***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: This retrospective study was conducted to compare the treatment results between radical surgery and definitive chemoradiotherapy for resectable squamous cell carcinoma of the esophagus . Between June 2000 and May 2005 , 82 consecutive patients were selected for this study in which 33 were treated with  chemoradiotherapy  and 49 with surgery . The patients in the chemoradiotherapy ( CRT ) group received 2 - 4 cycles of 5-fluorouracil ( 1000 mg/m(2)/day , day 1 - 4 , continuous ) combined with cisplatin ( 75 mg/m(2 ) , day 1 , bolus ) plus 50.4 Gy of radiation , while those in the surgery group were treated by an esophagectomy with radical node dissection .  Eighteen surgical patients received postoperative chemotherapy . The baseline clinical TNM stage was similar between the two groups . With a median follow-up period of 36 months ( range : 23 - 84 months ) with 47 survivors ( 57 % ) , the 3-year overall survival rates ( P = 0.22 ) and disease-free survival rates ( P = 0.16 ) were 48 % and 44 % in the chemoradiotherapy group versus 65 % and 59 % in the surgery group , and lacked statistical significance . This non-r and omized study on patients with resectable squamous cell carcinoma of the esophagus showed that chemoradiotherapy could result in survival comparable with conventional surgery in spite of selection bias of patients . There is a trend toward improved survival with surgery versus definitive CRT Background : The optimal treatment for localised oesophageal squamous cell carcinoma ( SCC ) is uncertain . We assessed the feasibility of an RCT comparing neoadjuvant treatment and surgery with definitive chemoradiotherapy . Methods : A feasibility RCT in three centres examined incident patients and reasons for in eligibility using multi-disciplinary team meeting records . Eligible patients were offered participation in the RCT with integrated qualitative research involving audio-recorded recruitment appointments and interviews with patients to inform recruitment training for staff . Results : Of 375 patients with oesophageal SCC , 42 ( 11.2 % ) were eligible .  Reasons for eligibility varied between centres , with significantly differing proportions of patients excluded because of total tumour length ( P=0.002 ) . Analyses of audio-recordings and patient interviews showed that recruiters had challenges articulating the trial design in simple terms , balancing treatment arms and explaining the need for r and omisation . Before analyses of the qualitative data and recruiter training no patients were r and omised . Following training in one centre 5 of 16 eligible patients were r and omised . Conclusions : An RCT of surgical vs non-surgical treatment for SCC of the oesophagus is not feasible in the UK alone because of the low number of incident eligible patients . A trial comparing diverse treatment approaches may be possible with investment to support the recruitment process The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . BACKGROUND The role of neoadjuvant chemoradiotherapy in the treatment of patients with esophageal or esophagogastric-junction cancer is not well established . We compared chemoradiotherapy followed by surgery with surgery alone in this patient population . METHODS We r and omly assigned patients with resectable tumors to receive surgery alone or weekly administration of carboplatin ( doses titrated to achieve an area under the curve of 2 mg per milliliter per minute ) and paclitaxel ( 50 mg per square meter of body-surface area ) for 5 weeks and concurrent radiotherapy ( 41.4 Gy in 23 fractions , 5 days per week ) , followed by surgery . RESULTS From March 2004 through December 2008 , we enrolled 368 patients , 366 of whom were included in the analysis : 275 ( 75 % ) had adenocarcinoma , 84 ( 23 % ) had squamous-cell carcinoma , and 7 ( 2 % ) had large-cell undifferentiated carcinoma . Of the 366 patients , 178 were r and omly assigned to chemoradiotherapy followed by surgery  , and 188 to surgery alone . The most common major hematologic toxic effects in the chemoradiotherapy-surgery group were leukopenia ( 6 % ) and neutropenia ( 2 % ) ; the most common major nonhematologic toxic effects were anorexia ( 5 % ) and fatigue ( 3 % ) . Complete resection with no tumor within 1 mm of the resection margins ( R0 ) was achieved in 92 % of patients in the chemoradiotherapy-surgery group versus 69 % in the surgery group ( P<0.001 ) . A pathological complete response was achieved in 47 of 161 patients ( 29 % ) who underwent resection after chemoradiotherapy . Postoperative complications were similar in the two treatment groups , and in-hospital mortality was 4 % in both . Median overall survival was 49.4 months in the chemoradiotherapy-surgery group versus 24.0 months in the surgery group . Overall survival was significantly better in the chemoradiotherapy-surgery group ( hazard ratio , 0.657 ; 95 % confidence interval , 0.495 to 0.871 ; P=0.003 ) . CONCLUSIONS Preoperative chemoradiotherapy improved survival among patients with potentially curable esophageal or esophagogastric-junction cancer . The regimen was associated with acceptable adverse-event rates . ( Funded by the Dutch Cancer Foundation [ KWF Kankerbestrijding ] ; Netherl and s Trial Register number , NTR487 . ) Methods for combining data from several studies exist and appear to be quite useful . None satisfactorily addresses the question of what studies should be combined . This issue is the most serious method ological limitation . Even studies with statistically significant interaction might still be combined if the effect were in the same direction . Thus , substantial scientific input is required as to what criteria must be met by each potential study . Much can be learned from combining or pooling data but it must be done cautiously . Pooling exercises do not replace well design ed prospect i ve clinical trials . Efforts for establishing basic design criteria to allow for multicentre and multicountry trials to be more easily combined might be useful . PURPOSE Two separate studies were conducted , the first to evaluate the maximal tolerated dose and the second the efficacy of raltitrexed plus oxaliplatin in conjunction with preoperative chemoradiation in patients with resectable T3 rectal carcinoma . METHODS AND MATERIAL S A total of 48 patients received radiotherapy ( 50 Gy ) administered to the posterior pelvis 5 d/wk for 5 weeks . Combination raltitrexed ( 3 mg/m(2 ) ) and oxaliplatin ( 60 to 130 mg/m(2 ) ) was administered on Days 1 , 19 , and 38 . RESULTS The recommended dose of oxaliplatin is 130 mg/m(2 ) ( maximal tolerated dose not reached ) . No patients developed Grade 4 acute toxicity . Grade 3 acute toxicity occurred in 9 patients ( 18.7 % ) . It was hematologic in 1 patient and GI in 1 patient ; 7 patients had an asymptomatic increase of transaminase . Surgery was performed in 47 ( 98 % ) of 48 patients . Of the 47 patients , 42 underwent sphincter-saving surgery ; in 19 , the tumor at diagnosis was located < 30 mm from the anorectal ring . Chemoradiation in combination with raltitrexed and oxaliplatin produced high rates of tumor response . The overall tumor downstaging rate was 73 % for T and N stages . A complete pathologic tumor response ( pT0 ) or microscopic tumor foci ( pTmic ) was observed in 28 patients . The tumor regression grade ( TRG ) , using the M and ard scoring system , was TRG1 in 16 patients ( 43.2 % ) , TRG2 in 12 ( 32.4 % ) , TRG3 in 12 ( 32.4 % ) , TRG4 in 6 ( 16.2 % ) , and TRG5 in 1 patient ( 2.7 % ) . CONCLUSION Raltitrexed plus oxaliplatin combined with pelvic radiotherapy was effective and well tolerated in patients with resectable T3 rectal carcinoma BACKGROUND The aim of this study was to report on the 5-year survival outcomes of patients with resectable esophageal carcinoma who were treated by definitive chemoradiotherapy ( CRT ) or st and ard esophagectomy .  PATIENTS AND METHODS Between July 2000 and December 2004 , 81 patients with resectable squamous cell carcinoma of the mid- or lower thoracic esophagus were r and omized to receive esophagectomy or definitive CRT . The primary outcome was the overall survival and secondary outcomes included disease-free survival , morbidities and mortalities . RESULTS Forty-five patients received esophagectomy and 36 patients were treated by definitive CRT . The overall 5-year survival favors CRT but the difference did not reach statistical significance ( surgery 29.4 % and CRT 50 % , P=0.147 ) . A trend to improved 5-year survival was observed for patients suffering from node-positive disease ( P=0.061 ) . The 5-year disease-free survival also showed a trend to significance favoring CRT ( P=0.068 ) , particularly for patients suffering from node-positive disease ( P=0.017 ) . Both the stage of the disease and albumin level were significant predictors to mortality and disease-free survival . CONCLUSIONS Definitive CRT for squamous esophageal carcinoma result ed in comparable long-term survival to surgery . Further large-scale studies would be required to further investigate the role of CRT in node-positive patients . Clinical trials.gov identifier : NCT01032967 4013 Background : To compare the treatment results between radical surgery and late-course accelerated hyperfractionation radiotherapy ( LCAHFR ) for patients with resectable thoracic segment esophageal cancer . METHODS From June 1998 to September 2002 , 269 patients with resectable thoracic esophageal cancer were r and omized into two groups . 135 were with surgery and 134 with late-course accelerated hyperfractionated ( LCAF ) radiotherapy . Chemotherapy only for clinical recurrence and salvage therapy . RESULTS The 1- , 3- and 5- year overall survival rate were 88.6 % , 56.2 % and 34.7 % in the surgery group and 93.3 % , 61.5 % and 36.9 % in the radiotherapy group . There was no statistical difference between the two groups ( P = 0.58 ) . Median survival was 28.5 months and 30.5 months respectively . The 1- , 3- and 5-year progression-free survival rate was 73.3 % , 39.7 % and 20.6 % in the surgery group and 75.9 % , 43.7 % and 23.1 % in the radiotherapy group ( P = 0.65 ) . There was no difference between the two groups in survival rates including different location and length ( P > 0.05 ) . The incidence of failure by hematogenous metastasis and distant lymphatic metastasis in the radiotherapy group ( 16.6 % and 13.3 % respectively ) was lower than in the surgery group ( 25.3 % and 20.3 % respectively ) , there was no significance between them . The incidence of local failure in the radiotherapy and surgery group was 57.3 % and 27.8 % respectively ( P = 0.001 ) The incidence of death by local reasons was higher than in the surgery group ( P = 0.02 ) . The incidence of death by distant metastasis was lower than in the surgery group ( P = 0.02 ) . CONCLUSION The treatment results between radical surgery and LCAHFR with conformal radiotherapy for patients with resectable thoracic esophageal cancer were comparable . No significant financial relationships to disclose PURPOSE Combined chemoradiotherapy with and without surgery are widely accepted alternatives for the curative treatment of patients with locally advanced esophageal cancer . The value of adding surgery to chemotherapy and radiotherapy is unknown . PATIENTS AND METHODS Patients with locally advanced squamous cell carcinoma ( SCC ) of the esophagus were r and omly allocated to either induction chemotherapy followed by chemoradiotherapy ( 40 Gy ) followed by surgery ( arm A ) , or the same induction chemotherapy followed by chemoradiotherapy ( at least 65 Gy ) without surgery ( arm B ) . Primary outcome was overall survival time . RESULTS The median observation time was 6 years . The analysis of 172 eligible , r and omized patients ( 86 patients per arm ) showed overall survival to be equivalent between the two treatment groups ( log-rank test for equivalence , P < .05 ) . Local progression-free survival was better in the surgery group ( 2-year progression- 
    Output:
    
Based on low quality evidence , chemoradiotherapy appears to be at least equivalent to surgery in terms of short-term and long-term survival in people with oesophageal cancer ( squamous cell carcinoma type ) who are fit for surgery and are responsive to induction chemoradiotherapy .
However , there is uncertainty in the comparison of definitive chemoradiotherapy versus surgery for oesophageal cancer ( adenocarcinoma type ) and we can not rule out significant benefits or harms of definitive chemoradiotherapy versus surgery .
Based on very low quality evidence , radiotherapy results in less long-term survival than surgery in people with oesophageal cancer who are fit for surgery .
Early identification of responders to chemoradiotherapy and better second-line treatment for non-responders will also increase the need and acceptability of trials that compare definitive chemoradiotherapy with surgery