human
***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 Current st and ard therapy for children and adolescents with Hodgkin 's disease includes combination chemotherapy and low-dose involved-field radiation ( LD-IFRT ) . Because radiation may be associated with adverse late effects , the Children 's Cancer Group ( CCG ) investigated whether radiation could be omitted in patients achieving a complete response to initial chemotherapy without jeopardizing the excellent outcome obtained with combined-modality therapy . PATIENTS AND METHODS Between January 1995 and December 1998 , 829 eligible patients were enrolled onto CCG 5942 . A total of 501 patients who achieved an initial complete response after risk-adapted combination chemotherapy were r and omized to receive LD-IFRT or no further treatment .  Event-free survival ( EFS ) and overall survival were assessed from the date of study entry or the date of r and omization , as appropriate . RESULTS The projected 3-year EFS from study entry for the entire cohort was 87 % + /- 1.2 % . Among patients who achieved a complete response to initial chemotherapy , 92 % + /- 1.9 % of those r and omized to receive LD-IFRT were alive and disease free 3 years after r and omization , versus 87 % + /- 2.2 % for patients r and omized to receive no further therapy ( stratified log-rank test ; P = .057 ) . With an " as-treated " analysis , 3-year EFS after r and omization for the radiation cohort was 93 % + /- 1.7 % versus 85 % + /- 2.3 % for patients receiving no further therapy ( stratified log-rank test ; P = .0024 ) . Three-year survival estimates for patients treated with and without LD-IFRT were 98 % + /- 1.1 % for patients who received radiation and 99 % + /- 0.5 % for patients who did not receive radiation . CONCLUSION LD-IFRT after an initial complete response to risk-adapted chemotherapy improved EFS . At this time , there is no survival advantage for LD-IFRT , but follow-up remains short PURPOSE To investigate whether combined-modality treatment ( CMT ) with two cycles of doxorubicin , bleomycin , vinblastine , and dacarbazine ( ABVD ) followed by extended-field radiotherapy ( EF-RT ) is superior to EF-RT alone in patients with early favorable Hodgkin 's lymphoma ( HL ) . PATIENTS AND METHODS Between 1993 and 1998 , 650 patients with newly diagnosed , histology-proven HL in clinical stages IA to IIB without risk factors were enrolled onto this multicenter study and r and omly assigned to receive 30 Gy EF-RT plus 10 Gy to the involved field ( arm A ) or two cycles of ABVD followed by the same radiotherapy ( arm B ) . Results At a median observation time of 87 months , there was no difference between treatment arms in terms of complete response rate ( arm A , 95 % ; arm B , 94 % ) and overall survival ( at 7 years : arm A , 92 % ; arm B , 94 % ; P = .43 ) . However , freedom from treatment failure was significantly different , with 7-year rates of 67 % in arm A ( 95 % CI , 61 % to 73 % ) and 88 % in arm B ( 95 % CI , 84 % to 92 % ; P < or= .0001 ) . This was due mainly to significantly more relapses after EF-RT only ( arm A , 22 % ; arm B , 3 % ) . No patient treated with CMT experienced relapse before year 3 . Relapses were treated mainly with bleomycin , etoposide , doxorubicin , cyclophosphamide , vincristine , procarbazine , and prednisone , or with the combination cyclophosphamide , vincristine , procarbazine , and prednisone/ABVD ;  treatment of relapse was significantly more successful in arm A than in arm B ( P = .017 ) . In total , there were 39 second malignancies , with 21 in arm A and 18 in arm B , respectively . The incidence was approximately 0.8 % per year during years 2 to 9 and was highest in older patients ( P < .0001 ) and those with " B " symptoms ( P = .012 ) . CONCLUSION CMT consisting of two cycles of ABVD plus EF-RT is more effective than EF-RT alone PURPOSE In early-stage Hodgkin 's lymphoma ( HL ) , subtotal nodal irradiation ( STNI ) and combined chemotherapy/radiotherapy produce high disease control rates but also considerable late toxicity . The aim of this study was to reduce this toxicity using a combination of low-intensity chemotherapy and involved-field radiotherapy ( IF-RT ) without jeopardizing disease control . PATIENTS AND METHODS Patients with stage I or II HL were stratified into two groups , favorable and unfavorable , based on the following four prognostic factors : age , symptoms , number of involved areas , and mediastinal-thoracic ratio . The experimental therapy consisted of six cycles of epirubicin , bleomycin , vinblastine , and prednisone ( EBVP ) followed by IF-RT . It was r and omly compared , in favorable patients , to STNI and , in unfavorable patients , to six cycles of mechlorethamine , vincristine , procarbazine , prednisone , doxorubicin , bleomycin , and vinblastine ( MOPP/ABV hybrid ) and IF-RT . RESULTS Median follow-up time of the 722 patients included was 9 years . In 333 favorable patients , the 10-year event-free survival rates ( EFS ) were 88 % in the EBVP arm and 78 % in the STNI arm ( P = .0113 ) , with similar 10-year overall survival ( OS ) rates ( 92 % v 92 % , respectively ; P = .79 ) . In 389 unfavorable patients , the 10-year EFS rate was 88 % in the MOPP/ABV arm compared with 68 % in the EBVP arm ( P < .001 ) , leading to 10-year OS rates of 87 % and 79 % , respectively ( P = .0175 ) . CONCLUSION A treatment strategy for early-stage HL based on prognostic factors leads to high OS rates in both favorable and unfavorable patients . In favorable patients , the combination of EBVP and IF-RT can replace STNI as st and ard treatment . In unfavorable patients , EBVP is significantly less efficient than MOPP/ABV PURPOSE Chemoradiotherapy has been considered st and ard treatment for patients with limited-stage aggressive lymphoma on the basis of trials conducted before the introduction of the International Prognostic Index . To evaluate this approach in elderly patients with low-risk localized lymphoma , we conducted a trial comparing chemoradiotherapy with chemotherapy alone . PATIENTS AND METHODS Previously untreated patients older than 60 years with localized stage I or II histologically aggressive lymphoma and no adverse prognostic factors of the International Prognostic Index were r and omly assigned to receive either four cycles of cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP ) plus involved-field radiotherapy ( 299 patients ) or chemotherapy alone with four cycles of CHOP ( 277 patients ) . RESULTS With a median follow-up time of 7 years , event-free and overall survival did not differ between the two treatment groups ( P = .6 and P = .5 , respectively ) . The 5-year estimates of event-free survival were 61 % for patients receiving chemotherapy alone and 64 % for patients receiving CHOP plus radiotherapy ; the 5-year estimates of overall survival were 72 % and 68 % , respectively . In a multivariate analysis , overall survival was affected by stage II disease ( P < .001 ) and male sex ( P = .03 ) . CONCLUSION In this large prospect i ve study , CHOP plus radiotherapy did not provide any advantage over CHOP alone for the treatment of low-risk localized aggressive lymphoma in elderly patients To determine whether combined modality therapy ( CMT ) is superior to chemotherapy ( CT ) alone , 152 untreated Hodgkin disease patients with clinical stages ( CSs ) IA , IB , IIA , IIB , and IIIA without bulk disease were prospect ively r and omized to 6 cycles of doxorubicin , bleomycin , vinblastine , dacarbazine ( ABVD ) alone or 6 cycles of ABVD followed by radiation therapy ( RT ) ( 3600 cGy : involved field for 11 patients , modified extended field for the rest ) . Of 76 patients r and omized to receive RT , 65 actually received it , and 11 did not ( 4 progressed , 1 had bleomycin toxicity , 6 refused ) . For ABVD + RT , the complete remission ( CR ) percentage was 94 % and no major response , 6 % . For ABVD alone , 94 % achieved a CR ; 1.5 % , a partial response ( PR ) ; and 4.5 % , no major response . At 60 months CR duration , freedom from progression ( FFP ) , and overall survival ( OS ) for ABVD + RT versus ABVD alone are 91 % versus 87 % ( P = .61 ) , 86 % versus 81 % ( P = .61 ) , and 97 % versus 90 % ( P = .08 ) , respectively ( log-rank ) . The 95 % confidence intervals for CR duration , FFP , and OS differences at 5 years were -8 % to 15 % , -8 % to 18 % , and -4 % to 12 % , respectively . Although significant differences were not seen , it is possible that a benefit in outcome of less than 20 % for CMT might be seen in a larger trial PURPOSE To evaluate the effect of doxorubicin , bleomycin , vinblastine , and dacarbazine ( ABVD ) chemotherapy alone and of ABVD with mantle or mediastinal irradiation ( RT ) on the pulmonary function of patients with early-stage Hodgkin 's disease . PATIENTS AND METHODS Between 1989 and 1993 , 60 patients with clinical stage I to IIIA HD enrolled onto r and omized trials at Memorial Sloan-Kettering Cancer Center ( MSKCC ) underwent prospect i ve evaluation of pulmonary function . All patients received six cycles of ABVD , and 30 patients received mantle or mediastinal RT .  Pulmonary function tests ( PFTs ) and symptom evaluation were conducted before , during , and after completion of chemotherapy and RT , and at various intervals thereafter . The median follow-up time was 30 months . RESULTS During chemotherapy , symptoms of cough and dyspnea on exertion developed in 32 of 60 patients ( 53 % ) and declines in pulmonary function occurred in 22 of 60 patients ( 37 % ) . Discontinuation of bleomycin was necessary in 14 of 60 patients ( 23 % ) . Following chemotherapy , there was a significant decline in median forced vital capacity ( FVC ) and diffusing capacity of carbon monoxide ( DLCO ) . In patients who received mantle or mediastinal RT , there was a further decline in FVC following radiation therapy . At the most recent follow-up evaluation , five of 29 patients ( 18 % ) who received ABVD alone and nine of 30 ( 30 % ) who received ABVD and RT reported persistent mild pulmonary symptoms ( P = .36 ) , which did not significantly affect normal daily activity . CONCLUSION ABVD chemotherapy induced acute pulmonary toxicity that required bleomycin dose modification in a substantial number of patients . The addition of RT result ed in a further decrease in FVC ; however , this did not significantly affect the functional status of patients This study aim ed at evaluating the role of consolidation radiation in a setting of Hodgkin 's lymphoma ( HL ) patients , using event-free survival ( EFS ) as end point . Among 260 patients treated with induction chemotherapy for bulky HL , 160 patients achieved negative residual masses at 2-[18F]fluoro-2-deoxy-d-glucose positron emission tomography ( FDG-PET ) scans .  They were r and omly divided into two well-matched groups to receive either 32 Gy radiotherapy to bulky area or no further therapy . At a median follow-up of 40 months , histology showed a malignancy in 14 % of patients in the chemotherapy-only group ( HL , 11 patients ) and in 4 % of patients in the chemotherapy + radiotherapy group ( HL , 2 patients ; carcinoma in previously irradiated area , 1 patient ) ( P = 0.03 ) . All the relapses in the chemotherapy-only group involved the bulky site and the contiguous nodal regions . Thus , the overall diagnostic accuracy of FDG-PET to exclude future relapses in the patients nonprotected by radiotherapy was 86 % with a false-negative rate of 14 % . Our study suggests that the addition of irradiation helps improve EFS in HL patients with post-chemotherapy FDG-PET-negative residual masses We performed a r and omized clinical trial to assess the usefulness and toxicity of combined therapy compared with chemotherapy and radiotherapy in the treatment of early stage Hodgkin 's disease with bulky disease as an adverse prognostic factor . Three-hundred and seven patients were enrolled into the study . They were r and omized to receive either radiotherapy ( extended field , generally mantle , 3500 cG 
    Output:
    
agent
***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 Current st and ard therapy for children and adolescents with Hodgkin 's disease includes combination chemotherapy and low-dose involved-field radiation ( LD-IFRT ) . Because radiation may be associated with adverse late effects , the Children 's Cancer Group ( CCG ) investigated whether radiation could be omitted in patients achieving a complete response to initial chemotherapy without jeopardizing the excellent outcome obtained with combined-modality therapy . PATIENTS AND METHODS Between January 1995 and December 1998 , 829 eligible patients were enrolled onto CCG 5942 . A total of 501 patients who achieved an initial complete response after risk-adapted combination chemotherapy were r and omized to receive LD-IFRT or no further treatment .  Event-free survival ( EFS ) and overall survival were assessed from the date of study entry or the date of r and omization , as appropriate . RESULTS The projected 3-year EFS from study entry for the entire cohort was 87 % + /- 1.2 % . Among patients who achieved a complete response to initial chemotherapy , 92 % + /- 1.9 % of those r and omized to receive LD-IFRT were alive and disease free 3 years after r and omization , versus 87 % + /- 2.2 % for patients r and omized to receive no further therapy ( stratified log-rank test ; P = .057 ) . With an " as-treated " analysis , 3-year EFS after r and omization for the radiation cohort was 93 % + /- 1.7 % versus 85 % + /- 2.3 % for patients receiving no further therapy ( stratified log-rank test ; P = .0024 ) . Three-year survival estimates for patients treated with and without LD-IFRT were 98 % + /- 1.1 % for patients who received radiation and 99 % + /- 0.5 % for patients who did not receive radiation . CONCLUSION LD-IFRT after an initial complete response to risk-adapted chemotherapy improved EFS . At this time , there is no survival advantage for LD-IFRT , but follow-up remains short PURPOSE To investigate whether combined-modality treatment ( CMT ) with two cycles of doxorubicin , bleomycin , vinblastine , and dacarbazine ( ABVD ) followed by extended-field radiotherapy ( EF-RT ) is superior to EF-RT alone in patients with early favorable Hodgkin 's lymphoma ( HL ) . PATIENTS AND METHODS Between 1993 and 1998 , 650 patients with newly diagnosed , histology-proven HL in clinical stages IA to IIB without risk factors were enrolled onto this multicenter study and r and omly assigned to receive 30 Gy EF-RT plus 10 Gy to the involved field ( arm A ) or two cycles of ABVD followed by the same radiotherapy ( arm B ) . Results At a median observation time of 87 months , there was no difference between treatment arms in terms of complete response rate ( arm A , 95 % ; arm B , 94 % ) and overall survival ( at 7 years : arm A , 92 % ; arm B , 94 % ; P = .43 ) . However , freedom from treatment failure was significantly different , with 7-year rates of 67 % in arm A ( 95 % CI , 61 % to 73 % ) and 88 % in arm B ( 95 % CI , 84 % to 92 % ; P < or= .0001 ) . This was due mainly to significantly more relapses after EF-RT only ( arm A , 22 % ; arm B , 3 % ) . No patient treated with CMT experienced relapse before year 3 . Relapses were treated mainly with bleomycin , etoposide , doxorubicin , cyclophosphamide , vincristine , procarbazine , and prednisone , or with the combination cyclophosphamide , vincristine , procarbazine , and prednisone/ABVD ;  treatment of relapse was significantly more successful in arm A than in arm B ( P = .017 ) . In total , there were 39 second malignancies , with 21 in arm A and 18 in arm B , respectively . The incidence was approximately 0.8 % per year during years 2 to 9 and was highest in older patients ( P < .0001 ) and those with " B " symptoms ( P = .012 ) . CONCLUSION CMT consisting of two cycles of ABVD plus EF-RT is more effective than EF-RT alone PURPOSE In early-stage Hodgkin 's lymphoma ( HL ) , subtotal nodal irradiation ( STNI ) and combined chemotherapy/radiotherapy produce high disease control rates but also considerable late toxicity . The aim of this study was to reduce this toxicity using a combination of low-intensity chemotherapy and involved-field radiotherapy ( IF-RT ) without jeopardizing disease control . PATIENTS AND METHODS Patients with stage I or II HL were stratified into two groups , favorable and unfavorable , based on the following four prognostic factors : age , symptoms , number of involved areas , and mediastinal-thoracic ratio . The experimental therapy consisted of six cycles of epirubicin , bleomycin , vinblastine , and prednisone ( EBVP ) followed by IF-RT . It was r and omly compared , in favorable patients , to STNI and , in unfavorable patients , to six cycles of mechlorethamine , vincristine , procarbazine , prednisone , doxorubicin , bleomycin , and vinblastine ( MOPP/ABV hybrid ) and IF-RT . RESULTS Median follow-up time of the 722 patients included was 9 years . In 333 favorable patients , the 10-year event-free survival rates ( EFS ) were 88 % in the EBVP arm and 78 % in the STNI arm ( P = .0113 ) , with similar 10-year overall survival ( OS ) rates ( 92 % v 92 % , respectively ; P = .79 ) . In 389 unfavorable patients , the 10-year EFS rate was 88 % in the MOPP/ABV arm compared with 68 % in the EBVP arm ( P < .001 ) , leading to 10-year OS rates of 87 % and 79 % , respectively ( P = .0175 ) . CONCLUSION A treatment strategy for early-stage HL based on prognostic factors leads to high OS rates in both favorable and unfavorable patients . In favorable patients , the combination of EBVP and IF-RT can replace STNI as st and ard treatment . In unfavorable patients , EBVP is significantly less efficient than MOPP/ABV PURPOSE Chemoradiotherapy has been considered st and ard treatment for patients with limited-stage aggressive lymphoma on the basis of trials conducted before the introduction of the International Prognostic Index . To evaluate this approach in elderly patients with low-risk localized lymphoma , we conducted a trial comparing chemoradiotherapy with chemotherapy alone . PATIENTS AND METHODS Previously untreated patients older than 60 years with localized stage I or II histologically aggressive lymphoma and no adverse prognostic factors of the International Prognostic Index were r and omly assigned to receive either four cycles of cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP ) plus involved-field radiotherapy ( 299 patients ) or chemotherapy alone with four cycles of CHOP ( 277 patients ) . RESULTS With a median follow-up time of 7 years , event-free and overall survival did not differ between the two treatment groups ( P = .6 and P = .5 , respectively ) . The 5-year estimates of event-free survival were 61 % for patients receiving chemotherapy alone and 64 % for patients receiving CHOP plus radiotherapy ; the 5-year estimates of overall survival were 72 % and 68 % , respectively . In a multivariate analysis , overall survival was affected by stage II disease ( P < .001 ) and male sex ( P = .03 ) . CONCLUSION In this large prospect i ve study , CHOP plus radiotherapy did not provide any advantage over CHOP alone for the treatment of low-risk localized aggressive lymphoma in elderly patients To determine whether combined modality therapy ( CMT ) is superior to chemotherapy ( CT ) alone , 152 untreated Hodgkin disease patients with clinical stages ( CSs ) IA , IB , IIA , IIB , and IIIA without bulk disease were prospect ively r and omized to 6 cycles of doxorubicin , bleomycin , vinblastine , dacarbazine ( ABVD ) alone or 6 cycles of ABVD followed by radiation therapy ( RT ) ( 3600 cGy : involved field for 11 patients , modified extended field for the rest ) . Of 76 patients r and omized to receive RT , 65 actually received it , and 11 did not ( 4 progressed , 1 had bleomycin toxicity , 6 refused ) . For ABVD + RT , the complete remission ( CR ) percentage was 94 % and no major response , 6 % . For ABVD alone , 94 % achieved a CR ; 1.5 % , a partial response ( PR ) ; and 4.5 % , no major response . At 60 months CR duration , freedom from progression ( FFP ) , and overall survival ( OS ) for ABVD + RT versus ABVD alone are 91 % versus 87 % ( P = .61 ) , 86 % versus 81 % ( P = .61 ) , and 97 % versus 90 % ( P = .08 ) , respectively ( log-rank ) . The 95 % confidence intervals for CR duration , FFP , and OS differences at 5 years were -8 % to 15 % , -8 % to 18 % , and -4 % to 12 % , respectively . Although significant differences were not seen , it is possible that a benefit in outcome of less than 20 % for CMT might be seen in a larger trial PURPOSE To evaluate the effect of doxorubicin , bleomycin , vinblastine , and dacarbazine ( ABVD ) chemotherapy alone and of ABVD with mantle or mediastinal irradiation ( RT ) on the pulmonary function of patients with early-stage Hodgkin 's disease . PATIENTS AND METHODS Between 1989 and 1993 , 60 patients with clinical stage I to IIIA HD enrolled onto r and omized trials at Memorial Sloan-Kettering Cancer Center ( MSKCC ) underwent prospect i ve evaluation of pulmonary function . All patients received six cycles of ABVD , and 30 patients received mantle or mediastinal RT .  Pulmonary function tests ( PFTs ) and symptom evaluation were conducted before , during , and after completion of chemotherapy and RT , and at various intervals thereafter . The median follow-up time was 30 months . RESULTS During chemotherapy , symptoms of cough and dyspnea on exertion developed in 32 of 60 patients ( 53 % ) and declines in pulmonary function occurred in 22 of 60 patients ( 37 % ) . Discontinuation of bleomycin was necessary in 14 of 60 patients ( 23 % ) . Following chemotherapy , there was a significant decline in median forced vital capacity ( FVC ) and diffusing capacity of carbon monoxide ( DLCO ) . In patients who received mantle or mediastinal RT , there was a further decline in FVC following radiation therapy . At the most recent follow-up evaluation , five of 29 patients ( 18 % ) who received ABVD alone and nine of 30 ( 30 % ) who received ABVD and RT reported persistent mild pulmonary symptoms ( P = .36 ) , which did not significantly affect normal daily activity . CONCLUSION ABVD chemotherapy induced acute pulmonary toxicity that required bleomycin dose modification in a substantial number of patients . The addition of RT result ed in a further decrease in FVC ; however , this did not significantly affect the functional status of patients This study aim ed at evaluating the role of consolidation radiation in a setting of Hodgkin 's lymphoma ( HL ) patients , using event-free survival ( EFS ) as end point . Among 260 patients treated with induction chemotherapy for bulky HL , 160 patients achieved negative residual masses at 2-[18F]fluoro-2-deoxy-d-glucose positron emission tomography ( FDG-PET ) scans .  They were r and omly divided into two well-matched groups to receive either 32 Gy radiotherapy to bulky area or no further therapy . At a median follow-up of 40 months , histology showed a malignancy in 14 % of patients in the chemotherapy-only group ( HL , 11 patients ) and in 4 % of patients in the chemotherapy + radiotherapy group ( HL , 2 patients ; carcinoma in previously irradiated area , 1 patient ) ( P = 0.03 ) . All the relapses in the chemotherapy-only group involved the bulky site and the contiguous nodal regions . Thus , the overall diagnostic accuracy of FDG-PET to exclude future relapses in the patients nonprotected by radiotherapy was 86 % with a false-negative rate of 14 % . Our study suggests that the addition of irradiation helps improve EFS in HL patients with post-chemotherapy FDG-PET-negative residual masses We performed a r and omized clinical trial to assess the usefulness and toxicity of combined therapy compared with chemotherapy and radiotherapy in the treatment of early stage Hodgkin 's disease with bulky disease as an adverse prognostic factor . Three-hundred and seven patients were enrolled into the study . They were r and omized to receive either radiotherapy ( extended field , generally mantle , 3500 cG 
    Output:
    