***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: OBJECTIVE Patients with completely resected stages I-IV high grade uterine leiomyosarcoma are at high risk for recurrence . No adjuvant treatment has been shown to improve survival , although prospect i ve data are limited . We sought to determine whether adjuvant gemcitabine-docetaxel would yield a 2-year progression-free survival of at least 50 % in this leiomyosarcoma population . METHODS Eligible patients were treated with gemcitabine 900 mg/m(2 ) over 90 min days 1 and 8 plus docetaxel 75 mg/m(2 ) day 8 , every 3 weeks for 4 cycles . CT imaging  was performed at baseline , after cycle 4 , and every 3 months . Progression was defined as evidence of new disease on CT . RESULTS Twenty-five patients ( median age 49 ; range , 37 - 73 ) enrolled ; 23 were evaluable ( 1-never treated , 1-ineligible ) . With median follow-up of 49 months for all patients , 10 ( 45 % ) of the 23 evaluable patients remained progression free at 2 years , with a median progression-free survival of 13 months . The median overall survival is not yet reached . Among the 18 patients with stages I or II uterine leiomyosarcoma , 59 % remain progression-free at 2 years , with a median progression-free survival of 39 months . Median overall survival for stages I and II patients is not yet reached with median follow-up duration of 49 months . Sites of first recurrence were : lung only - 3/23 ( 13 % ) ; pelvis only - 5/23 ( 22 % ) ; both - 5 ( 22 % ) . CONCLUSIONS Post-resection gemcitabine-docetaxel for stages I-IV high- grade uterine leiomyosarcoma yields 2-year progression-free survival rates that appear superior to historical rates . Gemcitabine-docetaxel merits further study as part of an adjuvant strategy for patients with completely resected , early-stage uterine leiomyosarcoma PURPOSE To determine the long-term outcome of uterine fibroid therapy ( UFE ) using tris-acryl gelatin microspheres ( TAGM ) . MATERIAL S This was a multicenter prospect i ve study of patients undergoing UFE with TAGM  , and during this phase of the study , the clinical outcomes 3 years after treatment were assessed . Measures of outcome included the Ruta Menorrhagia Question naire , patient self- assessment s of symptoms and impact on activities , patient satisfaction and health-related quality of life as measured by the SF-12 . Long-term re-intervention rates were also assessed . The data were analyzed at each interval compared to baseline using appropriate statistical tests . RESULTS Of the 102 patients enrolled , 96 patients had complete baseline data and of these , 69 ( 72 % ) had known outcomes at 3 years after treatment . Sixty-one patients ( 64 % ) completed long-term follow-up without major intervention . An additional 8 patients ( 8.3 % ) underwent fibroid surgery ( 7 hysterectomies and 1 myomectomy ) . Among those without intervention , at 3 years after treatment , the mean Ruta Question naire Score was 19.3 , compared to 47.9 at baseline and 24.5 at 3 months ( P < .01 ) . At baseline , 57 % of patients had extremely heavy bleeding , while only 2 % had that complaint at 36 months . At 36 months , much or moderate improvement in pelvic pain occurred in 83 % of patients , pelvic discomfort in 83 % , and urinary problems in 69 % and 84 % were moderately or very satisfied with their outcome . CONCLUSIONS Over the long-term , UFE using TAGM is effective and safe , with high levels of durable symptom control , improved health-related quality of life and patient satisfaction AIM The purpose of this study was to compare the depth of vascular penetration of non-spherical polyvinyl alcohol ( PVA ) versus trisacryl gelatin microspheres ( MS ) in women undergoing uterine artery embolization ( UAE ) immediately before transabdominal myomectomy . MATERIAL S AND METHODS A total of 17 patients who had been referred for embolization before myomectomy underwent bilateral uterine artery embolization using either 355 - 500 microm PVA ( group A ) or 700 - 900 microm MS ( group B ) . The depth of penetration of the particles was assessed by identifying their presence and location in the resected specimen . RESULTS Of the 17 women enrolled in this study , 10 were in group A and 6 in group B. One woman underwent embolization using both types of particle and was excluded from the analysis . Embolic particles were significantly ( p = 0.048 ) more frequently located within the fibroid ( 4/6 , 67 % ) in Group B than Group A ( 1/10 , 10 % ) . Particles were also identified in the perifibroid tissues in 4/6 ( 67 % ) in Group B and 4/10 ( 40 % ) in Group A , with no statistical difference . There were no procedural complications . CONCLUSION MS particles ( 700 - 900 microm ) penetrate significantly deeper into leiomyomata compared with non-spherical PVA ( 355 - 500 microm ) . MS may therefore confer advantages in UAE , as they may more specifically target the fibroid , allowing an earlier end-point to embolization and minimizing ischaemic damage to normal myometrium and ovaries OBJECTIVE Uterine leiomyoma , or fibroid tumors , are the leading indication for hysterectomy in the United States , but the proportion of women in whom fibroid tumors develop is not known . This study screened for fibroid tumors , independently of clinical symptoms , to estimate the age-specific proportion of black and white women in whom fibroid tumors develop . STUDY DESIGN R and omly selected members of an urban health plan who were 35 to 49 years old participated ( n = 1364 women ) .  Medical records and self-report were used to assess fibroid status for those women who were no longer menstruating ( most of whom had had hysterectomies ) . Premenopausal women were screened by ultrasonography . We estimated the age-specific cumulative incidence of fibroid tumors for black and white women . RESULTS Thirty-five percent of premenopausal women had a previous diagnosis of fibroid tumors . Fifty-one percent of the premenopausal women who had no previous diagnosis had ultrasound evidence of fibroid tumors . The estimated cumulative incidence of tumors by age 50 was > 80 % for black women and nearly 70 % for white women . The difference between the age-specific cumulative incidence curves for black and white women was highly significant ( odds ratio , 2.9 ; 95 % CI , 2.5 - 3.4 ; P < .001 ) . CONCLUSION The results of this study suggest that most black and white women in the United States develop uterine fibroid tumors before menopause and that uterine fibroid tumors develop in black women at earlier ages than in white women PURPOSE To compare tris-acryl microspheres and polyvinyl alcohol ( PVA ) microspheres as embolic agents in uterine artery embolization ( UAE ) for uterine leiomyomas in terms of clinical outcome , inflammatory response , and adverse reactions . MATERIAL S AND METHODS A double-blinded r and omized controlled trial was performed , with 27 patients in the tris-acryl microsphere group and 29 in the PVA microsphere group .  The primary endpoint was clinical success , defined as a 2-year freedom from subsequent surgery as a result of persistent or deteriorated symptoms . Secondary endpoints included ( i ) posttreatment leiomyoma enlargement , ( ii ) leiomyoma volume reduction at 3 and 9 months , ( iii ) significant residual intratumoral perfusion , ( iv ) increase in inflammatory and stress markers , ( v ) incidence of complications , and ( vi ) duration of hospital stay . RESULTS There was no statistically significant difference between the two groups in patient demographics , clinical presentation , initial tumor findings , change in inflammatory and stress markers after treatment , incidence of complications , and duration of hospital stay .  Tris-acryl microspheres were associated with a higher rate of clinical success than PVA microspheres ( 96.3 % [ 26 of 27 ] vs 69 % [ 20 of 29 ] ; P = .012 ) , a lower incidence of posttreatment leiomyoma enlargement ( P = .030 ) , and a lower incidence of significant residual intratumoral perfusion ( P = .030 ) . CONCLUSIONS In the treatment of uterine leiomyomas , UAE with tris-acryl microspheres was associated with a higher clinical success rate , a lower incidence of tumor enlargement , and no significant differences in adverse reactions and inflammatory response compared with the use of PVA microspheres . Tris-acryl microspheres therefore represent the preferred agent for UAE of uterine leiomyomas Objective To evaluate the efficacy of acrylamido polyvinyl alcohol microspheres ( a-PVAM ) as an embolic agent for uterine artery embolization ( UAE ) compared with Tris-acryl gelatin microspheres ( TAGM ) . Design , Setting , Participants Prospect i ve r and omized double-blind noninferiority trial . Conducted at two sites both with regional UAE practice s. Forty-six women with symptomatic leiomyomas . InterventionUAE procedure was performed with either of the two embolic agents . Either 700–900-μm a-PVAM or 500–700-μm TAGM was used . Main Outcome Measures Changes in leiomyoma perfusion , overall uterine volume , and dominant leiomyomas volume measured by contrast-enhanced magnetic resonance imaging at 1 week , 3 months , and 6 months after UAE by a reader blinded to the embolic agent used . Changes in Uterine Fibroid Symptoms and Quality of Life question naire scores were measured at 3 , 6 , and 12 months after UAE . Results Forty-six patients were r and omized and treated under the study protocol ( a-PVAM n = 22 , TAGM n = 24 ) . There were no procedure-related complications . Two patients were excluded from analysis ( one technical failure of the procedure , one withdrawal from study ) . Successful ( > 90 % ) leiomyoma devascularization was observed in 81 % of subjects at 1 week after UAE , 97 % at 3 months after UAE , and 95 % at 6 months after UAE . No significant differences were observed in 14 of 15 outcome measurements , consistent with noninferiority . TAGM was slightly superior to a-PVAM on one comparison ( overall quality of life at 3 months after UAE ) Purpose This study was design ed to compare quality of life ( QoL ) outcomes after uterine artery embolization ( UAE ) or myomectomy . Methods Women with symptomatic fibroids diagnosed by ultrasound who wished to preserve their uterus were r and omized to myomectomy ( n = 81 ) or UAE ( n = 82 ) . Endpoints at 1 year were QoL measured by a vali date d question naire , hospital stay , rates of complications , and need for reintervention . Results UAE patients had shorter hospitalization ( 2 vs. 6 days , p < 0.001 ) . By 1 year postintervention , significant and equal improvements in QoL scores had occurred in both groups ( myomectomy n = 59 ; UAE n = 61 ) . There had been two ( 2.9 % ) major complications among UAE versus 6 ( 8 % ) among myomectomy patients ( not significant ) . By 2 years , among UAE patients ( n = 57 ) there were eight ( 14.0 % ) re interventions for inadequate symptom control compared with one ( 2.7 % ) among myomectomy patients ( n = 37 ) . Half of the women who required hysterectomy had concomitant adenomyosis missed by US . Conclusions UAE and myomectomy both result in significant and equal improvements in QoL.  UAE allows a shorter hospital stay and fewer major complications but with a higher rate of reintervention Purpose To report 5-year contrast-enhanced magnetic resonance imaging findings of the REST trial recruits who underwent either uterine artery embolization ( UAE ) or myomectomy .  Methods A total of 157 patients were r and omized to UAE or surgery ( hysterectomy or myomectomy ) . Ninety-nine patients who had UAE and eight patients who had myomectomy were analyzed . MRI scans at baseline , 6 months , and 5 years were independently interpreted by two radiologists . Dominant fibroid diameter , uterine volume , total fibroid infa rct ion ( complete 100 % , almost complete 90–99 % , partial < 90 % ) , and new fibroid formation were the main parameters assessed and related to the need for reintervention . Results In the UAE group , mean ± st and ard deviation uterine volume was 670 ± 503 , 422 ± 353 , and 292 ± 287 mL at baseline , 6 months , and 5 years , respectively . Mean dominant fibroid diameter was 7.6 ± 3.0 , 5.8 ± 2.9 , and 5 ± 2.9 cm at baseline , 6 months , and 
    Output:
    
Compared to polyvinyl alcohol , tris-acryl gelatin microsphere showed a significant benefit in improving the overall quality of life and in reducing uterine volume at three and six months , in reducing overall symptom severity at 6 and 12 months , and furthermore in reducing treatment failure .
In addition , tris-acryl gelatin microsphere could significantly reduce leiomyoma volume and decrease < 90 % complete leiomyoma infa rct ion rate at three months .
There were no differences in pain severity , other post-procedural symptoms or medication use in the two groups .
Conclusions : A better effect of tris-acryl gelatin microsphere in leiomyoma embolization for patients with symptomatic leiomyoma