***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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    Input: PURPOSE Recent studies have suggested an alpha/beta ratio in prostate cancer of 1.5 - 3 Gy , which is lower than that assumed for late-responsive normal tissues . Therefore the administration of a single , intraoperative dose of irradiation should represent a convenient irradiation modality in prostate cancer . MATERIAL S AND METHODS Between February 2002 and June 2004 , 34 patients with localized prostate cancer with only one risk factor ( Gleason score > or = 7 , Clinical Stage [ cT ] > or = 2c , or prostate-specific antigen [ PSA ] of 11 - 20 ng/mL ) and without clinical evidence of lymph node metastases were treated with radical prostatectomy ( RP ) and intraoperative radiotherapy on the tumor bed . A dose-finding procedure based on the Fibonacci method was employed . Dose levels of 16 , 18 , and 20 Gy were selected , which are biologically equivalent to total doses of about 60 - 80 Gy administered with conventional fractionation , using an alpha/beta ratio value of 3 . RESULTS At a median follow-up of 41 months , 24 ( 71 % ) patients were alive with an undetectable PSA value . No patients died from disease , whereas 2 patients died from other malignancies . Locoregional failures were detected in 3 ( 9 % ) patients , 2 in the prostate bed and 1 in the common iliac node chain outside the radiation field . A PSA rise without local or distant disease was observed in 7 ( 21 % ) cases . The overall 3-year biochemical progression-free survival rate was 77.3 % . CONCLUSIONS Our dose-finding study demonstrated the feasibility of intraoperative radiotherapy in prostate cancer also at the highest administered dose PURPOSE We evaluated patients at our institution who underwent radical prostatectomy for clinical stage T3 prostate cancer to determine their long-term clinical outcomes . MATERIAL S AND METHODS We review ed our prospect i ve surgical data base and identified 176 men who underwent radical retropubic prostatectomy for clinical stage T3 prostate cancer from 1983 to 2003 . Clinical and pathological data were review ed and evaluated in a Cox proportional hazards model to determine preoperative predictors of biochemical recurrence . Clinical progression following biochemical recurrence was evaluated and clinical failure was defined as the development of clinical metastases or progression to hormone refractory prostate cancer . RESULTS Of the 176 patients with cT3 prostate cancer 64 ( 36 % ) received neoadjuvant hormonal therapy . At a mean followup of 6.4 years 84 ( 48 % ) patients had disease recurrence with a median time to biochemical recurrence of 4.6 years . The actuarial 10-year probability of freedom from recurrence was 44 % . On multivariate analysis biopsy Gleason score , pretreatment serum prostate specific antigen and year of surgery were independent predictors of biochemical recurrence . Neoadjuvant hormonal therapy was not a significant predictor of biochemical recurrence . Following biochemical recurrence clinical failure developed in 30 of 84 ( 36 % ) men with a median time of 11 years . Overall the 5 , 10 and 15-year probabilities of death from prostate cancer were 6 % , 15 % and 24 % , respectively . CONCLUSIONS More than half ( 52 % ) of our patients remained free of disease recurrence following radical prostatectomy . In our series neoadjuvant hormonal therapy offered no advantage with respect to disease recurrence .  Radical prostatectomy remains an integral component in the treatment of select patients with clinical stage T3 prostate cancer BACKGROUND To present the technique and dose distribution of intraoperative radiotherapy ( IORT ) for prostate cancer . PATIENTS AND METHODS Pelvic lymphadenectomy , prostate IORT and radical retropubic prostatectomy was performed in 11 prostate cancer patients . Prostate thickness and rectum depth were measured with intraoperative ultrasound . IORT was delivered by a mobile linear accelerator in the operating room ( electron beam , 12 Gy at 90 % isodose ) . RESULTS The mean preoperative probability of organ-confined disease was 10 % ( Memorial Sloan Kettering Cancer Center nomograms ) . Mean prostate thickness , width and length were 3.4 cm , 4.6 and 4.9 cm , respectively . Mean rectum depth was 3.3 cm . Mean doses to the posterior prostate capsule , 5-mm lateral prostate margins and at the subsequent uretheral stump area were 4.6 Gy , 8 . 7 Gy and 11.3 Gy , respectively . Maximum mean rectal dose was 4.9 Gy . CONCLUSION IORT appeared a feasible approach for prostate cancer , showing a satisfactory dose coverage to the prostate bed with relatively low rectal dose . However , high variability in dose distribution calls for further study of patient selection criteria and dosimetry Radiotherapy  and and rogen deprivation in combination  after local surgery ( RADICALS ) : A new Medical Research Council/National Cancer Institute of Canada phase III trial of  adjuvant treatment after radical prostatectomy  Chris Parker , Matthew R. Sydes 1 , Charles Catton 2 , Howard Kynaston 3 , John Logue , Claire Murphy 1 , Rachel C. Morgan 1 , Kilian Mellon 5 , Chris Morash 6 , Wendy Parulekar 7 , Mahesh K.B. Parmar 1 , Heather Payne 8 , Colleen Savage 7 , Jim Stansfeld 9 and Noel W. Clarke 10 ( The RADICALS Trial Management Group ) Academic Unit of Radiotherapy & Oncology , Institute of Cancer Research and the Royal , Marsden NHS Foundation Trust , Sutton , Surrey , 1 Medical Research Council ( MRC ) Clinical Trials Unit , London , UK , 2 Princess Margaret Hospital , Toronto , Ontario , Canada , 3 Department of Urology , University Hospital of Wales , Heath Park , Cardiff , 4 Christie Hospital NHS Trust , Manchester , UK , 5 Urology Section , University of Leicester , UK , 6 University of Ottawa , The Ottawa Hospital General Campus , Ottawa , 7 National Cancer Institute of Canada ( NCIC ) Clinical Trials Group , Kingston , Ontario , Canada , 8 Department of Oncology , University College Hospital , London , UK , 9 Hon . Treasurer , PCaSO Prostate Cancer Network , Emsworth , Hants , UK , 10 Salford Royal Hospitals NHS Trust , Salford , BACKGROUND We did a r and omised phase III trial comparing external irradiation alone and external irradiation combined with an analogue of luteinising-hormone releasing hormone ( LHRH ) to investigate the added value of long-term and rogen suppression in locally advanced prostate cancer . METHODS Between 1987 and 1995 , 415 patients were r and omly assigned radiotherapy alone or radiotherapy plus immediate and rogen suppression . Eligible patients had T1 - 2 tumours of WHO grade 3 or T3 - 4 N0 - 1 M0 tumours ; the median age of participants was 71 years ( range 51 - 80 ) . In both treatment groups , 50 Gy radiation was delivered to the pelvis over 5 weeks , and 20 Gy over 2 weeks as a prostatic boost . Goserelin ( 3.6 mg subcutaneously every 4 weeks ) was started on the first day of irradiation and continued for 3 years ; cyproterone acetate ( 150 mg orally ) was given for 1 month starting 1 week before the first goserelin injection . The primary endpoint was clinical disease-free survival . Analyses were by intention to treat . FINDINGS 412 patients had evaluable data , with median follow-up of 66 months ( range 1 - 126 ) . 5-year clinical disease-free survival was 40 % ( 95 % CI 32 - 48 ) in the radiotherapy-alone group and 74 % ( 67 - 81 ) in the combined-treatment group ( p=0.0001 ) . 5-year overall survival was 62 % ( 52 - 72 ) and 78 % ( 72 - 84 ) , respectively ( p=0.0002 ) and 5-year specific survival 79 % ( 72 - 86 ) and 94 % ( 90 - 98 ) . INTERPRETATION Immediate and rogen suppression with an LHRH analogue given during and for 3 years after external irradiation improves disease-free and overall survival of patients with locally advanced prostate cancer CONTEXT Despite a stage-shift to earlier cancer stages and lower tumor volumes for prostate cancer , pathologically advanced disease is detected at radical prostatectomy in 38 % to 52 % of patients . However , the optimal management of these patients after radical prostatectomy is unknown . OBJECTIVE To determine whether adjuvant radiotherapy improves metastasis-free survival in patients with stage pT3 N0 M0 prostate cancer . DESIGN , SETTING , AND PATIENTS R and omized , prospect i ve , multi-institutional , US clinical trial with enrollment between August 15 , 1988 , and January 1 , 1997 ( with data base frozen for statistical analysis on September 21 , 2005 ) . Patients were 425 men with pathologically advanced prostate cancer who had undergone radical prostatectomy . INTERVENTION Men were r and omly assigned to receive 60 to 64 Gy of external beam radiotherapy delivered to the prostatic fossa ( n = 214 ) or usual care plus observation ( n = 211 ) . MAIN OUTCOME MEASURES Primary outcome was metastasis-free survival , defined as time to first occurrence of metastatic disease or death due to any cause . Secondary outcomes included prostate-specific antigen ( PSA ) relapse , recurrence-free survival , overall survival , freedom from hormonal therapy , and postoperative complications . RESULTS Among the 425 men , median follow-up was 10.6 years ( interquartile range , 9.2 - 12.7 years ) . For metastasis-free survival , 76 ( 35.5 % ) of 214 men in the adjuvant radiotherapy group were diagnosed with metastatic disease or died ( median metastasis-free estimate , 14.7 years ) , compared with 91 ( 43.1 % ) of 211 ( median metastasis-free estimate , 13.2 years ) of those in the observation group ( hazard ratio [ HR ] , 0.75 ; 95 % CI , 0.55 - 1.02 ; P = .06 ) . There were no significant between-group differences for overall survival ( 71 deaths , median survival of 14.7 years for radiotherapy vs 83 deaths , median survival of 13.8 years for observation ; HR , 0.80 ; 95 % CI , 0.58 - 1.09 ; P = .16 ) . PSA relapse ( median PSA relapse-free survival , 10.3 years for radiotherapy vs 3.1 years for observation ; HR , 0.43 ; 95 % CI , 0.31 - 0.58 ; P<.001 ) and disease recurrence ( median recurrence-free survival , 13.8 years for radiotherapy vs 9.9 years for observation ; HR , 0.62 ; 95 % CI , 0.46 - 0.82 ; P = .001 ) were both significantly reduced with radiotherapy . Adverse effects were more common with radiotherapy vs observation ( 23.8 % vs 11.9 % ) , including rectal complications ( 3.3 % vs 0 % ) , urethral strictures ( 17.8 % vs 9.5 % ) , and total urinary incontinence ( 6.5 % vs 2.8 % ) . CONCLUSIONS In men who had undergone radical prostatectomy for pathologically advanced prostate cancer , adjuvant radiotherapy result ed in significantly reduced risk of PSA relapse and disease recurrence , although the improvements in metastasis-free survival and overall survival were not statistically significant . Trial Registration clinical trials.gov Identifier : NCT00394511 
    Output:
    
IOERT represents a feasible technique with acceptable surgical time and minimal toxicity .