***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: PURPOSE The unique dosimetric features of proton radiotherapy make it an attractive modality for normal tissue sparing . We present our initial experience with protons for three-dimensional , conformal , external-beam accelerated partial breast irradiation ( 3D-CPBI ) . METHODS AND MATERIAL S From March 2004 to June 2005 , 25 patients with tumors < or = 2 cm and negative axillary nodes were treated with proton 3D-CPBI .  The prescribed dose was 32 Cobalt Gray Equivalents ( CGE ) in 4 CGE fractions given twice daily . One to three fields were used to provide adequate planning target volume ( PTV ) coverage and dose homogeneity . RESULTS Excellent PTV coverage and dose homogeneity were obtained in all patients with one to three proton beams . The median PTV receiving 95 % of the prescribed dose was 100 % . Dose inhomogeneity exceeded 10 % in only 1 patient ( 4 % ) . The median volume of nontarget breast tissue receiving 50 % of the prescribed dose was 23 % . Median volumes of ipsilateral lung receiving 20 CGE , 10 CGE , and 5 CGE were 0 % , 1 % , and 2 % , respectively . The contralateral lung and heart received essentially no radiation dose . Cost analysis suggests that proton 3D-CPBI is only modestly more expensive ( 25 % ) than traditional whole-breast irradiation ( WBI ) . CONCLUSION Proton 3D-CPBI is technically feasible , providing both excellent PTV coverage and normal tissue sparing . It markedly reduces the volume of nontarget breast tissue irradiated compared with photon-based 3D-CPBI , addressing a principle disadvantage of external-beam approaches to PBI . As proton therapy becomes more widely available , it may prove an attractive tool for 3D-CPBI BACKGROUND Radiotherapy can impair Health Related Quality of Life ( HRQoL ) in survivors of childhood brain tumors , but proton radiotherapy ( PRT ) may mitigate this effect . This study compares HRQoL in PRT and photon ( XRT )  pediatric brain tumor survivors . METHODS HRQoL data were prospect ively collected on  PRT-treated patients aged 2 - 18 treated at Massachusetts General Hospital ( MGH ) .  Cross-sectional PedsQL data from XRT treated Lucile Packard Children 's Hospital ( LPCH ) patients provided the comparison data . RESULTS Parent proxy HRQoL scores were reported at 3 years for the PRT cohort ( PRT-C ) and 2.9 years ( median ) for the XRT cohort ( XRT-C ) . The total core HRQoL score for the PRT-C , XRT-C , and normative population differed from one another and was 75.9 , 65.4 and 80.9 respectively ( p=0.002 ; p=0.024 ; p<0.001 ) . The PRT-C scored 10.3 and 10.5 points higher than the XRT-C in the physical ( PhSD ) and psychosocial ( PsSD ) summary domains of the total core score ( TCS , p=0.015 ; p=0.001 ) . The PRT-C showed no difference in PhSD compared with the normative population , but scored 6.1 points less in the PsSD ( p=0.003 ) . Compared to healthy controls , the XRT-C scored lower in all domains ( p<0.001 ) . CONCLUSIONS The HRQoL of pediatric brain tumor survivors treated with PRT compare favorably to those treated with XRT and similar to healthy controls in the PhSD OBJECTIVE To evaluate late ( more than 5 years ) radiation failures after uveal melanoma treatment . DESIGN Comparison of three retrospective , interventional , partially r and omized case series . PARTICIPANTS Nine hundred ninety-six patients who were treated in several phase I , II , and III trials of uveal melanoma radiation . MAIN OUTCOME MEASURES Follow-up period , treatment history , recurrence rates , type of recurrence , and mortality associated with late local recurrences . RESULTS Eleven of 996 irradiated uveal melanoma patients experienced intraocular recurrence more than 5 years after radiation . All 11 of these patients were treated with iodine 125 ( (125)I ) brachytherapy .  Late recurrences were detected between 5.5 to 15.3 years after treatment . These patients did not have either high-risk clinical parameters ( thin , posterior tumors in proximity to the optic nerve ) or radiation dosimetry characteristics ( low dose-delivery radiation ) associated with a known increased risk for tumor recurrence after radioactive plaques . The annualized incidence rate for regrowth was 1.9 % per year between 5 and 15 years after (125)I brachytherapy . In contrast to charged particles , the risk of late recurrence after (125)I brachytherapy continued with increased follow-up . CONCLUSIONS There was a significantly higher late recurrence rate with (125)I brachytherapy as compared with charged particle radiation . Although tumor enlargement 5 or more years after radiation can be the result of intratumor hemorrhage , in a patient treated with radioactive plaque , a late failure is a distinct possibility PURPOSE Relevant clinical data are needed given the increasing national interest in charged particle radiation therapy ( CPT ) programs . Here we report long-term outcomes from the only r and omized , stratified trial comparing CPT with iodine-125 plaque therapy for choroidal and ciliary body melanoma . METHODS AND MATERIAL S From 1985 to 1991 , 184 patients met eligibility criteria and were r and omized to receive particle ( 86 patients ) or plaque therapy ( 98 patients ) . Patients were stratified by tumor diameter , thickness , distance to disc/fovea , anterior extension , and visual acuity . Tumors close to the optic disc were included . Local tumor control , as well as eye preservation , metastases due to melanoma , and survival were evaluated . RESULTS Median follow-up times for particle and plaque arm patients were 14.6 years and 12.3 years , respectively ( P=.22 ) , and for those alive at last follow-up , 18.5 and 16.5 years , respectively ( P=.81 ) . Local control ( LC ) for particle versus plaque treatment was 100 % versus 84 % at 5 years , and 98 % versus 79 % at 12 years , respectively ( log rank : P=.0006 ) . If patients with tumors close to the disc ( < 2 mm ) were excluded , CPT still result ed in significantly improved LC : 100 % versus 90 % at 5 years and 98 % versus 86 % at 12 years , respectively ( log rank : P=.048 ) . Enucleation rate was lower after CPT : 11 % versus 22 % at 5 years and 17 % versus 37 % at 12 years , respectively ( log rank : P=.01 ) . Using Cox regression model , likelihood ratio test , treatment was the most important predictor of LC ( P=.0002 ) and eye preservation ( P=.01 ) . CPT was a significant predictor of prolonged disease-free survival ( log rank : P=.001 ) . CONCLUSIONS Particle therapy result ed in significantly improved local control , eye preservation , and disease-free survival as confirmed by long-term outcomes from the only r and omized study available to date comparing radiation modalities in choroidal and ciliary body melanoma BACKGROUND We aim ed to compare overall survival after st and ard-dose versus high-dose conformal radiotherapy with concurrent chemotherapy and the addition of cetuximab to concurrent chemoradiation for patients with inoperable stage III non-small-cell lung cancer . METHODS In this open-label r and omised , two-by-two factorial phase 3 study in 185 institutions in the USA and Canada , we enrolled patients ( aged ≥ 18 years ) with unresectable stage III non-small-cell lung cancer , a Zubrod performance status of 0 - 1 , adequate pulmonary function , and no evidence of supraclavicular or contralateral hilar adenopathy . We r and omly assigned ( 1:1:1:1 ) patients to receive either 60 Gy ( st and ard dose ) , 74 Gy ( high dose ) , 60 Gy plus cetuximab , or 74 Gy plus cetuximab . All patients also received concurrent chemotherapy with 45 mg/m(2 ) paclitaxel and carboplatin once a week ( AUC 2 ) ; 2 weeks after chemoradiation , two cycles of consolidation chemotherapy separated by 3 weeks were given consisting of paclitaxel ( 200 mg/m(2 ) ) and carboplatin ( AUC 6 ) . R and omisation was done with permuted block r and omisation methods , stratified by radiotherapy technique , Zubrod performance status , use of PET during staging , and histology ; treatment group assignments were not masked . Radiation dose was prescribed to the planning target volume and was given in 2 Gy daily fractions with either intensity-modulated radiation therapy or three-dimensional conformal radiation therapy . The use of four-dimensional CT and image-guided radiation therapy were encouraged but not necessary . For patients assigned to receive cetuximab , 400 mg/m(2 ) cetuximab was given on day 1 followed by weekly doses of 250 mg/m(2 ) , and was continued through consolidation therapy . The primary endpoint was overall survival . All analyses were done by modified intention-to-treat . The study is registered with Clinical Trials.gov , number NCT00533949 . FINDINGS Between Nov 27 , 2007 , and Nov 22 , 2011 , 166 patients were r and omly assigned to receive st and ard-dose chemoradiotherapy , 121 to high-dose chemoradiotherapy , 147 to st and ard-dose chemoradiotherapy and cetuximab , and 110 to high-dose chemoradiotherapy and cetuximab . Median follow-up for the radiotherapy comparison was 22.9 months ( IQR 27.5 - 33.3 ) . Median overall survival was 28.7 months ( 95 % CI 24.1 - 36.9 ) for patients who received st and ard-dose radiotherapy and 20.3 months ( 17.7 - 25.0 ) for those who received high-dose radiotherapy ( hazard ratio [ HR ] 1.38 , 95 % CI 1.09 - 1.76 ; p=0.004 ) . Median follow-up for the cetuximab comparison was 21.3 months ( IQR 23.5 - 29.8 ) . Median overall survival in patients who received cetuximab was 25.0 months ( 95 % CI 20.2 - 30.5 ) compared with 24.0 months ( 19.8 - 28.6 ) in those who did not ( HR 1.07 , 95 % CI 0.84 - 1.35 ; p=0.29 ) . Both the radiation-dose and cetuximab results crossed protocol -specified futility boundaries . We recorded no statistical differences in grade 3 or worse toxic effects between radiotherapy groups . By contrast , the use of cetuximab was associated with a higher rate of grade 3 or worse toxic effects ( 205 [ 86 % ] of 237 vs 160 [ 70 % ] of 228 patients ; p<0.0001 ) . There were more treatment-related deaths in the high-dose chemoradiotherapy and cetuximab groups ( radiotherapy comparison : eight vs three patients ; cetuximab comparison : ten vs five patients ) . There were no differences in severe pulmonary events between treatment groups . Severe oesophagitis was more common in patients who received high-dose chemoradiotherapy than in those who received st and ard-dose treatment ( 43 [ 21 % ] of 207 patients vs 16 [ 7 % ] of 217 patients ; p<0.0001 ) . INTERPRETATION 74 Gy radiation given in 2 Gy fractions with concurrent chemotherapy was not better than 60 Gy plus concurrent chemotherapy for patients with stage III non-small-cell lung cancer , and might be potentially harmful . Addition of cetuximab to concurrent chemoradiation and consolidation treatment provided no benefit in overall survival for these patients . FUNDING National Cancer Institute and Bristol-Myers Squibb COMMENTARY Recently , mature data were published from the MA.20 and European Organization for the Research and Treatment of Cancer ( EORTC ) 22922 trials , providing clinicians with increasing data supporting the value of regional nodal irradiation ( RNI ) . The MA.20 r and omized 1832 women with highrisk node-negative ( T3 , T2 with < 10 nodes removed and grade 3/estrogen receptor-negative/lymphovascular space invasion ) or node-positive disease to receive whole breast irradiation with or without RNI ( axillary apex , internal mammary , supraclavicular ) with > 80 % of patients having 1 to 3 nodes positive . Ten-year outcomes demonstrated an improvement in disease-free survival ( 82 % vs. 77 % ) with reductions in distant metastases and locoregional recurrences with the addition of RNI with modest increases in pneumonitis ( 1.2 % vs. 0.2 % ) and lymphedema 
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RESULTS The cost-effectiveness for prostate cancer-the single most common diagnosis currently treated with PBT-was suboptimal .
PBT was the most cost-effective option for several pediatric brain tumors .
PBT costs for breast cancer were increased but were favorable for appropriately selected patients with left-sided cancers at high risk of cardiac toxicity and compared with brachytherapy for accelerated partial breast irradiation .
For non-small cell lung cancer ( NSCLC ) , the greatest cost-effectiveness benefits using PBT were observed for locoregionally advanced-but not early stage-tumors .
PBT offered superior cost-effectiveness in selected head/neck cancer patients at higher risk of acute mucosal toxicities .
Similar cost-effectiveness was observed for PBT , enucleation , and plaque brachytherapy in patients with uveal melanoma .
With greatly limited amounts of data , PBT offers promising cost-effectiveness for pediatric brain tumors , well-selected breast cancers , locoregionally advanced NSCLC , and high-risk head/neck cancers .
Heretofore , it has not been demonstrated that PBT is cost-effective for prostate cancer or early stage NSCLC .