***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: Between January 1986 and December 1992 , sixty-nine patients with squamous esophageal cancer were r and omized to one or the other of two treatment groups . Group 1 ( 35 patients ) were scheduled to receive chemotherapy ( cisplatinum and 5-fluorouracil ) and radiation , followed by resection , while group 2 ( 34 patients ) received resection alone . Of the 35 patients entering combined treatment , 26 completed the protocol and 9 received only chemoradiation . A complete response to preoperative therapy was shown by 7 patients , and a partial response by the other 7 patients . Survival rates at one year and five years were slightly better among patients receiving combined treatment than among those undergoing surgery alone , but overall survival did not differ statistically between the two groups . Nor were operative mortality and complications statistical different between the two groups Surgery is the st and ard treatment for patients with resectable esophageal carcinoma , but the long term prognosis of these patients is unsatisfactory . Some r and omized trials of preoperative chemotherapy suggest that the prognosis of patients who respond may be improved PURPOSE A prospect i ve study of preoperative tumor-node-metastasis staging of patients with esophageal cancer ( EC ) was design ed to compare the accuracy of 18-F-fluoro-deoxy-D-glucose ( FDG ) positron emission tomography ( PET ) with conventional noninvasive modalities . PATIENTS AND METHODS Seventy-four patients with carcinomas of the esophagus ( n = 43 ) or gastroesophageal junction ( n = 31 ) were studied . All patients underwent attenuation-corrected FDG-PET imaging , a spiral computed tomography ( CT ) scan , and an endoscopic ultrasound ( EUS ) . RESULTS FDG-PET demonstrated increased activity in the primary tumor in 70 of 74 patients ( sensitivity : 95 % ) . False-negative PET images were found in four patients with T1 lesions . Thirty-four patients ( 46 % ) had stage IV disease . FDG-PET had a higher accuracy for diagnosing stage IV disease compared with the combination of CT and EUS ( 82 % v 64 % , respectively ; P : = .004 ) . FDG-PET had additional diagnostic value in 16 ( 22 % ) of 74 patients by upstaging 11 ( 15 % ) and downstaging five ( 7 % ) patients . Thirty-nine ( 53 % ) of the 74 patients underwent a 2- or 3-field lymphadenectomy in conjunction with primary curative esophagectomy . In these patients , tumoral involvement was found in 21 local and 35 regional or distant lymph nodes ( LN ) . For local LN , the sensitivity of FDG-PET was lower than EUS ( 33 % v 81 % , respectively ; P : = .027 ) , but the specificity may have been higher ( 89 % v 67 % , respectively ; P : = not significant [ NS ] ) . For the assessment of regional and distant LN involvement , compared with the combined use of CT and EUS , FDG-PET had a higher specificity ( 90 % v 98 % , respectively ; P : = . 025 ) and a similar sensitivity ( 46 % v 43 % , respectively ; P : = NS ) . CONCLUSION PET significantly improves the detection of stage IV disease in EC compared with the conventional staging modalities . PET improves diagnostic specificity for LN staging PURPOSE To compare the local/regional control , survival , and toxicity of combined-modality therapy using high-dose ( 64.8 Gy ) versus st and ard-dose ( 50.4 Gy ) radiation therapy for the treatment of patients with esophageal cancer . PATIENTS AND METHODS A total of 236 patients with clinical stage T1 to T4 , N0/1 , M0 squamous cell carcinoma or adenocarcinoma selected for a nonsurgical approach , after stratification by weight loss , primary tumor size , and histology , were r and omized to receive combined-modality therapy consisting of four monthly cycles of fluorouracil ( 5-FU ) ( 1,000 mg/m(2)/24 hours for 4 days ) and cisplatin ( 75 mg/m(2 ) bolus day 1 ) with concurrent 64.8 Gy versus the same chemotherapy schedule but with concurrent 50.4 Gy . The trial was stopped after an interim analysis . The median follow-up was 16.4 months for all patients and 29.5 months for patients still alive . RESULTS For the 218 eligible patients , there was no significant difference in median survival ( 13.0 v 18.1 months ) , 2-year survival ( 31 % v 40 % ) , or local/regional failure and local/regional persistence of disease ( 56 % v 52 % ) between the high-dose and st and ard-dose arms . Although 11 treatment-related deaths occurred in the high-dose arm compared with two in the st and ard-dose arm , seven of the 11 deaths occurred in patients who had received 50.4 Gy or less . CONCLUSION The higher radiation dose did not increase survival or local/regional control . Although there was a higher treatment-related mortality rate in the patients assigned to the high-dose radiation arm , it did not seem to be related to the higher radiation dose . The st and ard radiation dose for patients treated with concurrent 5-FU and cisplatin chemotherapy is 50.4 Gy AIMS This prospect i ve study was design ed to determine the utility of 18F-labelled deoxyglucose ( FDG ) in positron emission tomography ( PET ) ( FDG-PET ) for assessing the response to neoadjuvant chemoradiation therapy ( CRT ) in locally advanced oesophageal tumours . PATIENTS AND METHODS Thirty-six patients with locally advanced oesophageal cancer ( clinical T4 stage ) without organ metastases , underwent FDG-PET before and 1 month after CRT . Patients were classified as major responders by serial FDG-PET when the post-CRT PET demonstrated a strong reduction of FDG uptake at the primary tumour site ( > 80 % reduction of tumour-to-liver uptake ratio ) without any abnormal FDG uptake elsewhere in the body . PET response was compared with histology obtained during post-induction transthoracic oesophagectomy . RESULTS A strong correlation was found between the extent of lymph node ( LN ) involvement as shown by the pre-CRT PET and the major response rate ( P = 0.001 ) : such response occurred in nine of 11 N0M0 patients ( 82 % ) , in three of nine N(1 - 2)M0 patients ( 33 % ) and in two of 16 patients ( 13 % ) with distant lymphatic spread . Such a correlation was not found for computed tomography or endoscopic ultrasonography . The sensitivity of serial FDG-PET for a major CRT response was 10 of 14 ( 71 % ) , its specificity 18 of 22 ( 82 % ) . The concordance between the response assessment by PET and histopathology was 78 % . The median survival time after CRT of PET major responders compared with PET non-major responders was 16.3 months and 6.4 months , respectively . The metabolic response as measured by serial FDG-PET is a stronger prognostic factor for overall survival ( P = 0.002 ) than the extent of LN involvement seen on the pretreatment FDG-PET ( P = 0.087 ) . CONCLUSIONS These data indicate that CRT response as assessed by serial FDG-PET is strongly correlated with pathological response and survival Background . Despite well‐established surgical approaches , the prognosis for patients with squamous cell carcinoma of the esophagus remains dismal . To assess the benefit of adjuvant chemotherapy and radiation therapy ( CRT ) , a r and omized trial with and without sequential preoperative CRT was undertaken ; CRT combined 20 Gy and two courses of 5‐FU and cisplatin PURPOSE In 1990 we published the results of an intensive 3-week preoperative chemoradiation regimen for locoregional esophageal cancer that suggested improved survival compared with historical controls . We now report the long-term results at a median follow-up of 78.7 months . PATIENTS AND METHODS Forty-three patients with locoregional squamous cell carcinoma or adenocarcinoma of the esophagus or cardia were treated with fluorouracil ( 5-FU ) , cisplatin , and bolus vinblastine concurrent with radiation administered over 21 days . Transhiatal esophagectomy was performed on day 42 . RESULTS Forty-one patients ( 95 % ) completed the preoperative treatment , and 36 ( 84 % ) had a potentially curative resection . Ten of 41 ( 24 % ) had no tumor in the resected esophagus and nodal tissues ( path-negative group ) . The median survival duration of all 43 patients registered on study was 29 months ; 34 % were alive at 5 years . By histology , median survival duration s were 32 months for 21 adenocarcinoma patients and 23 months for 22 squamous cell patients , with corresponding 5-year survival rates of 34 % and 31 % , respectively . Analysis of the 36 patients who underwent a potentially curative resection demonstrated median survival duration s of 32 and 44 months and 5-year survival rates of 36 % and 43 % , respectively , for adenocarcinoma and squamous cell histologies . Path-negative ( complete response [ CR ] ) patients had a median survival duration of 70 months and 60 % were alive at 5 years , while those patients with residual tumor in the resected esophagus had a median survival duration of 26 months and 32 % were alive at 5 years ( P = .114 by the log-rank test and P = .04 by the Wilcoxon test ) . CONCLUSION The results of this regimen appear improved over those reported with surgery alone , with an approximate doubling of the 5-year survival rate . Thirty-two percent of patients with residual tumor in the esophageal specimen are long-term survivors , which suggests a benefit from esophagectomy . A r and omized trial is in progress to compare this preoperative regimen with immediate surgery BACKGROUND The efficacy of conventional treatment with surgery and radiation for cancer of the esophagus is limited . The median survival is less than 10 months , and less than 10 percent of patients survive for 5 years . Recent studies have suggested that combined chemotherapy and radiation therapy may result in improved survival . METHODS This phase III prospect i ve , r and omized , and stratified trial was undertaken to evaluate the efficacy of four courses of combined fluorouracil ( 1000 mg per square meter of body-surface area daily for four days ) and cisplatin ( 75 mg per square meter on the first day ) plus 5000 cGy of radiation therapy , as compared with 6400 cGy of radiation therapy alone , in patients with squamous-cell carcinoma or adenocarcinoma of the thoracic esophagus . The trial was stopped after the accumulated results in 121 patients demonstrated a significant advantage for survival in the patients who received chemotherapy and radiation therapy .  RESULTS The median survival was 8.9 months in the radiation-treated patients , as compared with 12.5 months in the patients treated with chemotherapy and radiation therapy . In the former group , the survival rates at 12 and 24 months were 33 percent and 10 percent , respectively , whereas they were 50 percent and 38 percent in the patients receiving combined therapy ( P less than 0.001 ) . Seven patients in the radiotherapy group and 25 in the combined-therapy group were alive at the time of the analysis . The patients who received combined treatment had fewer local ( P less than 0.02 ) and fewer distant ( P less than 0.01 ) recurrences . Severe and life-threatening side effects occurred in 44 percent and 20 percent , respectively , of the patients who received combined therapy , as compared with 25 percent and 3 percent of those treated with radiation alone . CONCLUSIONS Concurrent therapy with cisplatin and fluorouracil and radiation is superior to radiation therapy alone in patients with localized carcinoma of the esophagus , as measured by control of local tumors , distant metastases , and survival , but at the cost of increased side effects BACKGROUND We conducted a multicenter , r and omized trial to compare preoperative chemoradiotherapy followed by surgery with surgery alone in patients with stage I and II squamous-cell cancer of the esophagus . METHODS The preoperative combined therapy consisted of two one-week courses ; each involved radiotherapy , in a dose of 18.5 Gy delivered in five fractions of 3.7 Gy each , and 80 mg of cisplatin per square meter of body-surface area , administered 0 to 2 days before the first day of radiotherapy . The surgical plan included one-stage en bloc esophagectomy and proximal gastrectomy by the abdominal and right thoracic routes , to be performed immediately after r and omization in the group assigned to surgery alone and two to four weeks after the completion of preoperative chemoradiotherapy in the group assigned to combined therapy . RESULTS A total of 297 patients entered the study ; 11 were found to be ineligible , 
    Output:
    
Pretreatment and posttreatment F-FDG-PET can be useful for predicting significant response to chemoradiation in esophageal cancer .