***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: A retrospective analysis was performed of 451 adult patients with clinical stage 1/1E non-Hodgkin 's lymphoma treated initially with radiotherapy alone . Histopathologically 208 patients had low- grade disease and 243 patients high- grade disease . The complete remission ( CR ) rate was higher in patients with low- grade disease ( 98 % ) than in those with high- grade disease ( 84 % ) ( P < 0.0001 ) . The relapse rate was similar in both histological categories , and relapse usually occurred within 5 years . The result ing overall actuarial percentage of patients achieving CR and remaining disease free ( at 10 years ) was 47 % in patients with low- grade disease and 45 % for those with high- grade disease .  Salvage therapy  was frequently successful in younger patients , and the overall cause-specific survival at 10 years was 71 % for low- grade disease and 67 % for high- grade disease . In those patients under 60 years of age at diagnosis , the overall cause-specific survival at 10 years was 84 % and 80 % for those with low- grade and high- grade disease respectively . These long-term results in young patients with clinical stage 1 disease are encouraging , and it will be difficult to demonstrate improved survival with initial chemotherapy either with or without radiotherapy , until new prognostic factors are found to identify poor-risk patients PURPOSE To compare low-dose ( 30 Gy ) radiotherapy ( RT ) with observation ( OBS ) in limited-stage aggressive lymphoma patients achieving complete remission ( CR ) after chemotherapy , and to measure conversion from partial response ( PR ) to CR with high-dose ( 40 Gy ) RT  . PATIENTS AND METHODS From 1984 to 1992 , stage I ( with risk factors ) and II adults with diffuse aggressive lymphoma in CR after eight cycles of cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP ) were r and omly assigned to 30 Gy involved-field RT or OBS .  PR patients received 40 Gy RT . RESULTS Among 172 CR patients , the 6-year disease-free survival ( DFS ) was 73 % for low-dose RT versus 56 % for OBS ( two-sided P = .05 ) . Failure-free survival ( two-sided P = .06 ) , and time to progression ( two-sided P = .06 ) also favored RT . Intent-to-treat analyses yielded similar results . No survival differences were observed . Three RT versus 15 OBS patients relapsed in initial disease sites . At 6 years , failure-free survival was 63 % in PR patients ; conversion to CR did not significantly influence clinical outcome . CONCLUSION For patients in CR after CHOP , low-dose RT prolonged DFS and provided local control , but no survival benefit was observed . The majority of PR patients were event-free at 6 years despite residual radiographic abnormalities . Future efforts should be directed toward improved imaging and more effective systemic therapies PURPOSE Chemoradiotherapy has been considered st and ard treatment for patients with limited-stage aggressive lymphoma on the basis of trials conducted before the introduction of the International Prognostic Index . To evaluate this approach in elderly patients with low-risk localized lymphoma , we conducted a trial comparing chemoradiotherapy with chemotherapy alone . PATIENTS AND METHODS Previously untreated patients older than 60 years with localized stage I or II histologically aggressive lymphoma and no adverse prognostic factors of the International Prognostic Index were r and omly assigned to receive either four cycles of cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP ) plus involved-field radiotherapy ( 299 patients ) or chemotherapy alone with four cycles of CHOP ( 277 patients ) . RESULTS With a median follow-up time of 7 years , event-free and overall survival did not differ between the two treatment groups ( P = .6 and P = .5 , respectively ) . The 5-year estimates of event-free survival were 61 % for patients receiving chemotherapy alone and 64 % for patients receiving CHOP plus radiotherapy ; the 5-year estimates of overall survival were 72 % and 68 % , respectively . In a multivariate analysis , overall survival was affected by stage II disease ( P < .001 ) and male sex ( P = .03 ) . CONCLUSION In this large prospect i ve study , CHOP plus radiotherapy did not provide any advantage over CHOP alone for the treatment of low-risk localized aggressive lymphoma in elderly patients We conducted a r and omized trial to compare the intensive conventional chemotherapy regimen ACVBP ( doxorubicin , cyclophosphamide , vindesine , bleomycin , prednisone ) with st and ard CHOP ( cyclophosphamide , doxorubicin , vincristine , and prednisone ) in previously untreated patients with poor-risk aggressive lymphoma . Patients aged 61 to 69 years who had aggressive non-Hodgkin lymphoma with at least one prognostic factor of the age-adjusted international prognostic index ( IPI ) were included .  ACVBP consisted of an induction phase of intensified chemotherapy and central nervous system ( CNS ) prophylaxis followed by a sequential consolidation phase .  Of the 708 patients registered for the study , 635 were eligible . The rate of complete response was 58 % in the ACVBP group and 56 % in the CHOP group ( P = .5 ) . Treatment-related death occurred in 13 % of the ACVBP group and 7 % of the CHOP group ( P = .014 ) . At 5 years , the event-free survival was 39 % in the ACVBP group and 29 % in the CHOP group ( P = .005 ) . The overall survival was significantly longer for patients treated with ACVBP , at 5 years it was 46 % compared with 38 % for patients treated with CHOP ( P = .036 ) . CNS progressions or relapses were more frequent in the CHOP group ( P = .004 ) . Despite higher toxicity , the ACVBP regimen , used as first-line treatment for patients with poor-risk aggressive lymphoma , is superior to st and ard CHOP with regard to both event-free survival and overall survival In order to assess long-term outcome of patients with localized ( stage I or II ) diffuse large-cell lymphoma treated with initial combination chemotherapy with cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP ) with or without involved-field radiotherapy following chemotherapy , we combined data from two prospect i ve trials in Tucson ( 64 patients ) and Vancouver ( 78 patients ) . Follow-up on 142 patients was up date d and a variety of potential pretreatment prognostic factors were analyzed for impact on outcome . One hundred forty patients ( 99 % ) achieved a complete remission and there were no differences in outcome between institutions . Twenty-three patients have relapsed and 22 have died from lymphoma at a median follow-up of 4.4 years , result ing in an overall relapse-free survival of 82 % at 5 years . There was no treatment-related mortality and were no instances of late cardiac toxicity or leukemia . Of the following potential pretreatment prognostic factors ( age , stage , " B " symptoms , extranodal disease , gastrointestinal tract involvement , bulky disease , or disease above or below the diaphragm ) , only stage affected relapse-free survival ( RFS ) ( P = .16 ) and survival ( .003 ) . Among 34 % of patients over age 65 , outcome was similar to younger patients . RFS for 108 patients treated with CHOP plus radiotherapy was not significantly superior to the use of CHOP alone in 34 patients ( P = .2 ) Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists BACKGROUND The st and ard treatment for patients with diffuse large-B-cell lymphoma is cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP ) . Rituximab , a chimeric monoclonal antibody against the CD20 B-cell antigen , has therapeutic activity in diffuse large-B-cell lymphoma . We conducted a r and omized trial to compare CHOP chemotherapy plus rituximab with CHOP alone in elderly patients with diffuse large-B-cell lymphoma . METHODS Previously untreated patients with diffuse large-B-cell lymphoma , 60 to 80 years old , were r and omly assigned to receive either eight cycles of CHOP every three weeks ( 197 patients ) or eight cycles of CHOP plus rituximab given on day 1 of each cycle ( 202 patients ) . RESULTS The rate of complete response was significantly higher in the group that received CHOP plus rituximab than in the group that received CHOP alone ( 76 percent vs. 63 percent , P=0.005 ) . With a median follow-up of two years , event-free and overall survival times were significantly higher in the CHOP-plus-rituximab group ( P<0.001 and P=0.007 , respectively ) . The addition of rituximab to st and ard CHOP chemotherapy significantly reduced the risk of treatment failure and death ( risk ratios , 0.58 [ 95 percent confidence interval , 0.44 to 0.77 ] and 0.64 [ 0.45 to 0.89 ] , respectively ) . Clinical ly relevant toxicity was not significantly greater with CHOP plus rituximab . CONCLUSIONS The addition of rituximab to the CHOP regimen increases the complete-response rate and prolongs event-free and overall survival in elderly patients with diffuse large-B-cell lymphoma , without a clinical ly significant increase in toxicity BACKGROUND Chemoradiotherapy is st and ard treatment for localized aggressive lymphoma . To determine the optimal therapy for nonelderly persons with low-risk localized lymphoma , we conducted a r and omized trial comparing chemoradiotherapy with chemotherapy alone . METHODS Previously untreated patients less than 61 years old with localized stage I or II aggressive lymphoma and no adverse prognostic factors according to the International Prognostic Index were r and omly assigned to three cycles of cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP ) plus involved-field radiotherapy ( 329 patients ) or chemotherapy alone with dose-intensified doxorubicin , cyclophosphamide , vindesine , bleomycin , and prednisone ( ACVBP ) plus sequential consolidation ( 318 patients ) . RESULTS With a median follow-up of 7.7 years , event-free and overall survival rates were significantly higher in the group given chemotherapy alone than in the group given CHOP plus radiotherapy ( P<0.001 and P=0.001 , respectively ) . The five-year estimates of event-free survival were 82 percent ( 95 percent confidence interval , 78 to 87 percent ) for patients receiving chemotherapy alone and 74 percent ( 95 percent confidence interval , 69 to 78 percent ) for those receiving chemoradiotherapy . The respective five-year estimates of overall survival were 90 percent ( 95 percent confidence interval , 87 to 93 percent ) and 81 percent ( 95 percent confidence interval , 77 to 86 percent ) . In a multivariate analysis , event-free and overall survival rates were affected by treatment group , independently of tumor stage and the presence or absence of bulky disease . CONCLUSIONS In patients under 61 years of age , chemotherapy with three cycles of ACVBP followed by sequential consolidation is superior to three cycles of CHOP plus radiotherapy for the treatment of low-risk localized lymphoma BACKGROUND Patients with clinical ly localized , intermediate- or high- grade non-Hodgkin 's lymphoma usually receive initial treatment with a doxorubicin-containing regimen such as cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP ) . Pilot studies suggest that eight cycles of CHOP alone or three cycles of CHOP followed by involved-field radiotherapy are effective in such patients . METHODS We compared these two approaches in a prospect i ve , r and omized , multi-institutional study . The end points were progression-free survival , overall survival , and life-threatening or fatal toxic effects .  Two hundred eligible patients were r and omly assigned to receive CHOP plus radiotherapy , and 201 received CHOP alone .  RESULTS Patients treated with three cycles of CH 
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Conclusions This systematic review with meta- analysis shows no improvement in survival when adding RT to systemic therapy for ALNHL .