***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: Although lymphedema of the arm is a well-known complication of breast and axillary surgery , breast lymphedema has received scant attention . We sought to prospect ively characterize breast lymphedema ’s incidence , associated symptoms , clinical course , and impact on quality of life . Subjects were enrolled prospect ively from a consecutive sample of patients undergoing non-mastectomy breast procedures ( excisional biopsy or wide local excision ± lymph node removal ) and followed for signs and symptoms of lymphedema in the operated breast . Symptoms and distress were serially assessed with 11-point linear analog scales . Breast lymphedema was diagnosed independent of symptoms , based on the distribution and degree of edema and erythema . One hundred twenty-four women were followed for a median of 11 months , and breast lymphedema was diagnosed in 38 ( 31 % ) women . Breast lymphedema was more frequent after breast surgery with axillary node removal ( 49 % ) compared to breast surgery alone ( 0 % ) , p < 0.0001 . Breast lymphedema involved multiple quadrants in most women and was characterized by edema in 100 % and erythema in 79 % . Patients with breast lymphedema were significantly more likely than women without breast lymphedema to report symptoms of breast heaviness ( 65 % vs 22 % , p < 0.0001 ) , redness ( 62 % vs 29 % , p = 0.0006 ) , and swelling ( 59 % vs 22 % , p < 0.0001 ) , but symptom-associated distress was low overall . Three of 32 breast lymphedema patients with clinical follow-up developed chronic edema . Breast lymphedema occurs in approximately one-half of women who undergo breast surgery with axillary node removal . The condition is characterized by diffuse skin edema and erythema as well as self-reported symptoms with a low level of distress The aim of this study was to report 3‐year outcomes of toxicity , cosmesis , and local control using a once daily fractionation scheme ( 49.95 Gy in 3.33 Gy once daily fractions ) for accelerated partial breast irradiation ( APBI ) using three‐dimensional conformal radiotherapy ( 3D‐CRT ) .  Between July 2008 and August 2010 , women aged ≥40 years with ductal carcinoma in situ or node‐negative invasive breast cancer ≤3 cm in diameter , treated with breast‐conserving surgery achieving negative margins , were accrued to a prospect i ve study . Women were treated with APBI using 3–5 photon beams , delivering 49.95 Gy over 15 once daily fractions over 3 weeks . Patients were assessed for toxicities , cosmesis , and local control rates before APBI and at specified time points . Thirty‐four patients ( mean age 60 years ) with Tis 0 ( n = 9 ) and T1N0 ( n = 25 ) breast cancer were treated and followed up for an average of 39 months . Only 3 % ( 1/34 ) patients experienced a grade 3 subcutaneous fibrosis and breast edema and 97 % of the patients had good/excellent cosmetic outcome at 3 years . The 3‐year rate of ipsilateral breast tumor recurrence ( IBTR ) was 0 % while the rate of contralateral breast events was 6 % . The 3‐year disease‐free survival ( DFS ) , overall survival ( OS ) , and breast cancer‐specific survival ( BCSS ) was 94 % , 100 % , and 100 % , respectively . Our novel accelerated partial breast fractionation scheme of 15 once daily fractions of 3.33 Gy ( 49.95 Gy total ) is a remarkably well‐tolerated regimen of 3D‐CRT‐based APBI . A larger cohort of patients is needed to further ascertain the toxicity of this accelerated partial breast regimen BACKGROUND 5-year results of the UK St and ardisation of Breast Radiotherapy ( START ) trials suggested that lower total doses of radiotherapy delivered in fewer , larger doses ( fractions ) are at least as safe and effective as the historical st and ard regimen ( 50 Gy in 25 fractions ) for women after primary surgery for early breast cancer . In this prespecified analysis , we report the 10-year follow-up of the START trials testing 13 fraction and 15 fraction regimens . METHODS From 1999 to 2002 , women with completely excised invasive breast cancer ( pT1 - 3a , pN0 - 1 , M0 ) were enrolled from 35 UK radiotherapy centres . Patients were r and omly assigned to a treatment regimen after primary surgery followed by chemotherapy and endocrine treatment ( where prescribed ) . R and omisation was computer-generated and stratified by centre , type of primary surgery ( breast-conservation surgery or mastectomy ) , and tumour bed boost radiotherapy . In START-A , a regimen of 50 Gy in 25 fractions over 5 weeks was compared with 41·6 Gy or 39 Gy in 13 fractions over 5 weeks . In START-B , a regimen of 50 Gy in 25 fractions over 5 weeks was compared with 40 Gy in 15 fractions over 3 weeks . Eligibility criteria included age older than 18 years and no immediate surgical reconstruction . Primary endpoints were local-regional tumour relapse and late normal tissue effects . Analysis was by intention to treat . Follow-up data are still being collected . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N59368779 . FINDINGS START-A enrolled 2236 women . Median follow-up was 9·3 years ( IQR 8·0 - 10·0 ) , after which 139 local-regional relapses had occurred . 10-year rates of local-regional relapse did not differ significantly between the 41·6 Gy and 50 Gy regimen groups ( 6·3 % , 95 % CI 4·7 - 8·5 vs 7·4 % , 5·5 - 10·0 ; hazard ratio [ HR ] 0·91 , 95 % CI 0·59 - 1·38 ; p=0·65 ) or the 39 Gy ( 8·8 % , 95 % CI 6·7 - 11·4 ) and 50 Gy regimen groups ( HR 1·18 , 95 % CI 0·79 - 1·76 ; p=0·41 ) . In START-A , moderate or marked breast in duration , telangiectasia , and breast oedema were significantly less common normal tissue effects in the 39 Gy group than in the 50 Gy group . Normal tissue effects did not differ significantly between 41·6 Gy and 50 Gy groups . START-B enrolled 2215 women . Median follow-up was 9·9 years ( IQR 7·5 - 10·1 ) , after which 95 local-regional relapses had occurred . The proportion of patients with local-regional relapse at 10 years did not differ significantly between the 40 Gy group ( 4·3 % , 95 % CI 3·2 - 5·9 ) and the 50 Gy group ( 5·5 % , 95 % CI 4·2 - 7·2 ; HR 0·77 , 95 % CI 0·51 - 1·16 ; p=0·21 ) . In START-B , breast shrinkage , telangiectasia , and breast oedema were significantly less common normal tissue effects in the 40 Gy group than in the 50 Gy group . INTERPRETATION Long-term follow-up confirms that appropriately dosed hypofractionated radiotherapy is safe and effective for patients with early breast cancer . The results support the continued use of 40 Gy in 15 fractions , which has already been adopted by most UK centres as the st and ard of care for women requiring adjuvant radiotherapy for invasive early breast cancer . FUNDING Cancer Research UK , UK Medical Research Council , UK Department of Health OBJECTIVE To investigate symptoms and functional impairment in women with secondary lymphoedema of the breast following surgical treatment and to assess the therapeutic benefit of treatment with low-intensity and extremely low-frequency electrostatic fields ( Deep Oscillation ) , supplementing manual lymphatic drainage . METHODS Twenty-one patients were r and omized either to the treatment group ( n=11 ) : 12 sessions of manual lymphatic drainage supplemented by Deep Oscillation , or to the control group ( n=10 ) : manual lymphatic drainage alone . Assessment included subjective pain and swelling evaluation , range of motion of the shoulder and the cervical spine , and analysis of breast volume using a 3D measuring system . RESULTS Patients had high  pain and swelling scores at baseline . Shoulder mobility was impaired in all patients ; restriction of cervical spine mobility was common at baseline and declined further in the control group . Deep Oscillation result ed in significant pain reduction in the treatment group . The subjective reported reduction of swelling in both groups was confirmed objective ly by 3D measurement only in the treatment group . CONCLUSION Additional Deep Oscillation supplementary to manual lymphatic drainage can significantly enhance pain alleviation and swelling reduction in patients with secondary breast lymphoedema compared with manual lymphatic drainage alone PURPOSE In 1996 , a multicenter r and omized study was initiated that compared sequential vs. concurrent adjuvant chemotherapy ( CT ) with radiation therapy ( RT )  after breast-conserving surgery ( ARCOSEIN study ) . After a median follow-up of 6.7 years ( range , 4.3 - 9 years ) , we decided to prospect ively evaluate the late effects of these 2 strategies . METHODS AND MATERIAL S A total of 297 patients from the 5 larger participating institutions were asked to report for a follow-up examination . Seventy-two percent ( 214 patients ) were eligible for evaluation of late toxicity . After breast-conserving surgery , patients were treated either with sequential treatment with CT first followed by RT ( Arm A ) or CT administered concurrently with RT ( Arm B ) . In all patients , CT regimen consisted of mitoxantrone ( 12 mg/m2 ) , 5-FU ( 500 mg/m2 ) , and cyclophosphamide ( 500 mg/m2 ) , 6 cycles ( Day 1 to Day 21 ) . Conventional RT was delivered to the whole breast by administration of a 2 Gy per fraction protocol to a total dose of 50 Gy ( + /- boost to the primary tumor bed ) . The assessment of toxicity was blinded to treatment and was grade d by the radiation oncologist , according to the LENT/SOMA scale . Skin pigmentation was also evaluated according to a personal 5-points scoring system ( excellent , good , moderate , poor , very poor ) . RESULTS Among the 214 evaluable patients , 107 were treated in each arm . The 2 population s were homogeneous for patient , tumor , and treatment characteristics . Subcutaneous fibrosis ( SF ) , telangectasia ( T ) , skin pigmentation ( SP ) , and breast atrophy ( BA ) were significantly increased in Arm B. No statistical difference was observed between the 2 arms of the study concerning Grade 2 or higher pain , breast edema , or lymphedema . No deaths were caused by late toxicity . CONCLUSION After breast-conserving surgery , the concurrent use of CT with RT is significantly associated with an increase incidence of Grade 2 or greater late side effects PURPOSE To report 3-year toxicity , cosmesis , and efficacy of a multicenter study of external beam , accelerated partial breast irradiation ( APBI ) for early-stage breast cancer . METHODS AND MATERIAL S Between March 2005 and August 2006 , 127 women aged ≥40 years with ductal carcinoma in situ or node-negative invasive breast cancer ≤3 cm in diameter , treated with breast-conserving surgery achieving negative margins , were accrued to a prospect i ve study involving five Canadian cancer centers . Women meeting predefined dose constraints were treated with APBI using 3 to 5 photon beams , delivering 35 to 38.5 Gy in 10 fractions , twice a day , over 1 week . Patients were assessed for treatment-related toxicities , cosmesis , and efficacy before APBI and at specified time points for as long as 3 years after APBI . RESULTS 104 women had planning computed tomography scans showing visible seromas , met dosimetric constraints , and were treated with APBI  to doses of 35 Gy ( n=9 ) , 36 Gy ( n=33 ) , or 38.5 Gy ( n=62 ) . Eighty-seven patients were evaluated with minimum 3-year follow-up after APBI  . Radiation dermatitis , breast edema , breast in duration , and fatigue decreased from baseline levels or stabilized by the 3-year follow-up . Hypopigmentation , hyperpigmentation , breast pain , and telangiectasia slightly increased from baseline levels . Most toxicities at 3 years were Grade 1 . Only 1 patient had a Grade 3 toxicity with telangiectasia in a skin fold inside the 95 % isodose . Cosmesis was good to excellent in 86 % ( 89/104 ) of women at baseline and 82 % ( 70/85 ) at 3 years . The 3-year disease-free survival was 97 % , with only one local recurrence that occurred in a different quadrant away from the treated site and two distant rec 
    Output:
    
However , their prognostic value remains uncertain .