***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: In a prospect i ve multicenter study , 186 patients with squamous cell esophageal carcinoma , who after evaluation were considered suitable for surgery , were r and omized to 4 treatment groups : Group 1 , surgery alone ; Group 2 , pre-operative chemotherapy ( cisplatin and bleomycin ) and surgery ; Group 3 , pre-operative irradiation ( 35 Gy ) and surgery ; Group 4 , pre-operative chemotherapy , radiotherapy , and surgery .  Three-year survival was significantly higher in the pooled groups receiving radiotherapy as compared with the pooled groups not receiving radiotherapy . Comparison of the groups having pre-operative chemotherapy with those not having chemotherapy showed no significant difference in survival .  Female patients had a significantly better survival than males . The results indicate that pre-operative irradiation had a beneficial effect on intermediate term survival , whereas the chemotherapy regime used did not influence survival . RésuméDans une étude prospect i ve , multicentrique , 186 patients ayant un cancer épidermoïde de l'oesophage ont été r and omisée dans quatre groupes : le groupe 1 a eu la chirurgie seule ; le groupe 2 , une chimiothérapie préopératoire ( cis-platine et bléomycine ) ; le groupe 3 , une radiothérapie préopératoire suivie de chirurgie ; et le groupe 4 , une chimiothérapie et une radiothérapie préopératoires suivies de chirurgie . La survie à trois ans a été supérieure chez l'ensemble des patients ayant reçu la radiothérapie préopératoire par rapport à ceux qui n'en ont pas eu . Aucune différence de survie n'a pu être mise en évidence dans les groupes ayant eu ou pas de chimiothérapie . La survie des femmes a été significativement supérieure à celle des hommes . Ces résultats indiquent que la radiothérapie préopératoire apporte un plus en ce qui concerne la survie à moyen terme , alors que la chimiothérapie n'influence pas la survie . ResumenEn un estudio prospect ivo multicéntrico sobre 186 pacientes con carcinoma escamocelular del esófago c and idatos para cirugía , se constituyeron cuatro grupos para r and omización : Grupo 1 , cirugía solamente ; Grupo 2 , quimioterapia preoperatoria ( cisplatino y bleomicina ) y cirugía ; Grupo 3 , irradiación preoperatoria ( 35 Gy ) y cirugía ; Grupo 4 , quimioterapia preoperatoria , radioterapia y cirugía . La comparación entre el grupo que recibió quimioterapia y el que no la recibió no demostró diferencia significativa en cuanto a supervivencia . Las pacientes femeninas exhibieron una mejor supervivencia que los pacientes masculinos . Los result ados indican que la irradiación preoperatoria tuvo un efecto benéfico sobre la sobrevida a término medio , en tanto que la quimioterapia , en el regimen utilizado , no tuvo influencia sobre la supervivencia 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 BACKGROUND This study analyzed the impact on long-term results of an increase in the dosage of an induction chemoradiotherapy protocol for squamous cell carcinoma ( SCC ) of the thoracic esophagus . METHODS Two groups were considered among 177 patients who underwent preoperative chemoradiotherapy for SCC of the thoracic esophagus . Group A includes 111 patients ( from 1987 to 1995 ) who were su bmi tted to cisplatin and 5-fluorouracil ( two cycles ) and radiotherapy ( 3,000 cGy ) . Group B includes 66 patients ( from 1995 to 2002 ) in which the doses were raised both in terms of chemotherapy ( three cycles ) and radiotherapy ( 5,000 cGy ) . RESULTS The induction treatment was completed in most of the patients ( 92.1 % ) with an acceptable treatment-related mortality ( 2.6 % ) . Surgery was accomplished in 148 patients ; 78.4 % and 92.4 % in groups A and B , respectively ( p = 0.015 ) . The postoperative in-hospital mortality was 8.8 % . Tumor resection was possible in 91.8 % with a better R0-resection rate for group B ( 83.9 % ; p = 0.004 ) . Responders represented 34.9 % of the patients with 20.1 % of " complete " responses ( 29.5 % in group B ; p = 0.018 ) . The overall 5-year survival rate was improved in group B ( 30.2 % ; p = 0.017 ) , and when survival analysis was restricted to responders ( 70.1 % ; p = 0.027 ) . CONCLUSIONS No differences in feasibility and complication rate were observed during the two study periods . A higher rate of R0-resections was achieved in group B. The increased dosage led to an increased rate of complete responses and to an improved overall 5-year survival Recent studies have cl aim ed a higher rate of perioperative complications related to the use of neoadjuvant chemoradiotherapy in the treatment of esophageal cancer . We tested the hypothesis that neoadjuvant chemoradiotherapy has no significant effect on the perioperative complication rate . Data on 155 patients with esophageal carcinoma treated between 1996 and 2001 were collected in a prospect i ve data base . This included 61 patients ( 40 % ) treated with neoadjuvant chemoradiotherapy ( group I ) and 94 patients ( 60 % ) who underwent esophagectomy alone ( group II ) .  Neoadjuvant therapy consisted of two courses of cisplatinum and continuous-infusion 5-fluorouracil with radiation followed by esophagectomy .  Ivor-Lewis  esophagectomy was performed in 146 ( 94 % ) and a transhiatal resection in nine ( 6 % ) . The two groups ( I vs. II ) were comparable in terms of age ( 61.3±11 years vs. 64.8 ±11 years ) , diagnosis ( adenocarcinoma : 82 % vs. 83 % ; squamous cell carcinoma:11 % vs. 16 % ) , and stage ( stage 0 to I : 39 % vs. 38 % ; stage II : 25 % vs. 34 % ; stage III : 30 % vs. 24 % ; and stage IV : 6 % vs. 4 % ) . The neoadjuvant group had 23 complete responses , 11 partial responses , and 27 nonresponses . There were 39 complications ( 25.1 % ) for the cohort , which included three deaths ( 1.9 % ) and four anastomotic leaks ( 2.6 % ) demonstrated by Gastrografin swallow ( 1 in group I vs. 3 in group II . Only one leak required reoperation ( group II ) ; all others responded to conservative treatment . Group I had 14 complications ( 22.9 % ) vs. 25 ( 26.5 % ) in group II ( P = NS ) . Groups were comparable with respect to the rate of pulmonary events ( 4.9 % vs. 6.3 % ) , arrhythmias ( 6.5 % vs. 8.5 % ) , and stricture formation ( 6.5 % vs. 7.4 % ) . Neoadjuvant chemoradiotherapy in patients with esophageal cancer was not associated with increased perioperative morbidity or mortality . Complete response to chemoradiotherapy also did not affect the complication rate ( 26 % vs. 22 % ) PURPOSE This phase II study was design ed to determine the feasibility , toxicity , and therapeutic efficacy of a novel outpatient combined-modality preoperative regimen in patients with localized esophageal cancer . PATIENTS AND METHODS One hundred twenty-nine eligible patients with previously untreated , potentially resectable , clinical stage I – III carcinoma of the esophagus were treated between July 1995 and July 1999 . Combined-modality treatment included : paclitaxel , 200 mg/m2 , 1-hour i.v . infusion , days 1 and 22 ; carboplatin , an area under the concentration time curve 6.0 i.v . , days 1 and 22 ; 5-fluorouracil , 225 mg/m2/day , continuous i.v . infusion , days 1–42 ; and radiation therapy , 45 Gy , 1.8-Gy single daily fractions 5 days weekly , beginning day 1 . All patients underwent surgical resection 4–8 weeks after completion of the preoperative therapy . RESULTS One hundred twenty-three patients ( 95 % ) completed preoperative therapy , 105 patients ( 81 % ) underwent attempted resection , and 96 patients ( 74 % ) had definitive resection . A pathological complete response was achieved in 47 of 123 evaluable patients ( 38 % ) ; an additional 30 patients ( 24 % ) had only microscopic residual tumor . With a median follow-up of 45 months , the median survival is 22 months ( 95 % CI = 15–32 months ) , with actuarial 1- , 2- , and 3-year survivals of 71 % , 47 % , and 41 % , respectively . The most frequent grade 3/4 toxicities of the neoadjuvant program were leukopenia ( 73 % ) and esophagitis ( 43 % ) . Although 73 patients ( 57 % ) required brief hospitalizations during preoperative therapy , there were no treatment-related deaths , and 94 % of patients remained c and i date s for resection after the completion of treatment . Six patients ( 6 % ) died after surgery . CONCLUSIONS This novel combined-modality regimen is highly active in the treatment of locoregional esophageal cancer , producing an actuarial 3-year survival of 41 % . Although this preoperative regimen produced moderate acute toxicity , there were no treatment-related deaths and the large majority of patients were able to undergo subsequent esophageal resection . These results , obtained in a community-based setting and involving multiple surgeons , radiation oncologists , and medical oncologists , compare favorably with those of previous single-center and multicenter results . Further evaluation of novel combined-modality programs is warranted , as is the incorporation of epidermal growth factor receptor antagonists or other targeted agents Background A surgical resection is currently the preferred treatment for esophageal cancer if the tumor is considered to be resectable without evidence of distant metastases ( cT1 - 3 N0 - 1 M0 ) . A high percentage of irradical resections is reported in studies using neoadjuvant chemotherapy followed by surgery versus surgery alone and in trials in which patients are treated with surgery alone . Improvement of locoregional control by using neoadjuvant chemoradiotherapy might therefore improve the prognosis in these patients . We previously reported that after neoadjuvant chemoradiotherapy with weekly administrations of Carboplatin and Paclitaxel combined with concurrent radiotherapy nearly always a complete R0-resection could be performed . The concept that this neoadjuvant chemoradiotherapy regimen improves overall survival has , however , to be proven in a r and omized phase III trial . Methods / design The CROSS trial is a multicenter , r and omized phase III , clinical trial . The study compares neoadjuvant chemoradiotherapy followed by surgery with surgery alone in patients with potentially curable esophageal cancer , with inclusion of 175 patients per arm . The objectives of the CROSS trial are to compare median survival rates and quality of life ( before , during and after treatment ) , pathological responses , progression free survival , the number of R0 resections , treatment toxicity and costs between patients treated with neoadjuvant chemoradiotherapy followed by surgery with surgery alone for surgically resectable esophageal adenocarcinoma or squamous cell carcinoma . Over a 5 week period concurrent chemoradiotherapy will be applied on an outpatient basis . Paclitaxel ( 50 mg/m2 ) and Carboplatin ( Area-Under-Curve = 2 ) are administered by i.v . infusion on days 1 , 8 , 15 , 22 , and 29 . External beam radiation with a total dose of 41.4 Gy is given in 23 fractions of 1.8 Gy , 5 fractions a week . After completion of the protocol , patients will be followed up every 3 months for the first year , every 6 months for the second year , and then at the end of each year until 5 years after treatment . Quality of life question naires will be filled out during the first year of follow-up 
    Output:
    
Chemoradiation had a temporary negative effect on quality of life .
CONCLUSION Neoadjuvant chemoradiation regimens for oesophageal cancer vary widely .