***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: BACKGROUND / AIMS Hepatocellular carcinoma ( HCC ) remains a disease with a poor prognosis . Several different therapies have been recommended for use as adjuvant treatment for this disease . One of the most promising therapies is targeted locoregional immuno-chemotherapy . MATERIAL S AND METHODS From 1990 to 1996 , 91 patients who were eligible for liver resection were treated in a prospect i ve r and omized study . Forty-two patients received resection alone ( Group A ) and 49 received resection plus chemoembolization and targeted locoregional immuno-chemotherapy ( Group B ) . RESULTS The mortality rate for these two groups was significantly different ( 13 % vs 4 % ) favoring Group B. Overall survival was also significantly different ( 18 months vs 36.3 months ) again favoring Group B. CONCLUSIONS Although prognosis is still miserable for HCC , the approach of targeted locoregional immuno-chemotherapy can offer new hope of improved resectability and survival OBJECTIVE To study the efficiency of arterial infusion chemotherapy via drug delivery system ( DDS ) for advanced primary hepatic carcinoma . METHODS Hepatic arterial infusion chemotherapy was performed in 82 cases of primary hepatic carcinoma with no indication for operation or transarterial embolism treatment . The patients were divided into 2 group as follows : ( 1 ) Group A : 42 patients were treated intra-arterially once every 1 or 2 weeks via implanted DDS . ( 2 ) Group B : 40 patients were treated through one bolus arterial infusion chemotherapy , once every month . RESULTS The response rate ( CR + PR ) was 38.1 % and 15.0 % respectively in group A and B ( P < 0.05 ) ; the 0.5- , 1- and 2- year survival rate was 61.9 % , 28.6 % and 9.5 % respectively in group A , but 20 % , 5 % , 0 % respectively in group B ( P < 0.01 ) ; Liver , biliary , gastrointestinal and bone marrow toxicity in group A patients was greatly lower than those in group B patients . CONCLUSION Intermittent arterial infusion chemotherapy via DDS significantly improves survival and quality of life in patients with advanced primary hepatic carcinoma Lipiodol injected into the hepatic artery is selectively retained in hepatomas so has been used as a vehicle for cytotoxic drugs . This study compared treatment with 5-epidoxorubicin emulsified in lipiodol and infused into the hepatic artery with symptomatic treatment alone in a r and omised trial . Of 136 patients with hepatoma 78 ( 57 % ) were not eligible , eight ( 6 % ) refused to take part , and 50 entered the trial  ( chemotherapy : n = 25 , symptomatic treatment : n = 25 ) . The two groups had similar prognostic indices . Seven of 25 patients allocated to chemotherapy were unable to receive it . The slight survival disadvantage associated with chemotherapy was not significant ( median survival 48 days compared with 51 days , log rank chi 2 = 0.07 , p > 0.05 ) . Patients given  chemotherapy  spent significantly longer in hospital , however ( median three days compared with one , p = 0.0008 ) . Changes in symptoms and indices of tumour growth did not differ significantly between the two groups . It is concluded that infusion of 5-epidoxorubicin emulsified in lipiodol for hepatoma increased morbidity but did not affect survival . In addition , most patients were unsuitable for this treatment because of advanced disease . The patients in the trial had a short median survival time so the conclusions may not be valid for other patients with hepatoma BACKGROUND / AIMS Lipiodol chemoembolization is a widely used method of treatment in patients with unresectable hepatocellular carcinoma , but its efficacy is still debated . The aim of our study was to assess the efficacy of lipiodol chemoembolization in patients with unresectable hepatocellular carcinoma . METHODS Seventy-three patients with unresectable hepatocellular carcinoma , but without severe liver disease or portal vein occlusion , were r and omly assigned to receive either repeated lipiodol chemoembolization ( lipiodol , cisplatin ( 2 mg/kg ) , lecithin , and gelatin sponge injected into the hepatic artery ) plus tamoxifen ( 40 mg ) or tamoxifen alone . The main end-point was survival . RESULTS The 37 patients in the lipiodol chemoembolization group received 104 courses ( median 3 per patient ) . By 1 September 1996 , 58 patients had died : 30 in the lipiodol chemoembolization group and 28 in the tamoxifen group . There was no difference in survival between the two groups ( p=0.77 ) . The relative risk of death in the lipiodol chemoembolization plus tamoxifen group as compared to the tamoxifen group was 0.92 ( 95 % confidence interval 0.55 to 1.56 ) . At 1 year , survival was 51 % and 55 % , respectively . An objective tumoral response was more frequently observed in the lipiodol chemoembolization group than in the tamoxifen group ( 24 versus 5.5 % , respectively , p=0.046 ) . Lipiodol chemoembolization caused two deaths and induced signs of liver failure in 51 % of the patients assigned to this treatment . CONCLUSION In our r and omized study , lipiodol chemoembolization did not improve the survival of patients with unresectable hepatocellular carcinoma treated with tamoxifen A r and omized trial of hepatic arterial chemoembolization was conducted in 42 patients with unresectable hepatocellular carcinoma . These patients represented 41 % of patients with hepatocellular carcinoma seen during the inclusion period . In the remaining 59 % , 9 % had resectable tumours and 50 % had unresectable tumours with contraindication for chemoembolization . Patients received either repeated chemoembolization with gelfoam powder and doxorubicin ( group 1 ) or symptomatic treatment ( group 2 ) . There was no difference in age , prevalence of cirrhosis or staging according to Okuda between the two groups of patients . A complete tumour response ( assessed by arteriography , ultrasonography and serum alphafetoprotein ) was observed in four patients , and a partial response in three other patients from group 1 . Actuarial survival rates were 33 and 24 % in group 1 and 52 and 31 % in group 2 at 6 and 12 months , respectively ( differences were not significant -- logrank test ) . With the treatment used in our study , chemoembolization did not prolong the survival time of patients with unresectable hepatocellular carcinoma . There were , however , some complete or partial responses . The high spontaneous 1-year survival rate of untreated patients was probably due to the exclusion of the most severely ill patients . Our results do not support the use of this method of chemoembolization in the treatment of hepatocellular carcinoma Meta-analytic investigations sometimes use assessment s of research quality according to a formal protocol as a tool for improving research synthesis . We asked whether a particular  quality scoring system could have a direct use in adjusting the summary estimates of a treatment difference . In an empirical study of the relation of quality scores to treatment differences in published meta-analyses of 7 groups of controlled r and omized clinical trials comprising 107 primary studies , we found no relation between treatment difference and overall quality score . We also found no relation between quality score and variation in treatment difference . The level of quality scores has increased at a rate of 9 % per decade for three decades , averaging 0.51 on a scale of 0 to 1 for the 1980s , and leaving much room for improvement . Nevertheless , attention to quality of studies by editors , review ers , and authors may be raising both the level of research done and quality of the reports This r and omized , controlled trial assessed the efficacy of transarterial Lipiodol ( Lipiodol Ultrafluide , Laboratoire Guerbet , Aulnay-Sous-Bois , France ) chemoembolization in patients with unresectable hepatocellular carcinoma . From March 1996 to October 1997 , 80 out of 279 Asian patients with newly diagnosed unresectable hepatocellular carcinoma fulfilled the entry criteria and r and omly were assigned to treatment with chemoembolization using a variable dose of an emulsion of cisplatin in Lipiodol and gelatin-sponge particles injected through the hepatic artery ( chemoembolization group , 40 patients ) or symptomatic treatment ( control group , 40 patients ) . One patient assigned to the control group secondarily was excluded because of unrecognized systemic metastasis . Chemoembolization was repeated every 2 to 3 months unless there was evidence of contraindications or progressive disease . Survival was the main end point . The chemoembolization group received a total of 192 courses of chemoembolization with a median of 4.5 ( range , 1 - 15 ) courses per patient . Chemoembolization result ed in a marked tumor response , and the actuarial survival was significantly better in the chemoembolization group ( 1 year , 57 % ; 2 years , 31 % ; 3 years , 26 % ) than in the control group ( 1 year , 32 % ; 2 years , 11 % ; 3 years , 3 % ; P = .002 ) . When adjustments for baseline variables that were prognostic on univariate analysis were made with a multivariate Cox model , the survival benefit of chemoembolization remained significant ( relative risk of death , 0.49 ; 95 % CI , 0.29 - 0.81 ; P = .006 ) . Although death from liver failure was more frequent in patients who received chemoembolization , the liver functions of the survivors were not significantly different . In conclusion , in Asian patients with unresectable hepatocellular carcinoma , transarterial Lipiodol chemoembolization significantly improves survival and is an effective form of treatment We report the results of a multicenter study on the diagnosis and interventional therapy of hepatocellular carcinoma ( HCC ) . The first aim --diagnosis -- was to evaluate the sensitivity of 4 imaging techniques , namely ultrasonography ( US ) , Computed Tomography ( CT ) , digital arteriography ( DSA ) and Lipiodol CT ( LCT ) , in HCC detection . The accuracy of these techniques was also investigated in tumor staging , which is important for treatment planning . Two hundred ninety patients underwent this imaging protocol . The patients were classified by tumor spread into three groups , namely group 1 ( single HCCs < 5 cm ) , group 2 ( multifocal HCCs with max . 3 nodules or tumor volume < 80 cc ) , group 3 ( multifocal HCCs with more than 3 nodules and /or tumor volume > 80 cc ) . US and CT diagnosed more cases as group 1 and fewer cases as group 3 than DSA and LCT ; the latter two techniques gave a similar classification . With LCT as the gold st and ard , US and CT understaged 27.9 % and 26.5 % of cases , respectively . Even though LCT is known to have 53 % sensitivity , it is currently the most sensitive preoperative investigation and therefore the best tool for treatment planning . In surgical patients , however , intraoperative US , with its nearly 100 % sensitivity , is suggested . The second aim --treatment -- consisted in assessing the therapeutic efficacy of intraarterial chemoembolization ( CEAT ) versus percutaneous ethanol injection ( PEI ) in non advanced HCC and of CEAT versus no treatment ( NT ) in advanced HCC . Treatment efficacy was evaluated with the following r and omized protocol s : PEI versus CEAT in group 1 , PEI versus CEAT in group 2 and CEAT versus NT in group 3 . The data were analyzed relative to 215 patients for 6 to 30 months . The Kaplan-Meier method was used to calculate survival rates , which were , at 24 and 30 months , 72 % and 72 % for PEI and 72 % and 52 % for CEAT in group 1 , 52 % and 28 % for PEI and 70 % and 50 % for CEAT in group 2 and finally 30 % and 20 % for NT and 45 % and 30 % for CEAT in group 3 . In group 1 , PEI appeared markedly superior to CEAT . In group 2 , the difference between PEI and CEAT was not statistically significant ; the results in this group indicate that CEAT should be considered when three nodules are present because of PEI invasiveness in these cases . In group 3 , CEAT results were definitely better in the first two years , but there was no difference with NT patients at the end of the third year . Therefore , CEAT is indicated in advanced HCC because it improves the survival rate in the first 24 months . After this period , the survival time is not modified by treatment BACKGROUND Assessment of the change in tumour burden is an important feature of the clinical evaluation of cancer therapeutics : both tumour shrinkage ( objective response ) and disease progression are useful endpoints in clinical trials . Since RECIST was published in 2000 , many investigators , cooperative groups , industry and government authorities have adopted these criteria in the assessment of treatment outcomes . However , a number of questions and issues have arisen which have led to the development of a revised RECIST guideline ( version 1.1 ) . Evidence for 
    Output:
    
There is no firm evidence to support or refute TACE or TAE for patients with unresectable HCC .