***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 : To assess the effectiveness of nurse led follow up in the management of patients with lung cancer . Design : R and omised controlled trial . Setting : Specialist cancer hospital and three cancer units in southeastern Engl and Participants : 203 patients with lung cancer who had completed their initial treatment and were expected to survive for at least 3 months . Intervention : Nurse led follow up of out patients compared with conventional medical follow up . Outcome measures : Quality of life , patients ' satisfaction , general practitioners ' satisfaction , survival , symptom-free survival , progression-free survival , use of re sources , and comparison of costs . Results : Patient acceptability of nurse led follow up was high : 75 % ( 203/271 ) of eligible patients consented to participate . Patients who received the intervention had less severe dyspnoea at 3 months ( P=0.03 ) and had better scores for emotional functioning ( P=0.03 ) and less peripheral neuropathy ( P=0.05 ) at 12 months . Intervention group patients scored significantly better in most satisfaction subscales at 3 , 6 , and 12 months ( P<0.01 for all subscales at 3 months ) . No significant differences in general practitioners ' overall satisfaction were seen between the two groups . No differences were seen in survival or rates of objective progression , although nurses recorded progression of symptoms sooner than doctors ( P=0.01 ) . Intervention patients were more likely to die at home rather than in a hospital or hospice ( P=0.04 ) , attended fewer consultations with a hospital doctor during the first 3 months ( P=0.004 ) , had fewer radiographs during the first 6 months ( P=0.04 ) , and had more radiotherapy within the first 3 months ( P=0.01 ) . No other differences were seen between the two groups in terms of the use of re sources . Conclusion : Nurse led follow up was acceptable to lung cancer patients and general practitioners and led to positive outcomes Background : CA-125 as a tumour progression criterion in relapsing ovarian cancer ( ROC ) trials remains controversial . CALYPSO is a large r and omised trial incorporating CA-125 ( GCIG criteria ) and symptomatic deterioration in addition to Response Evaluation Criteria in Solid Tumours ( RECIST ) criteria ( radiological ) to determine progression . Methods : In all , 976 patients with platinum-sensitive ROC were r and omised to carboplatin – paclitaxel ( C-P ) or carboplatin-pegylated liposomal doxorubicin ( C-PLD ) . CT-scan and CA-125 were performed every 3 months until progression . Results : In all , 832 patients ( 85 % ) progressed , with 60 % experiencing a first radiological progression , 10 % symptomatic progression , and 28 % CA-125 progression without evidence of radiological or symptomatic progression . The benefit of C-PLD vs C-P in progression-free survival was not influenced by type of first progression ( hazard ratio 0.85 ( 95 % confidence interval ( CI ) : 0.66–1.10 ) and 0.84 ( 95 % CI : 0.72–0.98 ) for CA-125 and RECIST , respectively ) . In patients with CA-125 first progression who subsequently progressed radiologically , a delay of 2.3 months was observed between the two progression types . After CA-125 first progression , median time to new treatment was 2.0 months . In all , 81%of the patients with CA-125 or radiological first progression and 60 % with symptomatic first progression received subsequent treatment . Conclusion : CA-125 and radiological tests performed similarly in determining progression with C-PLD or C-P. Additional follow-up with CA-125 measurements was not associated with overtreatment OBJECTIVE The role and type of procedures of follow-up in patients with gynecological tumors are still a debatable issue . We prospect ively analyzed the role of routine transabdominal and transvaginal ultrasound examination ( US ) in the detection of recurrent disease in gynecologic cancer patients . METHODS Among 552 patients who underwent surgery for gynecological cancer , 385 were available for the analysis . Follow-up examinations included clinical examination , serum tumor marker assay , transvaginal and transabdominal sonography and CT scan/MRI . RESULTS Positive US examination  was documented in 83/385 patients ( 21.5 % ) . In the overall series , the positive predictive value ( PPV ) of US examination was 100 % , while the negative predictive value ( NPV ) was 92.7 % failing to identify 22 cases of recurrences . When considering the subgroup of patients with positive clinical examination or abnormal tumor marker , positive US analysis was able to identify 66/66 cases of recurrence ( PPV=100 % ) , but exhibited an NPV of 22.2 % , with 21/27 ( 77.8 % ) false negative cases . Conversely , in cases without clinical /serological signs of disease , positive US recognized all cases of recurrences ( 17/17 , PPV=100 % ) , and exhibited a very high NPV , with only 1 false negative case out of 275 ( 0.4 % ) . The US detected recurrences appeared as a solitary lesion in 38/75 ( 50.6 % ) patients and in 28/75 ( 37 % ) appeared located central ly in the pelvis . The sonographic pattern of the ovarian recurrences was a solid lesion in most ( 33/40 , 82 % ) cases . In the other gynecological tumors , the lesions appeared as solid masses in 33/35 ( 94 % ) cases . CONCLUSIONS We showed that routine US might play a role in the follow-up of gynecologic malignancies , especially in the group of asymptomatic patients , while CT/MRI imaging might be more properly applied to patients with clinical or serological signs of disease OBJECTIVE Recurrence is often a major problem for patients who have undergone surgery for ovarian cancer . This prospect i ve study was undertaken to evaluate the clinical contribution of positron emission tomography ( PET ) using (18)F-fluorodeoxyglucose ( FDG ) for recurrent ovarian cancer . SUBJECTS AND METHODS Twenty-four women who had undergone surgery or chemoradiotherapy for histopathologically proven ovarian cancer were enrolled in this study . Ovarian cancer was thought to have recurred in 12 of these women because of evidence on conventional imaging modalities or tumor marker measurements ( group A ) . Clinical findings for the remaining 12 women showed them to be disease-free ( group B ) . PET findings for the women were compared with the final diagnoses obtained by histopathology or by clinical follow-up . The clinical contribution of PET was assessed by evaluating whether PET yielded information complementing the findings of conventional modalities and by examining its impact on treatment . RESULTS PET gave valuable information for seven of 12 patients in group A in addition to the information obtained from findings on conventional imaging , and treatment was affected in five patients . On the other h and , in group B , additional information was obtained in only three of 12 patients , and treatment of only one patient was affected . Overall sensitivity , specificity , and accuracy of conventional imaging modalities were 72.7 % , 75.0 % , and 73.3 % , respectively , and these rates improved to 92.3 % , 100.0 % , and 94.4 % , respectively , by considering both conventional imaging modalities and PET findings . CONCLUSION Our preliminary data suggest that whole-body PET with FDG can be a complementary modality for following up patients who have had ovarian cancer , especially patients believed to be at risk for recurrence A new combined enzyme linked immunoassay ( ELISA ) was developed to measure both serum placental-like alkaline phosphatase ( PLAP ) activity ( PLAPA ) and concentration ( PLAPC ) in the same microtitre plate using an Imperial Cancer Research Fund monoclonal antibody , design ated H17E2 . PLAP A and PLAP C were determined together with an existing marker , CA125 in 397 serial sample s from 87 patients with epithelial ovarian cancer . Retrospective assessment showed the sensitivity to increase from 73 % with CA125 alone , to 88 % using CA125 and PLAP A , and to 93 % with all three markers in 261 sample s from the patients with known active disease at the time of sampling . When the results for all 397 sample s were included in the analysis , however , the specificity , sensitivity , accuracy and predictive powers of this monoclonal antibody were not sufficiently high to assist in the prospect i ve follow up of patients with ovarian cancer . This was due to a significant number of false positive and false negative results . Our data indicate that PLAP A or PLAP C estimation with H17E2 may , therefore , only be of value in the management of those patients with known active disease who are already known to be " marker positive " for this antigen OBJECTIVE To evaluate low-dose non-enhanced CT ( ldCT ) and full-dose contrast-enhanced CT ( ceCT ) in integrated 18F-fluorodeoxyglucose (FDG)-PET/CT studies for restaging of ovarian cancer . MATERIAL S AND METHODS One hundred and twenty women who had undergone treatment for ovarian cancer underwent a conventional PET/CT scans with ldCT , and then ceCT . Two observers interpreted and decided in consensus on the PET/ldCT and PET/ceCT images by a 3-point scale ( N : negative , E : equivocal , P : positive ) per patient and lesion site . Final diagnoses were obtained by histopathological examinations , or clinical follow-up for at least 6 months . RESULTS Patient-based analysis showed that the sensitivity , specificity , and accuracy of PET/ceCT was 86.9 % ( 40/46 ) , 95.9 % ( 71/74 ) , and 92.5 % ( 111/120 ) , respectively , whereas those of PET/ldCT were 78.3 % ( 36/46 ) , 95.0 % ( 70/74 ) , and 88.3 % ( 106/120 ) , respectively . All sensitivity , specificity , and accuracy significantly differed between two methods ( McNemar test , p<0.0005 , p=0.023 , and p<0.0001 , respectively ) . The scales of detecting 104 recurrent lesion sites were N:14 , E:6 , P:84 for PET/ceCT , and N:15 , E:17 , P:72 for PET/ldCT , respectively . Eleven equivocal and one negative regions by PET/ldCT were correctly interpreted as positive by PET/ceCT . CONCLUSION PET/ceCT is a more accurate imaging modality with higher confidence for assessing ovarian cancer recurrence than PET/ldCT Serum cancer antigen 125 ( CA125 ) is widely used in ovarian cancer to monitor the effectiveness of therapy both in first line and recurrence . It is also widely used during follow-up , where it is able to identify a percentage of patients with asymptomatic recurrence . Although a recent Medical Research Council (UK)/European Organisation for Research and Treatment of Cancer trial has demonstrated that early chemotherapy in asymptomatic patients based only on CA125 increase does not prolong survival , we still believe that CA125 monitoring should be prescribed to patients during follow-up . In fact , it can help to identify patients who should undergo radiology in order to select those that can benefit from surgery or from early treatment before the onset of symptoms , which are usually related to an excessive disease burden . The delay of disease symptoms , such as those associated with the appearance of ascites or bowel occlusion , is in our view an important goal of our treatment of recurrence . Moreover , research should be done in patients with asymptomatic CA125 increase in order to identify more effective therapies that will improve survival . Finally , the reliability of CA125 as a surrogate of response under treatment with biological agents should be vali date d in prospect i ve trials Abstract Objective : To assess the effect on time to diagnosis of recurrence and on quality of life of transferring primary responsibility for follow up of women with breast cancer in remission from hospital to general practice . Design : R and omised controlled trial with 18 month follow up in which women received routine follow up either in hospital or in general practice . Subjects and setting : 296 women with breast cancer in remission receiving regular follow up care at district general hospitals in Engl and . Main outcome measures : Time between first presentation of symptoms to confirmation of recurrence ; quality of life measured by specific dimensions of the SF-36 schedule , the EORTC symptom scale , and hospital anxiety and depression scale . Results : Most recurrences ( 18/26 , 69 % ) presented as interval events , and almost half ( 7/16 , 44 % ) of the recurrences in the hospital group presented first to general practice . The median time to hospital confirmation of recurrence was 21 days in the hospital group ( range 1 - 376 days ) and 22 days in the general practice group ( range 4 - 64 ) . The differences between groups in the change in SF-36 mean scores from baseline were small : -1.8 ( 95 % confidence interval -7.2 to 3.5 ) for social functioning , 0.5 ( -4.1 to 5.1 ) for mental health , and 0.6 ( -3.6 to 4.8 ) for general health perception . The change from baseline in the mean depression score was higher in the general practice group at the mid-trial assessment ( difference 0.6 , 0.1 to 1.2 ) but there was 
    Output:
    
Limited evidence from a single trial suggests that routine surveillance with CA125 in asymptomatic patients and treatment at CA125 relapse does not seem to offer survival advantage when compared to treatment at symptomatic relapse .