***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 Uterine carcinosarcoma ( CS ) is a rare uterine tumor with an extremely poor prognosis . In the adjuvant setting , efficacy has been shown with radiotherapy ( RT ) , systemic chemotherapy , or both . This is the first report describing the efficacy and toxicity of adjuvant ifosfamide or ifosfamide plus cisplatin " s and wiched " with RT in patients with surgically staged and completely resected uterine carcinosarcoma . METHODS Women with surgically staged CS with no gross residual disease were initially administered ifosfamide ( 1.2 g/m(2)/day × 5 days ) with cisplatin ( 20 mg/m(2)/day × 5 days ) every 3 weeks for 3 cycles followed by pelvic external beam RT and brachytherapy followed by 3 additional cycles of ifosfamide ( 1.0 g/m2/day ) with cisplatin ( 20 mg/m(2)/day × 5 days ) every 3 weeks . Similar to the GOG trial in recurrent CS ( Sutton et al. , 2000 ) , the addition of cisplatin added toxicity without additional efficacy , so mid- study , the cisplatin was eliminated from the regimen . Toxicities were recorded and disease-free survival ( DFS ) was calculated with Kaplan-Meier statistical methods . RESULTS In total , 12 patients received ifosfamide and cisplatin and 15 patients received  ifosfamide alone , both 's and wiched ' with RT . The median follow up was 35.9 months ( range 6 - 88 ) . The 2 year DFS was similar in both the ifosfamide/cisplatin and ifosfamide groups ( log-rank p=0.16 ) , so they were combined for analysis . 19 patients ( 70 % ) completed the protocol . As expected , stage 1 patients had a better 2-year DFS ( 18.75 ± 1.12 months ; log-rank p=0.008 when compared to stages 2 , 3 , 4 ) . Also , in stages 2 , 3 and 4 patients , the DFS was 15.81 ± 1.73 months . Grade 3/4 neutropenia , anemia and thrombocytopenia occurred in 18 % , 4 % and 4 % of cycles , respectively . CONCLUSIONS Ifosfamide " s and wiched " with RT appears to be an efficacious regimen for surgically staged CS patients with no residual disease , even in patients with advanced stage . The addition of cisplatin to the regimen added toxicity without improving efficacy . Even with ifosfamide alone , the efficacy of this 's and wich ' regimen comes with a moderate but tolerable toxicity profile OBJECTIVES The appropriate sequencing of chemotherapy and radiation for the treatment of advanced endometrial cancer has not yet been determined . We sought to evaluate the outcome and adverse effects in patients with advanced stage endometrial cancer treated with postoperative chemotherapy and radiation  to determine whether there was an advantage to a particular sequencing modality . METHODS A multicenter retrospective analysis of patients with surgical stages III and IV endometrial cancer from 1993 to 2007 was conducted . Inclusion criteria were comprehensive staging procedure including  hysterectomy  ,  bilateral salpingo-oophorectomy  ,  + /- selective pelvic/aortic lymphadenectomy , and treatment with adjuvant chemotherapy and radiation . Differences in frequencies of adverse events were tested with Pearson 's chi-square test for comparing proportions . OS and PFS rates were calculated using Kaplan-Meier estimates . Hazard Ratios ( HR ) were estimated from multivariate Cox proportional hazards models . RESULTS One hundred and nine patients with advanced stage endometrial cancer were identified who received  postoperative adjuvant therapies ; 41 % ( n=45 ) chemotherapy followed by radiation and then further chemotherapy ( CRC ) , 17 % ( n=18 ) radiation followed by chemotherapy ( RC ) , and 42 % ( n=46 ) chemotherapy followed by radiation ( CR ) . The median age was 62 years ( range : 35 - 83 ) ; 48 % had endometrioid tumors ; and 90 % underwent optimal cytoreduction . There was no difference in the frequency of adverse effects due to either chemotherapy ( p=0.35 ) or radiotherapy ( p=0.14 ) ; dose modifications ( p=0.055 ) ; or delays ( p=0.80 ) between the various sequencing modalities . There was a significant difference between adjuvant treatment groups for both OS ( log rank p=0.011 ) and PFS ( log rank p=0.025 ) , with those receiving CRC having a superior 3-year OS ( 88 % ) and PFS ( 69 % ) compared to RC ( 54 % and 47 % ) or CR ( 57 % and 52 % ) . After adjusting for stage , age , grade , race , histology and cytoreduction status the OS HR for therapy was 5.74 ( 95 % CI , 1.96 to 16.77 ) for RC and 2.60 ( 95 % CI , 1.01 to 6.71 ) for CR , compared to CRC , p=0.003 . When the analysis was restricted to optimally cytoreduced patients , those who were treated with RC were at higher risk for disease progression [ HR=3.53 ( 95 % CI , 1.29 to 9.71 ) ] , p=0.024 , and death [ HR=7.24 ( 95 % CI , 2.25 to 23.37 ) ] , p=0.001 , than patients who received sequential CRC . CONCLUSIONS Sequential CRC was associated with improved survival in women with advanced stage disease compared to other sequencing modalities with a similar adverse effect profile . Future clinical trials are needed to prospect ively evaluate appropriate sequencing and types of adjuvant chemotherapy and radiotherapy for the treatment of advanced stage endometrial cancer OBJECTIVE We sought to evaluate the outcomes and feasibility associated with delivering sequential chemotherapy and radiation in advanced stage endometrial cancer . METHODS We conducted a retrospective analysis of patients treated at the University of Minnesota with sequential chemotherapy and radiation for advanced stage endometrial cancer from 1999 to 2007 . Inclusion criteria were endometrial cancer patients treated with comprehensive surgical staging followed by adjuvant therapy consisting of sequential chemotherapy , radiation , and consolidation chemotherapy in a " s and wich " fashion . Progression free survival ( PFS ) and overall survival ( OS ) were calculated by Kaplan-Meier ( KM ) method . RESULTS Twenty-three patients met entry criteria and were included in the analysis . The median age was 57 years ( range 28 - 78 ) . The majority of patients were stage III ( 78 % ) and the most common histologic type was serous ( 52 % ) . The combination of a taxane and carboplatin was administered in 100 % of cases . All planned cycles of chemotherapy were completed ( 100 % ) with the majority being prescribed six cycles ( 82 % ) . Of the 23 patients , 5 progressed of which 3 died during the follow up period . The KM estimate of 1 , 3 , and 5 year PFS is 100 % , 80 % , and 74 % , respectively . The KM estimate for 1 , 3 , and 5 year OS is 100 % , 88 % and 79 % , respectively . CONCLUSION Adjuvant therapy delivered in a " s and wich " fashion was feasible , well-tolerated and result ed in excellent long-term progression free and overall survival . A prospect i ve study is currently ongoing at our institution OBJECTIVE To determine feasibility and efficacy of administering docetaxel and carboplatin chemotherapy followed by pelvic radiotherapy and then consolidation chemotherapy in patients with advanced or recurrent endometrial cancer . METHODS Patients with surgically staged III-IV ( excluding IIIA from positive cytology alone ) endometrial cancer or biopsy confirmed recurrent disease were eligible . Treatment consisted of 3 cycles of docetaxel ( 75 mg/m² ) and carboplatin ( AUC 6 ) on a q21 day schedule followed by involved field irradiation ( 45 Gy)± brachytherapy and three additional cycles of docetaxel and carboplatin . Kaplan-Meier ( KM ) methods estimated overall survival ( OS ) and progression free survival ( PFS ) . RESULTS Forty-two patients enrolled , 7 did not complete therapy . 95 % ( 39/41 ) had primary disease . Median age=58 years ( range : 21 - 81 years ) . 78 % (32/41)=endometrioid histology . Stages=10 IIIA , 21 IIIC , 1 IVA , 7 IVB , ( recurrent=1 IC , 1 IIA ) . There were 23 non-hematologic and 14 grade 3 and 16 grade 4 hematologic toxicities . Seven patients died following treatment with a median follow-up of 28 months ( range : 7 - 70 months ) . KM estimates and 95 % confidence intervals for OS at 1 year were 95 % ( 82 - 99 % ) , at 3 years 90 % ( 75 - 96 % ) , and at 5 years 71 % ( 45 - 86 % ) . Of the 39 with primary disease , 11 progressed or died within 5 years of study enrollment . KM estimates and 95 % confidence intervals for PFS at 1 year were 87 % ( 72 - 94 % ) , at 3 years 71 % ( 51 - 83 % ) , and at 5 years 64 % ( 42 - 80 % ) . CONCLUSIONS " S and wiching " radiation between chemotherapy for advanced or recurrent endometrial cancer merits further development based on the reported PFS and OS OBJECTIVES To evaluate disease-free survival ( DFS ) and overall survival ( OS ) in patients treated with pelvic radiation " s and wiched " between six cycles of paclitaxel(T)/platinum(P ) chemotherapy with optimally reduced uterine papillary serous carcinoma ( UPSC ) . METHODS Surgically staged patients with UPSC and no visible residual disease were enrolled . Treatment involved T ( 175 mg/m2 ) and either cisplatin ( 75 mg/m2 ) or carboplatin ( AUC=6.0 , 6.5 , 7.5 ) every 21 days x 3 doses , followed by pelvic RT ( 45 Gy ) . Fields were extended for > 2 positive pelvic or confirmed para-aortic node disease . Three additional cycles of T/P were administered after RT . Toxicity was grade d by NCI CTC Version 3.0 . Kaplan-Meier survival statistics were used for DFS/OS . RESULTS 30 women were enrolled between 1999 and 2004 . Median age was 69 years ( 45 - 82 years ) . 60 % ( 18/30 ) of patients had disease confined to the uterus ( Stage I/II ) and 40 % ( 12/30 ) had extra-uterine disease ( Stage III/IV ) . 29 patients completed protocol treatment . One patient was discontinued due to non-compliance and recurred at 7 months . All 30 patients are included in survival analysis . Three-year DFS and OS with Stage I/II disease was 69 % and 75 % and Stage III/IV disease was 54 % and 52 % , respectively . Of 177 chemotherapy cycles administered , grade 3 or 4 neutropenia , thrombocytopenia or anemia occurred in 42 % , 1 % and 3 % of cycles , respectively . Six cycles were delayed 1 week for neutropenia . 43 % of all neutropenic episodes occurred after RT . CONCLUSION Radiation " s and wiched " between T/P chemotherapy is a well-tolerated and efficacious regimen for patients with completely resected UPSC . A larger multi-institutional clinical trial should be considered to confirm these pilot data OBJECTIVE To evaluate recurrence and survival associated with adjuvant carboplatin and paclitaxel chemotherapy interposed with involved field radiation for advanced endometrial cancer . METHOD This is a prospect i ve cohort study of women with Stage III and IV endometrial cancer treated at a single institution between April 2002 and July 2006 .  Adjuvant therapy consisted of 4 cycles of intravenous paclitaxel ( 175 mg/m(2 ) ) and carboplatin ( 350 mg/m(2 ) ) every 3 weeks , followed by external beam radiotherapy ( RT ) to the pelvis ( 45 Gy ) , then another 2 cycles of chemotherapy . Para-aortic RT and /or HDR vault brachytherapy were added at the discretion of the treating physician . Toxicity of this protocol was previously reported . Primary endpoints for this study were disease-free and overall survival rates . RESULTS Forty-three patients with a median age of 64 years ( 46 - 83 years ) were evaluated . The majority had Stage IIIC disease ( 63 % ) , and the most common histology was serous carcinoma ( 49 % ) . Six cycles of combination chemotherapy were completed in 81 % , and all patients completed pelvic RT . Median follow-up was 30 months ( 9 - 71 months ) . Twenty-one patients ( 49 % ) recurred at a median of 
    Output:
    
And most data showed “ s and wich ” therapy is feasible , efficacious , well-tolerated and result ed in excellent long-term progression free and overall survival in the setting of advanced endometrial cancer .