***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 
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    ***EXAMPLES*** 
    Input: This study is to compare the remission and complication rates of actinomycin D ( Act-D ) and methotrexate-folinic acid ( MTX-FA ) as single-agent treatments of stage I , low-risk gestational trophoblastic neoplasia ( GTN ) . From 1994 to 2005 , all women with International Federation of Gynecology and Obstetrics stage I , low-risk GTN were r and omly assigned to received either intravenous Act-D 10 & mgr;g/kg per day for 5 days every 2 weeks or intramuscular methotrexate 1 mg/kg per day on days 1 , 3 , 5 , and 7 with intramuscular folinic acid 0.1 mg/kg per day on days 2 , 4 , 6 , and 8 every 2 weeks . Forty-nine women met the eligibility criteria . Age , human chorionic gonadotropin level , and International Federation of Gynecology and Obstetrics score were similar in both treatment groups . Of the 22 women who received Act-D , 2 were lost to follow-up . Among the 27 women who received MTX-FA , 2 were lost to follow-up , and 6 had to switch to Act-D because of the rising levels of liver enzymes . All 20 women ( 100 % ) in the Act-D arm achieved remission compared with 14 ( 73.6 % ) in 19 women in the MTX-FA arm ( P = 0.02 ) . Mucositis and alopecia were reported more frequently in the Act-D group , whereas elevations of liver enzyme levels were more frequent in the MTX-FA group . Actinomycin D seems to be more effective than MTX-FA in the treatment of stage I , low-risk GTN . Larger multicenter r and omized controlled trials should be conducted to establish the most appropriate regimen for these patients OBJECTIVE To evaluate the efficacy of the FAEV regimen ( floxuridine , actinomycin D , etoposide , vincristine ) in the treatment of high-risk , drug-resistant gestational trophoblastic tumor ( GTT ) . STUDY DESIGN From October 2001 to May 2004 , 11 cases of high-risk , drug-resistant GTT were treated with the FAEV regimen .  All cases were referred to Peking Union Medical College Hospital because of previous failure of chemotherapy . The patients ' ages ranged from 21 to 60 ( median , 32 ) years . The International Federation of Gynecologists and Obstetricians score was 7 - 13 ( median , 9 ) . All cases were followed for 15 - 42 months after FAEV treatment . RESULTS Seven cases ( 63.6 % , 7 of 11 ) were cured by the FAEV regimen . The median course number for serum human chorionic gonadotropin reaching a normal level was 3 . Four cases ( 36 % , 4 of 11 ) showed drug resistance to the FAEV regimen . The major side effect of FAEV regimen is myelosuppression . Granulocyte colony-stimulating factor support was needed after 98.4 % ( 63 of 64 ) of the courses . CONCLUSION For high-risk , drug-resistant GTT cases , FAEV regimen could be an effective treatment OBJECTIVE To evaluate the results of etoposide/ methotrexate/actinomycin D/etoposide/cisplatin ( EMA/ EP ) chemotherapy in patients with chemorefractory gestational trophoblastic tumor ( GTT ) . STUDY DESIGN Fifteen patients with chemorefractory GTT were treated with EMA/EP . RESULTS Twelve of the 15 cases were choriocarcinoma , and the last 3 were metastatic placental site trophoblastic tumor ( PSTT ) : International Federation of Gynecology and Obstetrics ( FIGO ) stage I , 2 cases ; stage III , 10 cases ; stage IV , 3 cases . Seven cases have FIGO score 7 - 10 ; the scores of the remaining 8 cases were > 10 . Fifteen patients received a total of 93 cycles of the study regimen . The median number of courses for each patient was 6.2 . Eleven cases ( 73.3 % ) achieved complete remission , while 3 ( 20 % ) had partial remission ; 1 case ( 6.7 % ) showed no response . The main complications of EMA/EP chemotherapy were myelosuppression and gastrointestinal symptoms . CONCLUSION The EMA/EP regimen is effective for chemorefractory GTT , and the chemotherapeutic results can be improved when combined with surgery and arterial infusion chemotherapy in selected patients . The EMA/EP regimen should be considered for primary management of metastatic PSTT PURPOSE There is no consensus on the best regimen for the primary treatment of low-risk gestational trophoblastic neoplasia ( GTN ) . PATIENTS AND METHODS Two commonly used single-drug regimens were compared with respect to the proportion of patients meeting the criteria for a complete response ( CR ) in a r and omized phase III trial conducted by the Gynecologic Oncology Group . Eligibility was purpose fully broad to maximize the generalizability of the results and included patients with a WHO risk score of 0 to 6 and patients with metastatic disease ( limited to lung lesions < 2 cm , adnexa , or vagina ) or choriocarcinoma . RESULTS Two hundred forty women were enrolled , and 216 were deemed eligible . Biweekly intravenous dactinomycin 1.25 mg/m² was statistically superior to weekly intramuscular ( IM ) methotrexate 30 mg/m² ( CR : 70 % v 53 % ; P = .01 ) . Similarly , in patients with low-risk GTN as defined before the 2002 WHO risk score revisions ( risk score of 0 to 4 and excluding choriocarcinoma ) , response was 58 % and 73 % in the methotrexate and dactinomycin arms , respectively ( P = .03 ) . Both regimens were less effective if the WHO risk score was 5 or 6 or if the diagnosis was choriocarcinoma ( CR : 9 % and 42 % , respectively ) . There were two potential recurrences ; one at 4 months ( dactinomycin ) and one at 22 months ( methotrexate ) . Not all patients completed follow-up . Both regimens were well tolerated . CONCLUSION The biweekly dactinomycin regimen has a higher CR rate than the weekly IM methotrexate regimen in low-risk GTN , a generally curable disease OBJECTIVE To compare the efficacy of methotrexate and actinomycin D as single agents in first-line chemotherapy for women with low-risk gestational trophoblastic neoplasia ( LR-GTN ) . METHODS A total of 131 women with LR-GTN were r and omized to receive a weekly pulsed dose of 30 mg/m(2 ) of methotrexate intramuscularly ( n=81 ) or a pulsed intravenous bolus of 1.25 mg/m(2 ) of actinomycin D every 2 weeks ( n=50 ) . An additional cycle was administered as consolidation treatment following normalization of the serum level of beta-human chorionic gonadotropin ( < 5 IU/L ) . RESULTS Complete remission was achieved in 48.14 % of patients in the methotrexate group and 90.00 % in the actinomycin D group ( P<0.001 ) . The mean number of treatment cycles needed to achieve response was lower in the actinomycin D group ( 4.8 vs 6.8 ) . The risk of treatment failure was 26.4 greater with methotrexate than with actinomycin D ( 95 % confidence interval , 5.7 - 22.6 ; P<0.001 ) . CONCLUSION Actinomycin D may be a better option than methotrexate as a first-line chemotherapy agent for patients with LR-GTN The purpose of the study was to determine the activity and toxicity of pulse dactinomycin as salvage treatment of patients with low‐risk gestational trophoblastic neoplasia ( GTN ) who failed methotrexate therapy OBJECTIVE To evaluate the efficacy and safety of etoposide/methotrexate/actinomycin D ( MEA regimen ) as initial chemotherapy and 5-fluorouracil/actinomycin D ( FA regimen ) as salvage chemotherapy for high-risk gestational trophoblastic tumor ( GTT ) . STUDY DESIGN From 1985 to 2001 , 36 patients with World Health Organization (WHO)--defined high-risk GTT were treated with MEA or FA at Chiba University Hospital . Thirty-three patients were initially treated with MEA . FA was administered to 11 patients ; 1 had had no previous chemotherapy , 7 had developed drug resistance to MEA , 1 had relapsed following MEA , and 2 had relapsed following etoposide/methotrexate/actinomycin D/ cyclophosphamide/vincristine ( EMA/CO ) combination chemotherapy . RESULTS The primary remission rate with MEA was 69.7 % ( 23 of 33 ) . With FA the survival rate was 81.8 % ( 9 of 11 ) for a mean follow-up period of 11.5 years . Two patients died due to multidrug resistance , and 2 patients relapsed subsequently . The 2 relapse cases were successfully salvaged again with MEA . The toxicity of FA was evaluated in 89 cycles . Myelosuppression seemed to be the dose-limiting toxicity , and the incidence of WHO grade 4 leukocytopenia and thrombocytopenia were 5.6 % and 3.4 % , respectively . CONCLUSION Although etoposide-containing chemotherapy is currently the most effective and well tolerated regimen for high-risk GTT , 20 - 30 % of patients develop drug resistance to these regimens . Salvage combination chemotherapy with FA is effective for refractory patients , and the toxicity is predictable and manageable Multiple agent chemotherapy in high-risk metastatic gestational trophoblastic tumor patients is a problem for any medical team . In this study , EMA-EP chemotherapy ( etoposide , methotrexate , actinomycin , and cisplatinum ) was evaluated as firstline chemotherapy to manage high-risk GTT metastatic patients . Seventeen high-risk metastatic patients , including 14 without and 3 with brain metastasis , who were c and i date s to firstline multiple agent chemotherapy between April 2000 and March 2003 in Vali-e-Asr hospital took part in a prospect i ve study under EMA-EP regimen . EMA-EP was prescribed in two periods : EMA in two consecutive days in week 1 and EP in 1 day in the following week with a week interval between these two ( each cycle was repeated every 2 weeks ) . In brain metastasis group , patients got high-dose medication ( methotrexate ) together with brain radiotherapy .  Remission , toxicity , full dose tolerance , and recurrences of patients were evaluated . Median age of patients was 30 ( 15–49 ) , and they received 100 courses of chemotherapy including 75 low-dose courses and 25 high-dose courses . 71 % of courses were done in full dosage ( 83 % in low dose and 36 % in high dose ) . The most common cause for dosage reduction was leukopenia . Two patients did not complete the regimen , one due to hypersensitivity and the other due to fever and leukopenia leading to death . All others , who received complete courses , achieved remission . In the group without brain metastasis , one case of recurrence was observed . Grade 3 anemia , grade 3 and 4 leukopenia , and grade 3 and 4 thrombocytopenia were observed in 3 , 12 , and 3 % of patients , respectively . In current study , EMA-EP regimen in patients with high-risk metastatic GTN patients ( with or without brain metastasis ) lead to remission in all patients who completed the treatment courses OBJECTIVE To evaluate the effectiveness of the etoposide and cisplatin/etoposide , methotrexate and actinomycin D ( EP-EMA ) regimen in patients with gestational trophoblastic neoplasia who had been successfully treated with the etoposide , methotrexate , and actinomycin D/cyclophosphamide and vincristine ( EMA-CO ) regimen but experienced a relapse , or who became refractory to EMA-CO treatment .  METHODS From January 1999 to December 2005 , 18 patients with gestational trophoblastic neoplasia who had been successfully treated with the EMA-CO regimen but sustained a relapse ( n=7 ) or who became refractory to it ( n=11 ) were treated with the EP-EMA regimen .  The effectiveness , adverse effects , and tolerated dose intensity of the EP-EMA regimen were retrospectively analyzed . RESULTS The 18 patients received a total of 74 cycles of the EP-EMA regimen and 12 ( 66.7 % ) achieved complete remission . Nine of the 11 patients ( 81.8 % ) apparently resistant to the EMA-CO regimen achieved complete remission . However , only 3 of the 7 patients ( 42.9 % ) who experienced a relapse after 
    Output:
    
RCTs in GTN are scarce owing to the low prevalence of this disease and its highly chemosensitive nature .
However , five-day dactinomycin is associated with more side effects than pulsed dactinomycin , therefore an RCT comparing the relative efficacy and safety of these two regimens in the context of failed primary methotrexate treatment is desirable .