence of acute and late GU morbidity was higher after LDR-PB boost , and there was a nonsignificant trend for worse GI morbidity . No differences in the frequency of erectile dysfunction were observed 
    Output:
    
Receiving both EBRT and BT increased the risk of stricture formation .