***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 To assess in a prospect i ve trial the feasibility and late toxicity of hypofractionated radiotherapy ( RT ) for prostate cancer . METHODS AND MATERIAL S Eligible patients had clinical stage T1c-2cNXM0 disease . They received 60 Gy in 20 fractions over 4 weeks with intensity-modulated radiotherapy including daily on-line image guidance with intraprostatic fiducial markers . RESULTS Between June 2001 and March 2004 , 92 patients were treated with hypofractionated RT .  The cohort had a median prostate-specific antigen value of 7.06 ng/mL. The majority had Gleason grade 5 - 6 ( 38 % ) or 7 ( 59 % ) disease , and 82 patients had T1c-T2a clinical staging . Overall , 29 patients had low-risk , 56 intermediate-risk , and 7 high-risk disease . Severe acute toxicity ( Grade 3 - 4 ) was rare , occurring in only 1 patient . Median follow-up was 38 months . According to the Phoenix definition for biochemical failure , the rate of biochemical control at 14 months was 97 % . According to the previous American Society for Therapeutic Radiology and Oncology definition , biochemical control at 3 years was 76 % . The incidence of late toxicity was low , with no severe ( Grade > or =3 ) toxicity at the most recent assessment . CONCLUSIONS Hypofractionated RT using 60 Gy in 20 fractions over 4 weeks with image guidance is feasible and is associated with low rates of late bladder and rectal toxicity . At early follow-up , biochemical outcome is comparable to that reported for conventionally fractionated controls . The findings are being tested in an ongoing , multicenter , Phase III trial PURPOSE To perform a r and omized trial comparing 70 and 80 Gy radiotherapy for prostate cancer . PATIENTS AND METHODS A total of 306 patients with localized prostate cancer were r and omized . No and rogen deprivation was allowed . The primary endpoint was biochemical relapse according to the modified 1997-American Society for Therapeutic Radiology and Oncology and Phoenix definitions . Toxicity was grade d using the Radiation Therapy Oncology Group 1991 criteria and the late effects on normal tissues-subjective , objective , management , analytic scales ( LENT-SOMA ) scales . The patients ' quality of life was scored using the European Organization for Research and Treatment of Cancer Quality of Life Question  naire 30-item cancer-specific and 25-item prostate-specific modules . RESULTS The median follow-up was 61 months . According to the 1997-American Society for Therapeutic Radiology and Oncology definition , the 5-year biochemical relapse rate was 39 % and 28 % in the 70- and 80-Gy arms , respectively ( p = .036 ) . Using the Phoenix definition , the 5-year biochemical relapse rate was 32 % and 23.5 % , respectively ( p = .09 ) . The subgroup analysis showed a better biochemical outcome for the higher dose group with an initial prostate-specific antigen level > 15 ng/mL. At the last follow-up date , 26 patients had died , 10 of their disease and none of toxicity , with no differences between the two arms . According to the Radiation Therapy Oncology Group scale , the Grade 2 or greater rectal toxicity rate was 14 % and 19.5 % for the 70- and 80-Gy arms ( p = .22 ) , respectively . The Grade 2 or greater urinary toxicity was 10 % at 70 Gy and 17.5 % at 80 Gy ( p = .046 ) . Similar results were observed using the LENT-SOMA scale . Bladder toxicity was more frequent at 80 Gy than at 70 Gy ( p = .039 ) . The quality -of-life question naire results before and 5 years after treatment were available for 103 patients with no differences found between the 70- and 80-Gy arms . CONCLUSION High-dose radiotherapy provided a better 5-year biochemical outcome with slightly greater toxicity BACKGROUND / AIM Based on a radiobiological assumption of a low alpha/beta ( α/β ) ratio for prostate cancer , hypofractionated radiotherapy has increasingly gained traction in the clinical practice and recent guidelines have confirmed the non-inferiority of this approach . Nevertheless , the largest studies that have used hypofractionation so far , employed image-guided radiation therapy/intensity modulated radiation therapy ( IGRT/IMRT ) facilities that might have overcome the radiobiological advantages , which remain to be fully confirmed . The aim of this trial was to evaluate the feasibility of a hypofractionated schedule delivered with 3D-Conformal Radiotherapy to prostate and seminal vesicles in combination with hormonal therapy . PATIENTS AND METHODS The study included 97 consecutive patients with localized prostate cancer ( PCa ) , irrespective of risk class , treated with a schedule of 62 Gy in 20 fractions over 5 weeks ( 4 fractions of 3.1 Gy each per week ) . According to National Comprehensive Cancer Network ( NCCN ) prognostic classification , patients were divided into a favourable group ( 19 % ) , intermediate group ( 41 % ) and unfavourable group ( 40 % ) . Early and late toxicities were scored using the radiation toxicity grading/European Organisation for Research and Treatment of Cancer ( RTOG/EORTC ) criteria . Additionally , the international prostate symptom index ( IPSS ) for benign prostate hypertrophy was used to evaluate obstructive urinary symptoms . Biochemical outcome was reported according to the Phoenix definition for biochemical failure  . Hormonal therapy ( HT ) was administrated in 92 % of patients . RESULTS After a median follow-up of 39 months ( range=25 - 52 ) , maximum ≥G2 late genitourinary ( GU ) and gastrointestinal ( GI ) toxicities occurred in 8 % and 11 % patients , respectively . The corresponding figures for acute toxicities were 24 % and 15 % . Patients with higher IPSS score before enrolment had significantly worse urinary function after treatment . Only 2 % of patients died from PCa . Biochemical non- evidence of disease ( bNED ) was 83 % for all patients . CONCLUSION Our study confirms that 3D conformal radiotherapy ( 3DCRT ) remains a safe and effective method to deliver a dose-escalated hypofractionated regimen for PCa patients in all risk classes with acceptable toxicity rates and optimal biochemical control Background Quality of life ( QoL ) is one of the most significant issues in prostate cancer treatment decisions . This study aim ed to investigate the toxicity of hypofractionated stereotactic radiotherapy ( SBRT ) and QoL after treatment in localized prostate cancer patients . Material s and methods A prospect i ve single-center clinical study was performed in low- and intermediate-risk prostate cancer patients . Patients received 33.5 Gy in 5 fractions ( SHARP regimen ) .  Acute and late toxicity was assessed according to RTOG/EORTC score . Patients filled out EORTC QLQ-C30 and prostate cancer-specific QLQ-PR25 question naires . Results The analysis included 68 prostate cancer patients ( 55–83 years , median 73 ) with clinical stage T1c-T2cN0M0 , median combined Gleason score of 6 ( 3–8 ) , and median prostate-specific antigen ( PSA ) level of 10 ng/mL ( 4–20 ng/mL ) .  Neoadjuvant and rogen deprivation therapy was given to 52 patients ( 76.5 % ) , and stopped in 31 patients ( 45.5 % ) after 6 months ; in 21 patients ( 31 % ) after 2–3 years . Average and median follow-up was 24 months ( 18–45 ) . Median nadir PSA level was 0.03 ng/mL for all patients and 0.6 ng/mL for patients without hormone treatment . No patients had PSA failure . There were no acute grade IV toxicities . One patient ( 1.5 % ) developed grade III and 24 patients ( 35.3 % ) grade II acute bladder toxicity . No one developed grade III and 7 patients ( 10.3 % ) grade II acute rectal toxicity . No grade III or IV late gastrointestinal or genitourinary toxicities were reported . Grade II late urinary symptoms were observed in 8 patients ( 11.8 % ) and gastrointestinal symptoms in 3 patients ( 4.4 % ) . Global health status/QoL was good and improved during the observational period . ConclusionS BRT for prostate cancer patients is a well-tolerated treatment in terms of toxicity and QoL , has no negative impact on functioning and everyday life , with the important benefit of a short treatment period . However , long-term follow-up data are needed . ZusammenfassungHintergrundDie Lebensqualität ( QoL ) ist zu einem der wichtigsten Schwerpunkte bei der Wahl der Prostatakarzinombeh and lung geworden . Das Thema dieser Studie war die Untersuchung der Toxizität der hypofraktionierten stereotaktischen Radiotherapie ( SBRT ) und der QoL nach Beh and lung des lokal begrenzten Prostatakarzinoms . Material ien und Method enDie prospektive , monozentrische , klinische Studie wurde bei Prostatakarzinompatienten mit niedrigem bis mittlerem Risiko durchgeführt . Die Patienten erhielten  33,5 Gy in 5 Fraktionen  ( SHARP-Beh and lungsschema ) . Akute und späte Toxizität wurden nach den Kriterien des RTOG/EORTC-Scores klassifiziert . Die Patienten füllten das EORTC-QLQ-C30- und das prostatakarzinomspezifische QLQ-PR25-Formular aus . ErgebnisseDie Analyse umfasste 68 Prostatakarzinompatienten ( medianes Alter 73 , Spanne 55–83 Jahre ) i m klinischen Staging T1c – T2cN0M0 , mit einem medianen Gleason-Score von 6 ( Spanne 3–8 ) und einem medianen PSA-Wert ( prostataspezifisches Antigen ) von 10 ng/ml ( Spanne 4–20 ng/ml ) . Eine neoadjuvante And rogendeprivationstherapie erhielten 52 Patienten ( 76,5 % ) ; die Hormontherapie beendet 31 Patienten ( 45,5 % ) nach 6 Monaten und 21 Patienten ( 31 % ) nach 2–3 Jahren . Das durchschnittliche und mediane Follow-up dauerte 24 Monate ( Spanne 18–45 ) . Der mediane PSA-Nadir betrug 0,03 ng/ml für alle Patienten und 0,6 ng/ml für Patienten ohne Hormontherapie . PSA-Versagen und akute Grad-IV-Toxizitäten traten nicht auf . Ein Patient ( 1,5 % ) hatte eine Grad-III- und 24 Patienten ( 35,3 % ) eine Grad-II-Harnblasentoxizität , kein Patient eine Grad-III- und 7 Patienten ( 10,3 % ) eine akute Grad-II-Rektumtoxizität . Späte gastrointestinale oder urogenitale Toxizitäten III . oder IV . Grade s wurden nicht berichtet . Bei 8 Patienten ( 11,8 % ) traten späte Miktionsbeschwerden II . Grade s und bei 3 Patienten ( 4,4 % ) gastrointestinale Symptome auf . Globaler Gesundheitsstatus/QoL war gut und besserte sich in der untersuchten Zeit . SchlussfolgerungSBRT ist beim Prostatakarzinom eine gut tolerierte Beh and lung hinsichtlich Toxizität und QoL , ohne negativen Einfluss auf das Alltagsleben und dem wichtigen Vorteil einer kurzen Beh and lungszeit . Langfristige Follow-up-Untersuchungen müssen noch folgen Summary Background Prostate cancer might have high radiation-fraction sensitivity that would give a therapeutic advantage to hypofractionated treatment . We present a pre-planned analysis of the efficacy and side-effects of a r and omised trial comparing conventional and hypofractionated radiotherapy after 5 years follow-up . Methods CHHiP is a r and omised , phase 3 , non-inferiority trial that recruited men with localised prostate cancer ( pT1b – T3aN0M0 ) . Patients were r and omly assigned ( 1:1:1 ) to conventional ( 74 Gy delivered in 37 fractions over 7·4 weeks ) or one of two hypofractionated schedules ( 60 Gy in 20 fractions over 4 weeks or 57 Gy in 19 fractions over 3·8 weeks ) all delivered with intensity-modulated techniques . Most patients were given radiotherapy with 3–6 months of neoadjuvant and concurrent and rogen suppression . R and omisation was by computer-generated r and om permuted blocks , stratified by National Comprehensive Cancer Network ( NCCN ) risk group and radiotherapy treatment centre , and treatment allocation was not masked . The primary endpoint was time to biochemical or clinical failure ; the critical hazard ratio ( HR ) for non-inferiority was 1·208 . Analysis was by intention to treat . Long-term follow-up continues . The CHHiP trial is registered as an International St and ard R and om 
    Output:
    
RESULTS The initial search yielded 575 results , but only 32 manuscripts met all eligibility requirements : in terms of radiation-induced side effects , such as gastrointestinal and genitourinary acute and late toxicity , hypofractionated 3DCRT seemed to be more advantageous than 3DCRT with conventional fractionation as well as IMRT with conventional fractionation compared to 3DCRT with conventional fractionation ; furthermore , IMRT hypofractionated technique appeared more advantageous than IMRT with conventional fractionation in late toxicities .
R and omized trials meta- analysis disclosed an advantage in terms of acute gastrointestinal and late genitourinary toxicity for Hypofractionated schemes .