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: Background The aim of this study was to analyze the anatomic distribution , timing , and outcomes of recurrent disease after complete cytoreduction and perioperative intraperitoneal chemotherapy ( PIC ) for peritoneal carcinomatosis of colorectal origin . Methods Data regarding all patients who underwent complete cytoreduction and PIC for carcinomatosis from colorectal cancer were extracted from a prospect ively collected data base . The information regarding recurrent disease found on diagnostic evaluation and /or abdominal exploration was analyzed . Results Seventy patients underwent complete cytoreduction and perioperative intraperitoneal chemotherapy  , and 49 of them had documented recurrent disease . The median time to progression for these 49 patients was 9 months while their median survival was 30 months . Eighteen patients had a localized intra-abdominal recurrence , 10 had diffuse intraperitoneal recurrence , 10 had isolated distant metastases , and 11 had a combination of distant metastases and intra-abdominal recurrence . There was a statistically significant difference in survival for patients with different patterns of recurrence ( P = .012 ) . Twenty-six patients underwent a second operation . The median survival of these patients was significantly longer than that of patients who did not have a second operation ( 39 vs 20 months , P = .0003 ) . Four of the 49 patients with recurrences were still alive at the time of last follow-up , and three of them have no evidence of disease 73 , 96 , and 206 months after the diagnosis of recurrence . Conclusions Recurrence is a frequent event after optimal cytoreduction and PIC for carcinomatosis from colorectal cancer . Surgical treatment for a selected group of patients with recurrent disease may result in long-term survival Background Combined treatment involving peritonectomy procedures , multivisceral resections , and hyperthermic intraperitoneal chemotherapy ( HIPEC ) has reportedly result ed in survival benefit for peritoneal surface malignancies , including diffuse malignant peritoneal mesothelioma ( DMPM ) . Many unanswered questions remain regarding the surgical options in the management of DMPM . The aim of this case – control study was to assess the impact of the type and extent of parietal peritonectomy on survival and operative outcomes . Methods Thirty patients with DMPM undergoing selective parietal peritonectomy ( SPP ) of macroscopically involved regions , and 30 matched patients undergoing routine complete parietal peritonectomy ( CPP ) , regardless of disease distribution , were retrospectively identified from a prospect i ve data base . Results Groups were comparable for all characteristics , except for a higher proportion of patients treated before July 2003 and undergoing preoperative systemic chemotherapy in the SPP group . Median follow-up was 86.2 months in the SPP group and 50.3 months in the CPP group . Median overall survival was 29.6 months in the SPP group and not reached in the CPP group ; 5-year overall survival was 40.0 % and 63.9 % , respectively ( P = 0.0269 ) . At multivariate analysis , CPP versus SPP was recognized as an independent predictor of better prognosis , along with complete cytoreduction , negative lymph nodes , epithelial histology , and lower MIB-1 labelling index . Morbidity and reoperation rates were not different between groups . No operative mortality occurred . In 12 of 24 patients undergoing CPP , pathologic examination detected disease involvement on parietal surfaces with no evident tumor at surgical exploration . Conclusions CPP improved survival in patients with DMPM undergoing combined treatment . This information may contribute to st and ardize surgical options for DMPM and other peritoneal malignancies BACKGROUND Although systemic therapies have shown to result in survival benefit in patients with metastatic colorectal cancer ( mCRC ) , outcomes in patients with peritoneal carcinomatosis ( PC ) are poor . No data are available on outcomes of current chemotherapy schedules plus targeted agents in mCRC patients with PC . METHODS Previously untreated mCRC patients treated with chemotherapy in the CAIRO study and with chemotherapy and targeted therapy in the CAIRO2 study were included and retrospectively analysed according to presence or absence of PC at r and omisation . Patient demographics , primary tumour characteristics , progression-free survival ( PFS ) , overall survival ( OS ) , and occurrence of toxicity were evaluated . RESULTS Thirty-four patients with PC were identified in the CAIRO study and 47 patients in the CAIRO2 study .  Median OS was decreased for patients with PC compared with patients without PC ( CAIRO : 10.4 versus 17.3 months , respectively ( p ≤ 0.001 ) ; CAIRO2 : 15.2 versus 20.7 months , respectively ( p < 0.001 ) ) . Median number of treatment cycles did not differ between patients with or without PC in both studies . Occurrence of major toxicity was more frequent in patients with PC treated with sequential chemotherapy in the CAIRO study as compared to patients without PC . This was not reflected in reasons to discontinue treatment . In the CAIRO2 study , no differences in major toxicity were observed . CONCLUSION Our data demonstrate decreased efficacy of current st and ard chemotherapy with and without targeted agents in mCRC patients with PC . This suggests that the poor outcome can not be explained by undertreatment or increased susceptibility to toxicity , but rather by relative resistance to treatment Background In selected patients with colorectal peritoneal carcinomatosis ( PC ) , cytoreductive surgery ( CRS ) and hyperthermic intraperitoneal chemoperfusion ( HIPEC ) may improve survival . We aim ed to assess whether neoadjuvant chemotherapy with or without bevacizumab is indicated in this patient population . Methods Colorectal PC patients were treated with CRS and HIPEC using oxaliplatin ( 200–460 mg/m2 ) or mitomycin C ( 35 mg/m2 ) . Postoperative outcome and long-term survival were prospect ively recorded . The impact of clinical variables on overall survival ( OS ) was assessed using univariate and Cox multivariate analysis . Results Between October 2002 and May 2012 , 166 patients were treated with CRS and HIPEC . Neoadjuvant chemotherapy alone was administered to 21 % and neoadjuvant chemotherapy with bevacizumab to 16 % of patients . Postoperative mortality and major morbidity were 2.4 and 35 % , respectively . Half of the patients received adjuvant chemotherapy . After a median follow-up of 18 months , OS was 27 months ( 95 % confidence interval 20.8–33.2 ) . On univariate analysis , OS was associated with extent of disease ( P < 0.001 ) , neoadjuvant chemotherapy with bevacizumab ( P = 0.021 ) , completeness of cytoreduction ( CC ) ( P < 0.001 ) , and adjuvant chemotherapy ( P = 0.04 ) , but not with primary disease site , synchronous presentation , or chemoperfusion drug . In multivariate Cox regression , independent predictors of OS were CC ( hazard ratio 0.29 , P < 0.001 ) and neoadjuvant therapy containing bevacizumab ( hazard ratio 0.31 , P = 0.019 ) . Conclusions Long-term OS after CRS and HIPEC for colorectal cancer is associated with CC and neoadjuvant therapy containing bevacizumab . This regimen merits prospect i ve study in patients with resectable PC of colorectal origin Purpose Recurrent disease following complete cytoreductive surgery ( CRS ) and hyperthermic intraperitoneal chemotherapy ( HIPEC ) is a relevant clinical scenario . We aim ed to determine risk factors for recurrence . Methods Prospect ively collected data of patients enrolled in the Peritoneal Surface Malignancy Program at the University of Tübingen between 2005 and 2011 were retrospectively analyzed . All patients were treated by st and ardized CRS and HIPEC . Recurrence was defined either radiographically by CT , PET-CT scan , or reoperation . Results Fifty-two patients received complete CRS ( CC-0/CC-1 ) and HIPEC .  Median time to recurrence was 229 days ( 103–1,028 ) . Overall recurrence rate within follow-up was 48 % . Of patients with recurrent disease , 44 % experienced extraperitoneal systemic tumor spread . In multivariate analysis , grading of ≥3 was shown as an independent risk factor for recurrent disease , while a trend was observed for maximal tumor load in the upper abdominal region . Clinical parameters did not show an impact on recurrence . Conclusions Primary tumor grading seems to be an independent risk factor for recurrence following complete CRS and HIPEC in colorectal cancer-derived peritoneal surface malignancies Introduction : Cytoreductive surgery ( CRS ) combined with perioperative intraperitoneal chemotherapy ( PIC ) is a treatment option for peritoneal surface malignancy . Despite the survival benefits , this treatment was previously associated with a high morbidity and mortality rates and the perception of the poor perioperative outcomes associated with this regimen remains . The aim of this study was to report the perioperative outcomes of  CRS and PIC from a single institution to review factors that are associated with a poor perioperative outcome . Methods : The clinical - and treatment-related data of 243 consecutive procedures performed were prospect ively collected and retrospectively review ed . Adverse events were rated according to the National Cancer Institute 's Common Toxicity Criteria ( grade I – V ) . Univariate and multivariate analyses were performed to identify significant clinical and treatment-related factors for a poor perioperative outcome ( grade s III/IV/V morbidity ) . Results : The perioperative mortality rate was 3 % . The rate of severe morbidity was 43 % . Multivariate analysis demonstrated that left upper quadrant peritonectomy ( P < 0.001 ) and small bowel resection ( P < 0.01 ) were factors that predicted for a poor perioperative outcome . Conclusions : The morbidity and mortality rates of CRS and PIC are within an acceptable range for a major gastrointestinal surgery which is performed with a curative intent . Patient selection is important in ensuring that suitable patients receive this treatment . A new perspective of this treatment needs to be sought PURPOSE Complete resection of macroscopic colorectal peritoneal carcinomatosis ( PC ) , followed by intraoperative intraperitoneal chemohyperthermia ( IPCH ) to treat residual microscopic disease achieves cure in some patients . We report long-term results concerning survival of a phase II study using oxaliplatin ( LOHP ) . PATIENTS AND METHODS From June 1998 to December 2003 , thirty patients with macroscopic colorectal PC underwent complete resection of PC followed by IPCH with LOHP performed in an open abdominal cavity . The dose of LOHP was 460 mg/m2 in 2 L/m2 of iso-osmotic 5 % dextrose , over 30 min at an intraperitoneally homogenous temperature of 43 degrees C and at a flow rate of 2 L/min in the continuous closed circuit . During the hour preceding IPCH , patients received 5-fluorouracil ( 400 mg/m2 ) and leucovorin ( 20 mg/m2 ) intravenously . All patients received neoadjuvant and adjuvant systemic chemotherapy . RESULTS Mean peritoneal tumor extension ( Sugarbaker 's Score ) was 14.3 + /- 3.8 , median operative duration , 450 min , and median blood loss , 940 mL. Eleven ( 37 % ) patients had associated extra-peritoneal lesions which were resected during the same procedure . There were no postoperative deaths and grade 2 - 3 morbidity ( requiring specific treatment ) was 40 % . Median follow-up was 55 months ( range : 31 - 84 ) . Twenty-two patients ( 73 % ) relapsed after a median interval of 14 months , but 7 of them ( 32 % ) were amenable to curative repeat surgery . At 3 and 5 years , overall survival rates ( 95 % confidence interval ) were 53 % ( 9 - 72 ) , and 48.5 % ( 31 - 66 ) respectively . At 3 and 5 years , disease-free survival rates were 41.5 % ( 27 - 59 ) , and 34 % ( 19 - 52 ) respectively . Median survival was 60.1 months . CONCLUSION When feasible , this treatment modality yields a 5-year survival rate of 48.5 % , with median survival attaining 60.1 months Background We conducted a phase I clinical trial to evaluate the sensitivity , specificity , and safety of cytoreductive surgery ( CRS ) under aminolevulinic acid-mediated photodynamic diagnosis ( ALA-PDD ) plus hyperthermic intraperitoneal chemotherapy ( HIPEC ) on 20 patients with peritoneal carcinomatosis ( PC ) from ovarian cancer and primary peritoneal carcinoma ( PPC ) . Patients and Methods Patients took 5-aminolevulinic acid ( 5-ALA ) at a dose of 20 mg/kg orally with 50 mL of water 2 h before surgery . During surgery , the abdominal cavity was observed under blue light ( wavelength of 440 n 
    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: Background The aim of this study was to analyze the anatomic distribution , timing , and outcomes of recurrent disease after complete cytoreduction and perioperative intraperitoneal chemotherapy ( PIC ) for peritoneal carcinomatosis of colorectal origin . Methods Data regarding all patients who underwent complete cytoreduction and PIC for carcinomatosis from colorectal cancer were extracted from a prospect ively collected data base . The information regarding recurrent disease found on diagnostic evaluation and /or abdominal exploration was analyzed . Results Seventy patients underwent complete cytoreduction and perioperative intraperitoneal chemotherapy  , and 49 of them had documented recurrent disease . The median time to progression for these 49 patients was 9 months while their median survival was 30 months . Eighteen patients had a localized intra-abdominal recurrence , 10 had diffuse intraperitoneal recurrence , 10 had isolated distant metastases , and 11 had a combination of distant metastases and intra-abdominal recurrence . There was a statistically significant difference in survival for patients with different patterns of recurrence ( P = .012 ) . Twenty-six patients underwent a second operation . The median survival of these patients was significantly longer than that of patients who did not have a second operation ( 39 vs 20 months , P = .0003 ) . Four of the 49 patients with recurrences were still alive at the time of last follow-up , and three of them have no evidence of disease 73 , 96 , and 206 months after the diagnosis of recurrence . Conclusions Recurrence is a frequent event after optimal cytoreduction and PIC for carcinomatosis from colorectal cancer . Surgical treatment for a selected group of patients with recurrent disease may result in long-term survival Background Combined treatment involving peritonectomy procedures , multivisceral resections , and hyperthermic intraperitoneal chemotherapy ( HIPEC ) has reportedly result ed in survival benefit for peritoneal surface malignancies , including diffuse malignant peritoneal mesothelioma ( DMPM ) . Many unanswered questions remain regarding the surgical options in the management of DMPM . The aim of this case – control study was to assess the impact of the type and extent of parietal peritonectomy on survival and operative outcomes . Methods Thirty patients with DMPM undergoing selective parietal peritonectomy ( SPP ) of macroscopically involved regions , and 30 matched patients undergoing routine complete parietal peritonectomy ( CPP ) , regardless of disease distribution , were retrospectively identified from a prospect i ve data base . Results Groups were comparable for all characteristics , except for a higher proportion of patients treated before July 2003 and undergoing preoperative systemic chemotherapy in the SPP group . Median follow-up was 86.2 months in the SPP group and 50.3 months in the CPP group . Median overall survival was 29.6 months in the SPP group and not reached in the CPP group ; 5-year overall survival was 40.0 % and 63.9 % , respectively ( P = 0.0269 ) . At multivariate analysis , CPP versus SPP was recognized as an independent predictor of better prognosis , along with complete cytoreduction , negative lymph nodes , epithelial histology , and lower MIB-1 labelling index . Morbidity and reoperation rates were not different between groups . No operative mortality occurred . In 12 of 24 patients undergoing CPP , pathologic examination detected disease involvement on parietal surfaces with no evident tumor at surgical exploration . Conclusions CPP improved survival in patients with DMPM undergoing combined treatment . This information may contribute to st and ardize surgical options for DMPM and other peritoneal malignancies BACKGROUND Although systemic therapies have shown to result in survival benefit in patients with metastatic colorectal cancer ( mCRC ) , outcomes in patients with peritoneal carcinomatosis ( PC ) are poor . No data are available on outcomes of current chemotherapy schedules plus targeted agents in mCRC patients with PC . METHODS Previously untreated mCRC patients treated with chemotherapy in the CAIRO study and with chemotherapy and targeted therapy in the CAIRO2 study were included and retrospectively analysed according to presence or absence of PC at r and omisation . Patient demographics , primary tumour characteristics , progression-free survival ( PFS ) , overall survival ( OS ) , and occurrence of toxicity were evaluated . RESULTS Thirty-four patients with PC were identified in the CAIRO study and 47 patients in the CAIRO2 study .  Median OS was decreased for patients with PC compared with patients without PC ( CAIRO : 10.4 versus 17.3 months , respectively ( p ≤ 0.001 ) ; CAIRO2 : 15.2 versus 20.7 months , respectively ( p < 0.001 ) ) . Median number of treatment cycles did not differ between patients with or without PC in both studies . Occurrence of major toxicity was more frequent in patients with PC treated with sequential chemotherapy in the CAIRO study as compared to patients without PC . This was not reflected in reasons to discontinue treatment . In the CAIRO2 study , no differences in major toxicity were observed . CONCLUSION Our data demonstrate decreased efficacy of current st and ard chemotherapy with and without targeted agents in mCRC patients with PC . This suggests that the poor outcome can not be explained by undertreatment or increased susceptibility to toxicity , but rather by relative resistance to treatment Background In selected patients with colorectal peritoneal carcinomatosis ( PC ) , cytoreductive surgery ( CRS ) and hyperthermic intraperitoneal chemoperfusion ( HIPEC ) may improve survival . We aim ed to assess whether neoadjuvant chemotherapy with or without bevacizumab is indicated in this patient population . Methods Colorectal PC patients were treated with CRS and HIPEC using oxaliplatin ( 200–460 mg/m2 ) or mitomycin C ( 35 mg/m2 ) . Postoperative outcome and long-term survival were prospect ively recorded . The impact of clinical variables on overall survival ( OS ) was assessed using univariate and Cox multivariate analysis . Results Between October 2002 and May 2012 , 166 patients were treated with CRS and HIPEC . Neoadjuvant chemotherapy alone was administered to 21 % and neoadjuvant chemotherapy with bevacizumab to 16 % of patients . Postoperative mortality and major morbidity were 2.4 and 35 % , respectively . Half of the patients received adjuvant chemotherapy . After a median follow-up of 18 months , OS was 27 months ( 95 % confidence interval 20.8–33.2 ) . On univariate analysis , OS was associated with extent of disease ( P < 0.001 ) , neoadjuvant chemotherapy with bevacizumab ( P = 0.021 ) , completeness of cytoreduction ( CC ) ( P < 0.001 ) , and adjuvant chemotherapy ( P = 0.04 ) , but not with primary disease site , synchronous presentation , or chemoperfusion drug . In multivariate Cox regression , independent predictors of OS were CC ( hazard ratio 0.29 , P < 0.001 ) and neoadjuvant therapy containing bevacizumab ( hazard ratio 0.31 , P = 0.019 ) . Conclusions Long-term OS after CRS and HIPEC for colorectal cancer is associated with CC and neoadjuvant therapy containing bevacizumab . This regimen merits prospect i ve study in patients with resectable PC of colorectal origin Purpose Recurrent disease following complete cytoreductive surgery ( CRS ) and hyperthermic intraperitoneal chemotherapy ( HIPEC ) is a relevant clinical scenario . We aim ed to determine risk factors for recurrence . Methods Prospect ively collected data of patients enrolled in the Peritoneal Surface Malignancy Program at the University of Tübingen between 2005 and 2011 were retrospectively analyzed . All patients were treated by st and ardized CRS and HIPEC . Recurrence was defined either radiographically by CT , PET-CT scan , or reoperation . Results Fifty-two patients received complete CRS ( CC-0/CC-1 ) and HIPEC .  Median time to recurrence was 229 days ( 103–1,028 ) . Overall recurrence rate within follow-up was 48 % . Of patients with recurrent disease , 44 % experienced extraperitoneal systemic tumor spread . In multivariate analysis , grading of ≥3 was shown as an independent risk factor for recurrent disease , while a trend was observed for maximal tumor load in the upper abdominal region . Clinical parameters did not show an impact on recurrence . Conclusions Primary tumor grading seems to be an independent risk factor for recurrence following complete CRS and HIPEC in colorectal cancer-derived peritoneal surface malignancies Introduction : Cytoreductive surgery ( CRS ) combined with perioperative intraperitoneal chemotherapy ( PIC ) is a treatment option for peritoneal surface malignancy . Despite the survival benefits , this treatment was previously associated with a high morbidity and mortality rates and the perception of the poor perioperative outcomes associated with this regimen remains . The aim of this study was to report the perioperative outcomes of  CRS and PIC from a single institution to review factors that are associated with a poor perioperative outcome . Methods : The clinical - and treatment-related data of 243 consecutive procedures performed were prospect ively collected and retrospectively review ed . Adverse events were rated according to the National Cancer Institute 's Common Toxicity Criteria ( grade I – V ) . Univariate and multivariate analyses were performed to identify significant clinical and treatment-related factors for a poor perioperative outcome ( grade s III/IV/V morbidity ) . Results : The perioperative mortality rate was 3 % . The rate of severe morbidity was 43 % . Multivariate analysis demonstrated that left upper quadrant peritonectomy ( P < 0.001 ) and small bowel resection ( P < 0.01 ) were factors that predicted for a poor perioperative outcome . Conclusions : The morbidity and mortality rates of CRS and PIC are within an acceptable range for a major gastrointestinal surgery which is performed with a curative intent . Patient selection is important in ensuring that suitable patients receive this treatment . A new perspective of this treatment needs to be sought PURPOSE Complete resection of macroscopic colorectal peritoneal carcinomatosis ( PC ) , followed by intraoperative intraperitoneal chemohyperthermia ( IPCH ) to treat residual microscopic disease achieves cure in some patients . We report long-term results concerning survival of a phase II study using oxaliplatin ( LOHP ) . PATIENTS AND METHODS From June 1998 to December 2003 , thirty patients with macroscopic colorectal PC underwent complete resection of PC followed by IPCH with LOHP performed in an open abdominal cavity . The dose of LOHP was 460 mg/m2 in 2 L/m2 of iso-osmotic 5 % dextrose , over 30 min at an intraperitoneally homogenous temperature of 43 degrees C and at a flow rate of 2 L/min in the continuous closed circuit . During the hour preceding IPCH , patients received 5-fluorouracil ( 400 mg/m2 ) and leucovorin ( 20 mg/m2 ) intravenously . All patients received neoadjuvant and adjuvant systemic chemotherapy . RESULTS Mean peritoneal tumor extension ( Sugarbaker 's Score ) was 14.3 + /- 3.8 , median operative duration , 450 min , and median blood loss , 940 mL. Eleven ( 37 % ) patients had associated extra-peritoneal lesions which were resected during the same procedure . There were no postoperative deaths and grade 2 - 3 morbidity ( requiring specific treatment ) was 40 % . Median follow-up was 55 months ( range : 31 - 84 ) . Twenty-two patients ( 73 % ) relapsed after a median interval of 14 months , but 7 of them ( 32 % ) were amenable to curative repeat surgery . At 3 and 5 years , overall survival rates ( 95 % confidence interval ) were 53 % ( 9 - 72 ) , and 48.5 % ( 31 - 66 ) respectively . At 3 and 5 years , disease-free survival rates were 41.5 % ( 27 - 59 ) , and 34 % ( 19 - 52 ) respectively . Median survival was 60.1 months . CONCLUSION When feasible , this treatment modality yields a 5-year survival rate of 48.5 % , with median survival attaining 60.1 months Background We conducted a phase I clinical trial to evaluate the sensitivity , specificity , and safety of cytoreductive surgery ( CRS ) under aminolevulinic acid-mediated photodynamic diagnosis ( ALA-PDD ) plus hyperthermic intraperitoneal chemotherapy ( HIPEC ) on 20 patients with peritoneal carcinomatosis ( PC ) from ovarian cancer and primary peritoneal carcinoma ( PPC ) . Patients and Methods Patients took 5-aminolevulinic acid ( 5-ALA ) at a dose of 20 mg/kg orally with 50 mL of water 2 h before surgery . During surgery , the abdominal cavity was observed under blue light ( wavelength of 440 n 
    Output:
    