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 AND PURPOSE To prospect ively assess the feasibility and efficacy of a hypofractionated accelerated radiotherapy regimen ( 72 Gy in 24 daily fractions , 3 Gy per fraction ) in patients ( pts ) with non-resectable non-small-cell lung cancer ( NSCLC ) . MATERIAL AND METHODS We included 25 pts with a histologically or cytologically proven NSCLC , with KPS > or = 70 and < or = 10 % weight loss over prior three months , and with tumour stage I/II medically inoperable ( 9 pts ) or non-resectable stage III a/b without pleural effusion ( 16 pts ) . Eleven pts received induction chemotherapy . No more than 30 % of the combined lung volume could receive more than 25 Gy and the maximal biological effective dose to the spinal cord was maintained below 44 Gy . RESULTS No grade -4 acute toxicity event was reported . Two pts had a treatment break because of grade -3 acute oesophagitis . Twenty-two pts were evaluable for long-term toxicity ( median follow-up=9.7 months , range 4 to 30.2 months ) . There were 4 Grade -1 pulmonary and 2 Grade -1 oesophageal long-term toxicity events . Twenty-two pts were evaluable for tumour response with 7 complete and 8 partial responses , 5 stable diseases and 2 progressive diseases . The actuarial 1-year overall and thoracic-progression-free survival rates were 68 % and 72 % respectively . CONCLUSIONS This study demonstrates the feasibility of the experimental radiotherapy schedule , however more data are needed to confirm its efficacy Purpose : St and ard chemoradiation therapy for stage III non-small cell lung cancer ( NSCLCa ) results in suboptimal outcomes with a high rate of local failure and poor overall survival . We hypothesize that dose escalation using stereotactic body radiotherapy ( SBRT ) boost could improve upon these results . We present here a study evaluating the dosimetric feasibility of such an approach . Methods : Anonymized CT data sets from five r and omly selected patients with stage III NSCLCa undergoing definitive chemoradiation therapy in our department with disease volumes appropriate for SBRT boost were selected .  Three-dimensional conformal radiation therapy ( 3D-CRT ) plans to 50.4 Gy in 28 fractions were generated follow by SBRT plans to two dose levels , 16 Gy in two fractions and 28 Gy in two fractions . SBRT plans and total composite ( 3D-CRT and SBRT ) were optimized and evaluated for target coverage and dose to critical structures ; lung , esophagus , cord , and heart . Results : All five plans met predetermined target coverage and normal tissue dose constraints . PTV V95 was equal to or greater than 95 % in all cases . The cumulative lung V20 and V5 of the combined 3D-CRT and SBRT plans were less than or equal to 30 and 55 % , respectively . The 5 cc esophageal dose was less than 12 Gy for all low and high dose SBRT plans . The cumulative dose to the esophagus was also acceptable with less than 10 % of the esophagus receiving doses in excess of 50 Gy . The cumulative spinal cord dose was less than 33 Gy and heart V25 was less than 5 % . Conclusion : The combination of chemoradiation to 50.4 Gy followed by SBRT boost to gross disease at the primary tumor and involved regional lymph nodes is feasible with respect to normal tissue dose constraints in this dosimetric pilot study . A phase I/II trial to evaluate the clinical safety and efficacy of this approach is being undertaken Background Results of high-dose chemo-radiotherapy ( CRT ) , using the treatment schedules of EORTC study 08972/22973 or radiotherapy ( RT ) alone were analyzed among all patients ( pts ) with Non Small Cell Lung Cancer ( NSCLC ) treated with curative intent in our department from 1995–2004 . Material Included are 131 pts with medically inoperable or with irresectable NSCLC ( TNM stage I:15 pts , IIB:15 pts , IIIA:57 pts , IIIB:43 pts , X:1 pt).TreatmentGroup I : Concomitant CRT : 66 Gy/2.75 Gy/24 fractions (fx)/33 days combined with daily administration of cisplatin 6 mg/m2 : 56 pts ( st and ard).Group II : Sequential CRT : two courses of a 21-day schedule of chemotherapy ( gemcitabin 1250 mg/m2 d1 , cisplatin 75 mg/m2 d2 ) followed by 66 Gy/2.75 Gy/24 fx/33 days without daily cisplatin : 26 pts . Group III : RT : 66 Gy/2.75 Gy/24 fx/33 days or 60 Gy/3 Gy/20 fx/26 days : 49 pts . Results The 1 , 2 , and 5 year actuarial overall survival ( OS ) were 46 % , 24 % , and 15 % , respectively . At multivariate analysis the only factor with a significantly positive influence on OS was treatment with  chemo-radiation  ( P = 0.024 ) ( 1- , 2- , and 5-yr OS 56 % , 30 % and 22 % respectively ) . The incidence of local recurrence was 36 % , the incidence of distant metastases 46%.Late complications grade 3 were seen in 21 pts and grade 4 in 4 patients . One patient had a lethal complication ( oesophageal ) . For 32 patients insufficient data were available to assess late complications . Conclusion In this study we were able to reproduce the results of EORTC trial 08972/22973 in a non-selected patient population outside of the setting of a r and omised trial . Radiotherapy ( 66 Gy/24 fx/33 days ) combined with either concomitant daily low dose cisplatin or with two neo-adjuvant courses of gemcitabin and cisplatin are effective treatments for patients with locally advanced Non-Small Cell Lung Cancer . The concomitant schedule is also suitable for elderly people with co-morbidity PURPOSE Hypofractionated radiation therapy ( HypoRT ) can potentially improve local control with a higher biological effect and shorter overall treatment time . Response , local control , toxicity rates , and survival rates were evaluated in patients affected by inoperable advanced stage non-small cell lung cancer ( NSCLC ) who received HypoRT .  METHODS AND MATERIAL S Thirty patients with advanced NSCLC were enrolled ; 27 % had stage IIIA , 50 % had stage IIIB , and 23 % had stage IV disease . All patients underwent HypoRT with a prescribed total dose of 60 Gy in 20 fractions of 3 Gy each . Radiation treatment was delivered using an image guided radiation therapy technique to verify correct position . Toxicities were grade d according to Radiation Therapy Oncology Group morbidity score . Survival rates were estimated using the Kaplan-Meier method . RESULTS The median follow-up was 13 months ( range , 4 - 56 months ) . All patients completed radiation therapy and received the total dose of 60 Gy to the primary tumor and positive lymph nodes . The overall response rate after radiation therapy was 83 % ( 3 patients with complete response and 22 patients with partial response ) . The 2-year overall survival and progression-free survival rates were 38.1 % and 36 % , respectively . Locoregional recurrence/persistence occurred in 11 ( 37 % ) patients . Distant metastasis occurred in 17 ( 57 % ) patients . Acute toxicities occurred consisting of grade 1 to 2 hematological toxicity in 5 patients ( 17 % ) and grade 3 in 1 patient ; grade 1 to 2 esophagitis in 12 patients ( 40 % ) and grade 3 in 1 patient ; and grade 1 to 2 pneumonitis in 6 patients ( 20 % ) and grade 3 in 2 patients ( 7 % ) . Thirty-three percent of patients developed grade 1 to 2 late toxicities . Only 3 patients developed grade 3 late adverse effects : esophagitis in 1 patient and pneumonitis in 2 patients . CONCLUSIONS Hypofractionated curative radiation therapy is a feasible and well-tolerated treatment for patients with locally advanced NSCLC . R and omized studies are needed to compare HypoRT to conventional treatment PURPOSE To prospect ively assess the feasibility , toxicity , and local control of a class solution protocol of moderately hypofractionated tomotherapy in Stage III , inoperable , locally advanced non-small-cell lung cancer patients . METHODS AND MATERIAL S Eligible patients were treated according to a uniform class solution ( 70.5 Gy in 30 fractions ) with fixed constraints and priorities using helical tomotherapy . Toxicity monitoring was performed using the Radiation Therapy Oncology Group criteria and the National Cancer Institute Common Terminology Criteria and Adverse Events ( CTCAE ) version 3.0 . Pulmonary function tests were performed at the start and repeated at 3 months after treatment . RESULTS Our class solution result ed in a deliverable plan in all 40 consecutive patients .  Acute Grade 3 lung toxicity was seen in 10 % of patients . Two patients died during acute follow-up with pulmonary toxicity . Correlations were found between changes in pulmonary function test results and mean lung dose or the lung volume receiving 20 Gy ( V(20 ) ) . The correlation was strongest for lung diffusion capacity for carbon monoxide . A V(20 ) of > 27 % and > 32 % were predictive for Grade s 2 and 3 acute lung toxicity respectively ( p < 0.05 ) . Late Grade 3 toxicity was exclusively pulmonary , with an incidence of 16 % . Overall Grade 3 lung toxicity correlated with a mean lung dose of > 18 Gy and a median lung dose of > 5 Gy ( p < 0.05 ) . Median survival was 17 months , and the 1-year and 2-year local progression-free survivals were 66 % and 50 % , respectively . CONCLUSION The current class solution using moderately hypofractionated helical tomotherapy in patients with locally advanced non-small-cell lung cancer is feasible . Toxicity was acceptable and in line with other reports on intensity-modulated radiotherapy . The local progression-free survival was encouraging considering the unselected population Background Concurrent chemo-radiotherapy is demonstrately superior to sequential chemo-radiotherapy in the treatment of advanced Non-Small-Cell Lung Cancer not suitable for surgery .  Docetaxel is considered to enhance the cytotoxic effect of radiotherapy on the tumour cells . Tomotherapy ( HT ) is a novel radiotherapeutic technique , which allows the delivery of Image Guided-IMRT ( IG-IMRT ) , with a highly conformal radiation dose distribution . The goal of the study was to estimate tolerability of Docetaxel concurrent with IMRT and to find the maximum tolerated dose of weekly Docetaxel concurrent with IMRT delivered with HT Tomotherapy after induction chemotherapy with Cisplatin and Docetaxel in patients affected with stage III Non-Small Cell Lung Cancer . Methods We design ed a phase I , dose-finding study to determine the dose of weekly Docetaxel concurrent with Tomotherapy after induction chemotherapy , in patients affected by Non-Small Cell Lung Cancer with Stage III disease , not suitable for surgery . Results Concurrent weekly Docetaxel and Tomotherapy are feasible ; we did not reach a maximum tolerated dose , because no life-threatening toxicity was observed , stopping the accrual at a level of weekly docetaxel 38 mg/m2 , a greater dose than in previous assessment s , from both phase-I studies with weekly docetaxel alone and with Docetaxel concomitant with st and ard radiotherapy . Conclusions Concurrent weekly Docetaxel and Tomotherapy are feasible , and even with Docetaxel at 38 mg/m2/week we did not observe any limiting toxicity . For those patients who completed the combined chemo-radio treatment , median progression-free survival ( PFS ) was 20 months and median overall survival ( OS ) was 24 months BACKGROUND AND PURPOSE A variety of radiotherapy fractionations are used as potentially curative treatments for non-small cell lung cancer . In the UK , 55 Gy in 20 fractions over 4 weeks ( 55/20 ) is the most commonly used fractionation schedule , though it has not been vali date d in r and omized phase III trials . This audit pooled together existing data from 4 UK centres to produce the largest published series for this schedule . MATERIAL S AND METHODS 4 UK centres contributed data ( Cambridge , Cardiff , Glasgow and Sheffield ) . Case notes and radiotherapy records of radically treated patients between 1999 and 2007 were retrospectively review ed . Basic patient demographics , tumour characteristics , radiotherapy and survival data were collected and analysed . RESULTS 609 patients were identified of whom 98 % received the prescribed dose of 55/20 . The median age was 71.3 years , 62 % were male . 90 % had histologically confirmed NSCLC , 49 % had stage I disease . 27 % had received chemotherapy  ( concurrent or sequential ) with their radiotherapy . The median overall survival from time of diagnosis was 24.0 months and 2 year overall survival was 50 % . CONCLUSION These data show respectable results for patients treated with accelerated hypo-fractionated radiother 
    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 AND PURPOSE To prospect ively assess the feasibility and efficacy of a hypofractionated accelerated radiotherapy regimen ( 72 Gy in 24 daily fractions , 3 Gy per fraction ) in patients ( pts ) with non-resectable non-small-cell lung cancer ( NSCLC ) . MATERIAL AND METHODS We included 25 pts with a histologically or cytologically proven NSCLC , with KPS > or = 70 and < or = 10 % weight loss over prior three months , and with tumour stage I/II medically inoperable ( 9 pts ) or non-resectable stage III a/b without pleural effusion ( 16 pts ) . Eleven pts received induction chemotherapy . No more than 30 % of the combined lung volume could receive more than 25 Gy and the maximal biological effective dose to the spinal cord was maintained below 44 Gy . RESULTS No grade -4 acute toxicity event was reported . Two pts had a treatment break because of grade -3 acute oesophagitis . Twenty-two pts were evaluable for long-term toxicity ( median follow-up=9.7 months , range 4 to 30.2 months ) . There were 4 Grade -1 pulmonary and 2 Grade -1 oesophageal long-term toxicity events . Twenty-two pts were evaluable for tumour response with 7 complete and 8 partial responses , 5 stable diseases and 2 progressive diseases . The actuarial 1-year overall and thoracic-progression-free survival rates were 68 % and 72 % respectively . CONCLUSIONS This study demonstrates the feasibility of the experimental radiotherapy schedule , however more data are needed to confirm its efficacy Purpose : St and ard chemoradiation therapy for stage III non-small cell lung cancer ( NSCLCa ) results in suboptimal outcomes with a high rate of local failure and poor overall survival . We hypothesize that dose escalation using stereotactic body radiotherapy ( SBRT ) boost could improve upon these results . We present here a study evaluating the dosimetric feasibility of such an approach . Methods : Anonymized CT data sets from five r and omly selected patients with stage III NSCLCa undergoing definitive chemoradiation therapy in our department with disease volumes appropriate for SBRT boost were selected .  Three-dimensional conformal radiation therapy ( 3D-CRT ) plans to 50.4 Gy in 28 fractions were generated follow by SBRT plans to two dose levels , 16 Gy in two fractions and 28 Gy in two fractions . SBRT plans and total composite ( 3D-CRT and SBRT ) were optimized and evaluated for target coverage and dose to critical structures ; lung , esophagus , cord , and heart . Results : All five plans met predetermined target coverage and normal tissue dose constraints . PTV V95 was equal to or greater than 95 % in all cases . The cumulative lung V20 and V5 of the combined 3D-CRT and SBRT plans were less than or equal to 30 and 55 % , respectively . The 5 cc esophageal dose was less than 12 Gy for all low and high dose SBRT plans . The cumulative dose to the esophagus was also acceptable with less than 10 % of the esophagus receiving doses in excess of 50 Gy . The cumulative spinal cord dose was less than 33 Gy and heart V25 was less than 5 % . Conclusion : The combination of chemoradiation to 50.4 Gy followed by SBRT boost to gross disease at the primary tumor and involved regional lymph nodes is feasible with respect to normal tissue dose constraints in this dosimetric pilot study . A phase I/II trial to evaluate the clinical safety and efficacy of this approach is being undertaken Background Results of high-dose chemo-radiotherapy ( CRT ) , using the treatment schedules of EORTC study 08972/22973 or radiotherapy ( RT ) alone were analyzed among all patients ( pts ) with Non Small Cell Lung Cancer ( NSCLC ) treated with curative intent in our department from 1995–2004 . Material Included are 131 pts with medically inoperable or with irresectable NSCLC ( TNM stage I:15 pts , IIB:15 pts , IIIA:57 pts , IIIB:43 pts , X:1 pt).TreatmentGroup I : Concomitant CRT : 66 Gy/2.75 Gy/24 fractions (fx)/33 days combined with daily administration of cisplatin 6 mg/m2 : 56 pts ( st and ard).Group II : Sequential CRT : two courses of a 21-day schedule of chemotherapy ( gemcitabin 1250 mg/m2 d1 , cisplatin 75 mg/m2 d2 ) followed by 66 Gy/2.75 Gy/24 fx/33 days without daily cisplatin : 26 pts . Group III : RT : 66 Gy/2.75 Gy/24 fx/33 days or 60 Gy/3 Gy/20 fx/26 days : 49 pts . Results The 1 , 2 , and 5 year actuarial overall survival ( OS ) were 46 % , 24 % , and 15 % , respectively . At multivariate analysis the only factor with a significantly positive influence on OS was treatment with  chemo-radiation  ( P = 0.024 ) ( 1- , 2- , and 5-yr OS 56 % , 30 % and 22 % respectively ) . The incidence of local recurrence was 36 % , the incidence of distant metastases 46%.Late complications grade 3 were seen in 21 pts and grade 4 in 4 patients . One patient had a lethal complication ( oesophageal ) . For 32 patients insufficient data were available to assess late complications . Conclusion In this study we were able to reproduce the results of EORTC trial 08972/22973 in a non-selected patient population outside of the setting of a r and omised trial . Radiotherapy ( 66 Gy/24 fx/33 days ) combined with either concomitant daily low dose cisplatin or with two neo-adjuvant courses of gemcitabin and cisplatin are effective treatments for patients with locally advanced Non-Small Cell Lung Cancer . The concomitant schedule is also suitable for elderly people with co-morbidity PURPOSE Hypofractionated radiation therapy ( HypoRT ) can potentially improve local control with a higher biological effect and shorter overall treatment time . Response , local control , toxicity rates , and survival rates were evaluated in patients affected by inoperable advanced stage non-small cell lung cancer ( NSCLC ) who received HypoRT .  METHODS AND MATERIAL S Thirty patients with advanced NSCLC were enrolled ; 27 % had stage IIIA , 50 % had stage IIIB , and 23 % had stage IV disease . All patients underwent HypoRT with a prescribed total dose of 60 Gy in 20 fractions of 3 Gy each . Radiation treatment was delivered using an image guided radiation therapy technique to verify correct position . Toxicities were grade d according to Radiation Therapy Oncology Group morbidity score . Survival rates were estimated using the Kaplan-Meier method . RESULTS The median follow-up was 13 months ( range , 4 - 56 months ) . All patients completed radiation therapy and received the total dose of 60 Gy to the primary tumor and positive lymph nodes . The overall response rate after radiation therapy was 83 % ( 3 patients with complete response and 22 patients with partial response ) . The 2-year overall survival and progression-free survival rates were 38.1 % and 36 % , respectively . Locoregional recurrence/persistence occurred in 11 ( 37 % ) patients . Distant metastasis occurred in 17 ( 57 % ) patients . Acute toxicities occurred consisting of grade 1 to 2 hematological toxicity in 5 patients ( 17 % ) and grade 3 in 1 patient ; grade 1 to 2 esophagitis in 12 patients ( 40 % ) and grade 3 in 1 patient ; and grade 1 to 2 pneumonitis in 6 patients ( 20 % ) and grade 3 in 2 patients ( 7 % ) . Thirty-three percent of patients developed grade 1 to 2 late toxicities . Only 3 patients developed grade 3 late adverse effects : esophagitis in 1 patient and pneumonitis in 2 patients . CONCLUSIONS Hypofractionated curative radiation therapy is a feasible and well-tolerated treatment for patients with locally advanced NSCLC . R and omized studies are needed to compare HypoRT to conventional treatment PURPOSE To prospect ively assess the feasibility , toxicity , and local control of a class solution protocol of moderately hypofractionated tomotherapy in Stage III , inoperable , locally advanced non-small-cell lung cancer patients . METHODS AND MATERIAL S Eligible patients were treated according to a uniform class solution ( 70.5 Gy in 30 fractions ) with fixed constraints and priorities using helical tomotherapy . Toxicity monitoring was performed using the Radiation Therapy Oncology Group criteria and the National Cancer Institute Common Terminology Criteria and Adverse Events ( CTCAE ) version 3.0 . Pulmonary function tests were performed at the start and repeated at 3 months after treatment . RESULTS Our class solution result ed in a deliverable plan in all 40 consecutive patients .  Acute Grade 3 lung toxicity was seen in 10 % of patients . Two patients died during acute follow-up with pulmonary toxicity . Correlations were found between changes in pulmonary function test results and mean lung dose or the lung volume receiving 20 Gy ( V(20 ) ) . The correlation was strongest for lung diffusion capacity for carbon monoxide . A V(20 ) of > 27 % and > 32 % were predictive for Grade s 2 and 3 acute lung toxicity respectively ( p < 0.05 ) . Late Grade 3 toxicity was exclusively pulmonary , with an incidence of 16 % . Overall Grade 3 lung toxicity correlated with a mean lung dose of > 18 Gy and a median lung dose of > 5 Gy ( p < 0.05 ) . Median survival was 17 months , and the 1-year and 2-year local progression-free survivals were 66 % and 50 % , respectively . CONCLUSION The current class solution using moderately hypofractionated helical tomotherapy in patients with locally advanced non-small-cell lung cancer is feasible . Toxicity was acceptable and in line with other reports on intensity-modulated radiotherapy . The local progression-free survival was encouraging considering the unselected population Background Concurrent chemo-radiotherapy is demonstrately superior to sequential chemo-radiotherapy in the treatment of advanced Non-Small-Cell Lung Cancer not suitable for surgery .  Docetaxel is considered to enhance the cytotoxic effect of radiotherapy on the tumour cells . Tomotherapy ( HT ) is a novel radiotherapeutic technique , which allows the delivery of Image Guided-IMRT ( IG-IMRT ) , with a highly conformal radiation dose distribution . The goal of the study was to estimate tolerability of Docetaxel concurrent with IMRT and to find the maximum tolerated dose of weekly Docetaxel concurrent with IMRT delivered with HT Tomotherapy after induction chemotherapy with Cisplatin and Docetaxel in patients affected with stage III Non-Small Cell Lung Cancer . Methods We design ed a phase I , dose-finding study to determine the dose of weekly Docetaxel concurrent with Tomotherapy after induction chemotherapy , in patients affected by Non-Small Cell Lung Cancer with Stage III disease , not suitable for surgery . Results Concurrent weekly Docetaxel and Tomotherapy are feasible ; we did not reach a maximum tolerated dose , because no life-threatening toxicity was observed , stopping the accrual at a level of weekly docetaxel 38 mg/m2 , a greater dose than in previous assessment s , from both phase-I studies with weekly docetaxel alone and with Docetaxel concomitant with st and ard radiotherapy . Conclusions Concurrent weekly Docetaxel and Tomotherapy are feasible , and even with Docetaxel at 38 mg/m2/week we did not observe any limiting toxicity . For those patients who completed the combined chemo-radio treatment , median progression-free survival ( PFS ) was 20 months and median overall survival ( OS ) was 24 months BACKGROUND AND PURPOSE A variety of radiotherapy fractionations are used as potentially curative treatments for non-small cell lung cancer . In the UK , 55 Gy in 20 fractions over 4 weeks ( 55/20 ) is the most commonly used fractionation schedule , though it has not been vali date d in r and omized phase III trials . This audit pooled together existing data from 4 UK centres to produce the largest published series for this schedule . MATERIAL S AND METHODS 4 UK centres contributed data ( Cambridge , Cardiff , Glasgow and Sheffield ) . Case notes and radiotherapy records of radically treated patients between 1999 and 2007 were retrospectively review ed . Basic patient demographics , tumour characteristics , radiotherapy and survival data were collected and analysed . RESULTS 609 patients were identified of whom 98 % received the prescribed dose of 55/20 . The median age was 71.3 years , 62 % were male . 90 % had histologically confirmed NSCLC , 49 % had stage I disease . 27 % had received chemotherapy  ( concurrent or sequential ) with their radiotherapy . The median overall survival from time of diagnosis was 24.0 months and 2 year overall survival was 50 % . CONCLUSION These data show respectable results for patients treated with accelerated hypo-fractionated radiother 
    Output:
    