***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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    ***EXAMPLES*** 
    Input: From November 1977 to July 1981 , 441 patients with cervical carcinoma were r and omized between pelvic irradiation and pelvic and para-aortic irradiation .  Included were patients with stage I and IIB with proximal vaginal and /or parametrial involvement with positive pelvic lymph nodes either on lymphangiogram or at surgery , and stage IIB with distal vaginal and /or parametrial involvement and III regardless of pelvic node status on lymphangiogram . Patients with clinical ly or surgically involved para-aortic nodes were not included . The external beam dose to the para-aortic area was fixed at 45 Gy . There was no statistically significant difference between the two treatment arms in terms of local control , overall distant metastases and survival with no evidence of disease ( NED ) , although the incidence of para-aortic metastases and distant metastases without tumor at pelvic sites was significantly higher in patients receiving pelvic irradiation alone ( pelvic group ) . The 4-year NED survival rate was 51 % . The incidence of severe digestive complications was significantly higher in patients receiving para-aortic irradiation ( para-aortic group ) . Routine para-aortic irradiation for all high risk patients with cervical carcinoma is of limited value , but patients with a high probability of local control can benefit from extended field irradiation , despite an increase in severe digestive complications Experimental evidence suggests that the hypoxic fraction in a solid tumor may increase its malignant potential and reduce its sensitivity towards non-surgical treatment modalities ( e.g. st and ard irradiation , certain anticancer agents ) . However , the clinical importance of tumor hypoxia remains uncertain since valid methods for the routine measurement of intratumoral O2-tensions in patients have so far been lacking . A clinical ly applicable st and ardized procedure has been established which enables the determination of intratumoral oxygen tensions in advanced cervical cancers by use of a computerized polarographic needle electrode histography system . Tumor oxygenation as measured by this method represents a novel tumor feature which can be individually determined for each tumor and which is independent from other known oncological parameters . The results of an interim analysis of an open prospect i ve clinical trial to evaluate the prognostic significance of tumor oxygenation based on the survival data of the first 31 patients are presented . Fifteen patients have been treated by primary radiation , 11 patients received multimodality therapy including irradiation .  After a median follow-up of 19 months ( range 5 - 31 months ) , Kaplan-Meier-life table analysis showed significantly lower survival and recurrence-free survival for patients with a median pO2 of < or = 10 mmHg compared to those with better oxygenated tumors ( median pO2 > 10 mmHg ) . The Cox proportional hazards model revealed that the median pO2 and the clinical stage according to the FIGO are independent , highly significant predictors of survival and recurrence-free survival . We conclude from these preliminary results that tumor oxygenation as determined with this st and ardized procedure appears to be a new independent prognostic factor influencing survival in advanced cancer of the uterine cervix PURPOSE To test the hypothesis that cisplatin ( CDDP ) administered concurrently with st and ard radiotherapy ( RT ) would improve pelvic control and survival in patients with advanced squamous cell cancer of the cervix . PATIENTS AND METHODS A total of 259 patients with International Federation of Gynecology and Obstetrics stage IB to IVA squamous cell cervical cancer with central disease greater-than-or-equal 5 cm or histologically confirmed pelvic lymph node involvement were r and omized to receive RT ( external-beam RT plus brachytherapy ) plus weekly CDDP chemotherapy ( 40 mg/m(2 ) ) ( arm 1 ) or the same RT without chemotherapy ( arm 2 ) . RESULTS A total of 253 patients were available for analysis . Median follow-up was 82 months . No significant difference was found in progression-free survival ( P = .33 ) . No significant difference in 3- and 5-year survival rates was found ( 69 % v 66 % and 62 % v 58 % , respectively ; P = .42 ) . The hazard ratio for survival ( arm 2 to arm 1 ) was 1.10 ( 95 % confidence interval , 0.75 to 1.62 ) . CONCLUSION This study did not show a benefit to either pelvic control or survival by adding concurrent weekly CDDP chemotherapy in a dose of 40 mg/m(2 ) to radical RT as given in this trial . Careful attention to RT details is important for achieving optimum outcome for patients with this disease Patients with advanced cervical carcinoma are treated routinely with radiotherapy and cisplatin‐containing chemotherapy . It has been shown that hyperthermia can improve the results of both radiotherapy and cisplatin . In the current study , the feasibility and efficacy of the combination of all three modalities was studied in previously untreated patients with cervical carcinoma PURPOSE To assess the impact of tumor size and extent , and dose of irradiation on pelvic tumor control , incidence of distant metastases , and disease-free survival in carcinoma of the uterine cervix . METHODS AND MATERIAL S Records were review ed of 1499 patients ( Stages IA-IVA ) treated with definitive irradiation ( combination of external beam plus two intracavitary insertions to deliver doses of 65 - 95 Gy to point A , depending on stage and tumor volume ) . Follow-up was obtained in 98 % of patients ( median 11 years , minimum 3 years , maximum 30 years ) . The relationship between outcome and tumor size was analyzed in each stage . Pelvic tumor control was correlated with total doses to point A and to the lateral pelvic wall . RESULTS The 10-year actuarial pelvic failure rate in Stage IB was 5 % for tumors < 2 cm , 15 % for 2.1 - 5 cm , and 35 % for tumors > 5 cm ( p = 0.01 ) ; in Stage IIA , the rates were 0 % , 28 % , and 25 % , respectively ( p = 0.12 ) . Stage IIB unilateral or bilateral nonbulky tumors < 5 cm had a 23 % pelvic failure rate compared with 34 % for unilateral or bilateral bulky tumors > 5 cm ( p = 0.13 ) . In Stage IIB , pelvic failures were 18 % with medial parametrial involvement only , compared with 28 % when tumor extended into the lateral parametrium ( p = 0.05 ) . In Stage III , unilateral parametrial involvement was associated with a 32 % pelvic failure rate versus 50 % for bilateral extension ( p < 0.01 ) . Ten-year disease-free survival rates were 90 % for IB tumors < 2 cm , 76 % for 2.1 - 4 cm , 61 % for 4.1 - 5 cm , and 47 % for > 5 cm ( p = 0.01 ) ; in Stage IIA , the rates were 93 % , 63 % , 39 % , and 59 % , respectively ( p < or = 0.01 ) . Patients with Stage IIB medial parametrial involvement had better 10-year disease-free survival ( 67 % ) than those with lateral parametrial extension ( 56 % ) ( p = 0.02 ) . Stage III patients with unilateral tumor extension had a 48 % 10-year disease-free survival rate compared with 32 % for bilateral parametrial involvement ( p < or = 0.01 ) . The presence of endometrial extension or tumor only in the endometrial curettings had no significant impact on pelvic failure . However , in patients with Stage IB disease , the incidence of distant metastases was 31 % with positive curettings , 15 % with negative curettings , and 22 % with admixture ( p < or = 0.01 ) . In Stage IIA , the corresponding values were 51 % , 33 % , and 18 % ( p = 0.05 ) . The 10-year disease-free survival rates in Stage IB were 67 % with positive curettings , 81 % for negative curettings , and 77 % for admixture ( p = 0.02 ) ; in Stage IIA , the rates were 45 % , 66 % , and 67 % , respectively ( p = 0.14 ) . Because this is not a prospect i ve Phase II dose-escalation study , the correlation of doses of irradiation with pelvic tumor control in the various stages and tumor size groups is not consistent . Nevertheless , with Stage IB and IIA tumors < 2 cm in diameter , the pelvic failure rate was under 10 % with doses of 70 - 80 Gy to point A , whereas for larger lesions even doses of 85 - 90 Gy result ed in 25 % to 37 % pelvic failure rates . In Stage IIB with doses of 70 Gy to point A , the pelvic failure rate was about 50 % compared with about 20 % in nonbulky and 30 % in bulky tumors with doses > 80 Gy . In Stage III unilateral lesions , the pelvic failure rate was about 50 % with < or = 70 Gy to point A versus 35 % with higher doses , and in bilateral or bulky tumors it was 60 % with doses < 70 Gy and 50 % with higher doses . CONCLUSIONS Clinical stage and size of tumor are critical factors in prognosis , therapy efficacy , and evaluation of results in carcinoma of the uterine cervix . The doses to point A suggest that for lesions < 2 cm , doses of 75 Gy result in < or = 10 % pelvic failures , whereas in more extensive lesions , even with doses of 85 Gy , the pelvic failure rate is about 30 % ; and in Stage IIB-III tumors , doses of 85 Gy result in 35 - 50 % pelvic failures . Refinements in brachytherapy techniques and /or use of agents to selectively sensitize the tumors to irradiation will be necessary to improve the present results in invasive carcinoma of Background In the United Kingdom ( UK ) , there is an extensive market for the class ' A ' drug heroin . Many heroin users spend time in prison . People addicted to heroin often require prescribed medication when attempting to cease their drug use . The most commonly used detoxification agents in UK prisons are buprenorphine , dihydrocodeine and methadone . However , national guidelines do not state a detoxification drug of choice . Indeed , there is a paucity of research evaluating the most effective treatment for opiate detoxification in prisons . This study seeks to address the paucity by evaluating routinely used interventions amongst drug using prisoners within UK prisons . Methods / Design The Leeds Evaluation of Efficacy of Detoxification Study ( LEEDS ) Prisons Pilot Study will use r and omised controlled trial methodology to compare the open use of buprenorphine and dihydrocodeine for opiate detoxification , given in the context of routine care , within HMP Leeds . Prisoners who are eligible and give informed consent will be entered into the trial . The primary outcome measure will be abstinence status at five days post detoxification , as determined by a urine test . Secondary outcomes during the detoxification and then at one , three and six months post detoxification will be recorded Summary We investigated the feasibility and the anti-tumour activity of weekly cisplatin and the simultaneous application of local hyperthermia in patients with a pelvic recurrence of cervical cancer in previously irradiated area . Dose levels of cisplatin 60 mg m–2 , 70 mg m–2 and 80 mg m–2 were studied . Treatment objective of hyperthermia was the achievement of a tumour temperature of ≥ 42 ° for 60 min , during cisplatin administration . The protocol advised six weekly cycles of combined treatment . Nineteen patients , median age 47 years ( range 26–71 ) , were treated . A total of 89 cycles of combined treatment were administered . Even at the highest dose level of cisplatin , 80 mg m–2 weekly , no dose-limiting toxicity was observed . Leucocytopenia at scheduled retreatment result ed in 1 or 2 weeks postponement in five cases . Neurotoxicity and renal toxicity were mild or absent . Maximum tumour temperatures achieved ranged 39.7–43.6 ° C , mean 41.6 ± 0.7 ° C . All 19 patients were evaluable for response . One patient achieved a complete response that lasted 20 months , and nine patients achieved a partial response for a median duration of 6 months ( range 4–50 + months ) , for an overall response rate of 53 % . One patient subsequently underwent salvage surgery and currently remains free of disease at 4 years . We found that this combined hyperthermia- dose-intensive cisplatin regimen was well-tolerated . The true impact of the combination of cisplatin and locoregional hyperthermia can only be answered in a r and omized study . Nonetheless , based on existing data on the poor efficacy of cisplatin in pelvic recurrent cervical cancer , we believe that the combined modality approach of weekly hyperthermia plus dose-intensive cisplatin is an attractive regimen , particularly if subsequent salvage surgery is available PURPOSE The local failure rate in patients with locoregionally advanced cervical cancer is 41 - 72 % after radiotherapy ( RT ) alone , whereas local control is a prerequisite for cure . The Dutch Deep Hyperthermia Trial showed that combining RT with 
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Treatment outcome was significantly better for patients receiving the combined treatment ( Figures 4 to 6 ) .
The limited number of patients available for analysis , method ological flaws and a significant over-representation of patients with FIGO stage IIIB prohibit drawing definite conclusions regarding the impact of adding hyperthermia to st and ard radiotherapy .
However , available data do suggest that the addition of hyperthermia improves local tumour control and overall survival in patients with locally advanced cervix carcinoma without affecting treatment related grade 3 to 4 acute or late toxicity