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: Two hundred and forty-one patients , with advanced squamous cell carcinoma of head and neck , were r and omized to receive three courses of  induction chemotherapy . The chemotherapy regimens were delivered every 3 weeks , and consisted in 1 ) cisplatin , 80 mg/m2 given alone ( CDDP regimen ) , or 2 ) in combination with vincristine , 1 mg , d 1 , methotrexate 10 mg/m2 d 1 , 2 , 3 , and bleomycin 10 mg/m2 , d 1 , 2 , and 3 ( MOB-P ) . Tolerance was significantly better with the CDDP regimen ( p less than 0.05 ) ; severe side effects , affecting mainly digestive tract , and bone marrow , were encountered in 7 % of the patients in the CDDP group , vs 15 % in the MOB-P group , without death related to pancytopenia . Short-term results were better for patients treated by the MOB-P regimen , with a 42 % response rate ( including 9 complete responses ) vs 22 % with the CDDP regimen ( p = 0.01 ) . A superiority of combination chemotherapy was more significant for primary sites than regional lymph nodes . The relapse-free survival was not statistically different in the 2 groups , as well as the 2 years overall survival . Among responders , the survival was found highly correlated with a good initial general status ( p less than 0.01 ) , and with the highest total doses of cisplatin ( p less than 0.02 ) . ( ABSTRACT TRUNCATED AT 250 WORDS In a prospect i ve , r and omized , multicenter study , neoadjuvant chemotherapy ( CT ) with carboplatin and 5-fluorouracil ( 5-FU ) followed by locoregional treatment ( LRT ) was compared with locoregional treatment alone in the treatment of patients with head and neck cancer . This study , which includes 324 patients , was conducted from January 1988 to July 1991 . The aim of this study was to evaluate the impact of the carboplatin/5-FU regimen both on the incidence of mutilating surgery and on the survival rate .  Chemotherapy consisted of three cycles of carboplatin 400 mg/m2 day 1 and 5-FU 1 g/m2 days 1 - 5 , repeated every 3 weeks . Patients with a complete tumor response then received radiotherapy alone , instead of the treatment planned initially . Three hundred patients were analyzed : 79 had tumors of the oral cavity , 106 oropharyngeal tumors , and 115 pharyngolaryngeal tumors . One hundred fifty patients underwent CT+LRT ; 150 patients had LRT alone .  Grade 3 and 4 toxicity rates were minimal in the CT+LRT group ; toxicity was mainly hematologic ( 24 % neutropenia , 19 % thrombocytopenia ) . There were 3 toxic deaths ( 2 % ) , 2 due to septicemia and 1 due to cardiac toxicity .  One hundred forty-three patients were evaluable for efficacy . The tumor objective response rate was 63 % and complete response rate was 31 % ( 35 % for oropharyngeal , 34 % for pharyngolaryngeal tumors , 22.5 % for oral cavity tumors ) , which led to a 29 % decrease in the rate of mutilating surgery . Conservative treatment was performed in 57 % of patients in the CT+LRT group vs. 24 % in the LRT group ( p = 0.001 ) . There was no significant difference between survival curves in the CT+LRT and LRT groups . At 4 years , overall survival rates were 56 and 46 % ; disease-free survival rates were 33 and 30 % in the CT+LRT and the LRT groups , respectively . The survival rates were not significantly different in the two groups . The locoregional recurrence rates were 35 % in the CT+LRT arm and 25 % in the LRT arm ( p = 0.04 ) , with median follow-up of 25 months . The rates of secondary localization and distant metastasis were not significantly different in the two groups PURPOSE To report the results and corresponding acute and late reactions of a prospect i ve , r and omized , clinical study in locally advanced head and neck cancer comparing concurrent fluorouracil ( FU ) and mitomycin ( MMC ) chemotherapy and hyperfractionated accelerated radiation therapy ( C-HART ; 70.6 Gy ) to hyperfractionated accelerated radiation therapy alone ( HART ; 77.6 Gy ) . PATIENTS AND METHODS Three hundred eighty-four stage III ( 6 % ) and IV ( 94 % ) oropharyngeal ( 59.4 % ) , hypopharyngeal ( 32.3 % ) , and oral cavity ( 8.3 % ) cancer patients were r and omly assigned to receive either 30 Gy ( 2 Gy every day ) followed by 1.4 Gy bid to a total of 70.6 Gy concurrently with FU ( 600 mg/m(2 ) , 120 hours continuous infusion ) days 1 through 5 and MMC ( 10 mg/m(2 ) ) on days 5 and 36 ( C-HART ) or 14 Gy ( 2 Gy every day ) followed by 1.4 Gy bid to a total dose of 77.6 Gy ( HART ) . The data were analyzed on an intent-to-treat basis . RESULTS At 5 years , the locoregional control and overall survival rates were 49.9 % and 28.6 % for C-HART versus 37.4 % and 23.7 % for HART , respectively ( P = .001 and P = .023 , respectively ) . Progression-free and freedom from metastases rates were 29.3 % and 51.9 % for C-HART versus 26.6 % and 54.7 % for HART , respectively ( P = .009 and P = .575 , respectively ) . For C-HART , maximum acute reactions of mucositis , moist desquamation , and erythema were lower than with HART , whereas no differences in late reactions and overall rates of secondary neoplasms were observed . CONCLUSION C-HART ( 70.6 Gy ) is superior to dose-escalated HART ( 77.6 Gy ) with comparable or less acute reactions and equivalent late reactions , indicating an improvement of the therapeutic ratio PURPOSE We report the 5-year survival and late toxicity results of a r and omized clinical trial , which showed a 3-year improvement in overall survival and locoregional control of stage III or IV oropharynx carcinoma , using concomitant radiochemotherapy ( arm B ) , compared with st and ard radiotherapy ( arm A ) . PATIENTS AND METHODS A total of 226 patients were entered onto a phase III multicenter r and omized trial comparing radiotherapy alone ( 70 Gy in 35 fractions ; arm A ) with concomitant radiochemotherapy ( 70 Gy in 35 fractions with three cycles of a 4-day regimen comprising carboplatin and fluorouracil ; arm B ) . Prognostic factors were evaluated by univariate and multivariate analysis . Five-year late toxicity was evaluated using National Cancer Institute Common Toxicity Criteria for neurological toxicity , hearing , taste , m and ibula , and teeth damage , and Radiation Therapy Oncology Group toxicity criteria for skin , salivary gl and , and mucosa . RESULTS Five-year overall survival , specific disease-free survival , and locoregional control rates were 22 % and 16 % ( log-rank P = .05 ) , 27 % and 15 % ( P = .01 ) , and 48 % and 25 % ( P = .002 ) , in arm B and arm A , respectively . Stage IV , hemoglobin level lower than 125 g/L , and st and ard treatment were independent prognostic factors of short survival and locoregional failure by univariate and multivariate analysis . One or more grade 3 to 4 complications occurred in 56 % of the patients in arm B , compared with 30 % in arm A ( P was not significant ) . CONCLUSION Concomitant radiochemotherapy improved overall survival and locoregional control rates and does not statistically increase severe late morbidity . Anemia was the most important prognostic factor for survival in both arms Forty‐eight patients with locally confined ( MO ) squamous cell head and neck cancer were prospect ively r and omized to receive either simultaneous ( SIM ) or sequential ( SEQ ) combined technique therapy with a 5‐fluorouracil infusion , a cisplatin bolus injection , and radiation therapy .  Patients with residual resectable disease underwent surgery after induction therapy , whereas those achieving a complete response to induction did not require surgery . Patients on the two treatment arms were equivalent in all measured variables , including disease extent . Toxicities of the SIM and SEQ arms also were equivalent except for mucositis and the result ant weight loss , which were more severe on the SIM arm ( P = 0.002 ) . With a follow‐up time ranging from 9 to 41 months , seven of the 24 SIM patients and 14 of the 24 SEQ patients are considered treatment failures . The relapse‐free survival is significantly better on the SIM arm ( P = 0.03 ) , although an overall survival advantage has not yet been demonstrated ( P = 0.13 ) . The achievement of a complete response after induction therapy correlates with both the relapse‐free ( P = 0.0005 ) and overall ( P = 0.05 ) survival , and the likelihood of an induction complete response also is significantly better for those treated with the SIM schedule ( P = 0.02 ) . Eighteen patients did not require surgery after achieving an induction complete response . Relapse‐free survival does not appear to be compromised in this patient subset Purpose To assess the survival rate , the probability of local control , the patterns of relapse and late sequelae including self-reported quality of life in patients treated with hyperfractionated radiotherapy ( RT ) and simultaneous CDDP chemotherapy for stage-III to stage-IV carcinomas of the head and neck . Methods From 1988 to 1994 , 64 patients ( median age 55.5 years ) with carcinomas of different subsites , excluding the nasopharynx , were treated in a pilot study with 1.2 Gy bid ( 6 h interval ; total dose 74.4 Gy ) and simultaneous CDDP ( 20 mg/m2 daily , 5 days in week 1 and 5 ) and followed at regular intervals . Overall survival and local control , as well as the rates of late toxicity , were estimated using the actuarial method . Median follow-up was 3.3 years for all and 5.2 years for surviving patients . To assess the quality of life , the EORTC QLQ-C 30 question naire and the H&N35 module question naire were sent to the patients surviving with no evidence of disease or second primary tumors ; they were answered by 15/23 ( 67 % ) . Results Overall survival was 37 % at 5 years , whereas disease-specific survival was 59 % . Twenty-three patients died from uncontrolled head and neck cancer . Second primary tumors were observed in 13 patients , most frequently in the lung . Local control without salvage surgery was 74 % at 5 years for all subsites and stages , and loco-regional disease-free survival was 72 % . Eleven patients developed distant metastases , which was the only site of failure in 6 cases . Salvage surgery was successful in 2 cases . The actuarial estimates of ≥ grade -3 late toxicity was 4 % for the m and ibular bone and 23 % for dysphagia , and 50 % of the patients experienced a permanent xerostomy . Self-reported global quality of life in surviving patients was good ( mean 68 points on a scale 0 to 100 ) ; consequences of impaired salivary function had most impact on nutritional and social aspects . Conclusions Hyperfractionated RT with concomitant CDDP is well tolerated and highly efficient in controlling moderately advanced to advanced cancers of the head and neck . Second primary tumors are the main cause of death after 3 years and were observed outside of the irradiated area , most frequently in the lung . Even after RT of large volumes to a high dose , salvage surgery can be successfully performed in individual cases . Self-reported quality of life of surviving patients is good , despite xerostomy-associated nutritional difficulties . ZusammenfassungZielAnalyse der Überlebensrate , des krankheitsspezifischen Überlebens , des Rezidivmusters , der Spättoxizität sowie der subjektiven Lebensqualität nach hyperfraktionierter Radiotherapie ( RT ) und gleichzeitiger Cisplatin-Chemotherapie ( CDDP ) bei Patienten mit mindestens zwei Jahren Beobachtungszeit i m Rahmen einer prospektiven Phase-II-Studie . Patienten und Method eIm Rahmen einer Pilotstudie ( 1988 bis 1994 ) wurden 64 Patienten ( medianes Alter 55,5 Jahre ) mit Stadium III oder IV kombiniert beh and elt :  RT 1,2 Gy zweimal täglich bis 74,4 Gy , CDDP 20 mg/m2 täglich an den Tagen 1 bis 5 der ersten und fünften Woche . Die Überlebenskurven sowie die Toxizität wurden aktuariell berechnet . Die mediane Beobachtungszeit war 3,3 Jahre für alle respektive 5,2 Jahre für die überlebenden Patienten . Zur Einschätzung 
    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: Two hundred and forty-one patients , with advanced squamous cell carcinoma of head and neck , were r and omized to receive three courses of  induction chemotherapy . The chemotherapy regimens were delivered every 3 weeks , and consisted in 1 ) cisplatin , 80 mg/m2 given alone ( CDDP regimen ) , or 2 ) in combination with vincristine , 1 mg , d 1 , methotrexate 10 mg/m2 d 1 , 2 , 3 , and bleomycin 10 mg/m2 , d 1 , 2 , and 3 ( MOB-P ) . Tolerance was significantly better with the CDDP regimen ( p less than 0.05 ) ; severe side effects , affecting mainly digestive tract , and bone marrow , were encountered in 7 % of the patients in the CDDP group , vs 15 % in the MOB-P group , without death related to pancytopenia . Short-term results were better for patients treated by the MOB-P regimen , with a 42 % response rate ( including 9 complete responses ) vs 22 % with the CDDP regimen ( p = 0.01 ) . A superiority of combination chemotherapy was more significant for primary sites than regional lymph nodes . The relapse-free survival was not statistically different in the 2 groups , as well as the 2 years overall survival . Among responders , the survival was found highly correlated with a good initial general status ( p less than 0.01 ) , and with the highest total doses of cisplatin ( p less than 0.02 ) . ( ABSTRACT TRUNCATED AT 250 WORDS In a prospect i ve , r and omized , multicenter study , neoadjuvant chemotherapy ( CT ) with carboplatin and 5-fluorouracil ( 5-FU ) followed by locoregional treatment ( LRT ) was compared with locoregional treatment alone in the treatment of patients with head and neck cancer . This study , which includes 324 patients , was conducted from January 1988 to July 1991 . The aim of this study was to evaluate the impact of the carboplatin/5-FU regimen both on the incidence of mutilating surgery and on the survival rate .  Chemotherapy consisted of three cycles of carboplatin 400 mg/m2 day 1 and 5-FU 1 g/m2 days 1 - 5 , repeated every 3 weeks . Patients with a complete tumor response then received radiotherapy alone , instead of the treatment planned initially . Three hundred patients were analyzed : 79 had tumors of the oral cavity , 106 oropharyngeal tumors , and 115 pharyngolaryngeal tumors . One hundred fifty patients underwent CT+LRT ; 150 patients had LRT alone .  Grade 3 and 4 toxicity rates were minimal in the CT+LRT group ; toxicity was mainly hematologic ( 24 % neutropenia , 19 % thrombocytopenia ) . There were 3 toxic deaths ( 2 % ) , 2 due to septicemia and 1 due to cardiac toxicity .  One hundred forty-three patients were evaluable for efficacy . The tumor objective response rate was 63 % and complete response rate was 31 % ( 35 % for oropharyngeal , 34 % for pharyngolaryngeal tumors , 22.5 % for oral cavity tumors ) , which led to a 29 % decrease in the rate of mutilating surgery . Conservative treatment was performed in 57 % of patients in the CT+LRT group vs. 24 % in the LRT group ( p = 0.001 ) . There was no significant difference between survival curves in the CT+LRT and LRT groups . At 4 years , overall survival rates were 56 and 46 % ; disease-free survival rates were 33 and 30 % in the CT+LRT and the LRT groups , respectively . The survival rates were not significantly different in the two groups . The locoregional recurrence rates were 35 % in the CT+LRT arm and 25 % in the LRT arm ( p = 0.04 ) , with median follow-up of 25 months . The rates of secondary localization and distant metastasis were not significantly different in the two groups PURPOSE To report the results and corresponding acute and late reactions of a prospect i ve , r and omized , clinical study in locally advanced head and neck cancer comparing concurrent fluorouracil ( FU ) and mitomycin ( MMC ) chemotherapy and hyperfractionated accelerated radiation therapy ( C-HART ; 70.6 Gy ) to hyperfractionated accelerated radiation therapy alone ( HART ; 77.6 Gy ) . PATIENTS AND METHODS Three hundred eighty-four stage III ( 6 % ) and IV ( 94 % ) oropharyngeal ( 59.4 % ) , hypopharyngeal ( 32.3 % ) , and oral cavity ( 8.3 % ) cancer patients were r and omly assigned to receive either 30 Gy ( 2 Gy every day ) followed by 1.4 Gy bid to a total of 70.6 Gy concurrently with FU ( 600 mg/m(2 ) , 120 hours continuous infusion ) days 1 through 5 and MMC ( 10 mg/m(2 ) ) on days 5 and 36 ( C-HART ) or 14 Gy ( 2 Gy every day ) followed by 1.4 Gy bid to a total dose of 77.6 Gy ( HART ) . The data were analyzed on an intent-to-treat basis . RESULTS At 5 years , the locoregional control and overall survival rates were 49.9 % and 28.6 % for C-HART versus 37.4 % and 23.7 % for HART , respectively ( P = .001 and P = .023 , respectively ) . Progression-free and freedom from metastases rates were 29.3 % and 51.9 % for C-HART versus 26.6 % and 54.7 % for HART , respectively ( P = .009 and P = .575 , respectively ) . For C-HART , maximum acute reactions of mucositis , moist desquamation , and erythema were lower than with HART , whereas no differences in late reactions and overall rates of secondary neoplasms were observed . CONCLUSION C-HART ( 70.6 Gy ) is superior to dose-escalated HART ( 77.6 Gy ) with comparable or less acute reactions and equivalent late reactions , indicating an improvement of the therapeutic ratio PURPOSE We report the 5-year survival and late toxicity results of a r and omized clinical trial , which showed a 3-year improvement in overall survival and locoregional control of stage III or IV oropharynx carcinoma , using concomitant radiochemotherapy ( arm B ) , compared with st and ard radiotherapy ( arm A ) . PATIENTS AND METHODS A total of 226 patients were entered onto a phase III multicenter r and omized trial comparing radiotherapy alone ( 70 Gy in 35 fractions ; arm A ) with concomitant radiochemotherapy ( 70 Gy in 35 fractions with three cycles of a 4-day regimen comprising carboplatin and fluorouracil ; arm B ) . Prognostic factors were evaluated by univariate and multivariate analysis . Five-year late toxicity was evaluated using National Cancer Institute Common Toxicity Criteria for neurological toxicity , hearing , taste , m and ibula , and teeth damage , and Radiation Therapy Oncology Group toxicity criteria for skin , salivary gl and , and mucosa . RESULTS Five-year overall survival , specific disease-free survival , and locoregional control rates were 22 % and 16 % ( log-rank P = .05 ) , 27 % and 15 % ( P = .01 ) , and 48 % and 25 % ( P = .002 ) , in arm B and arm A , respectively . Stage IV , hemoglobin level lower than 125 g/L , and st and ard treatment were independent prognostic factors of short survival and locoregional failure by univariate and multivariate analysis . One or more grade 3 to 4 complications occurred in 56 % of the patients in arm B , compared with 30 % in arm A ( P was not significant ) . CONCLUSION Concomitant radiochemotherapy improved overall survival and locoregional control rates and does not statistically increase severe late morbidity . Anemia was the most important prognostic factor for survival in both arms Forty‐eight patients with locally confined ( MO ) squamous cell head and neck cancer were prospect ively r and omized to receive either simultaneous ( SIM ) or sequential ( SEQ ) combined technique therapy with a 5‐fluorouracil infusion , a cisplatin bolus injection , and radiation therapy .  Patients with residual resectable disease underwent surgery after induction therapy , whereas those achieving a complete response to induction did not require surgery . Patients on the two treatment arms were equivalent in all measured variables , including disease extent . Toxicities of the SIM and SEQ arms also were equivalent except for mucositis and the result ant weight loss , which were more severe on the SIM arm ( P = 0.002 ) . With a follow‐up time ranging from 9 to 41 months , seven of the 24 SIM patients and 14 of the 24 SEQ patients are considered treatment failures . The relapse‐free survival is significantly better on the SIM arm ( P = 0.03 ) , although an overall survival advantage has not yet been demonstrated ( P = 0.13 ) . The achievement of a complete response after induction therapy correlates with both the relapse‐free ( P = 0.0005 ) and overall ( P = 0.05 ) survival , and the likelihood of an induction complete response also is significantly better for those treated with the SIM schedule ( P = 0.02 ) . Eighteen patients did not require surgery after achieving an induction complete response . Relapse‐free survival does not appear to be compromised in this patient subset Purpose To assess the survival rate , the probability of local control , the patterns of relapse and late sequelae including self-reported quality of life in patients treated with hyperfractionated radiotherapy ( RT ) and simultaneous CDDP chemotherapy for stage-III to stage-IV carcinomas of the head and neck . Methods From 1988 to 1994 , 64 patients ( median age 55.5 years ) with carcinomas of different subsites , excluding the nasopharynx , were treated in a pilot study with 1.2 Gy bid ( 6 h interval ; total dose 74.4 Gy ) and simultaneous CDDP ( 20 mg/m2 daily , 5 days in week 1 and 5 ) and followed at regular intervals . Overall survival and local control , as well as the rates of late toxicity , were estimated using the actuarial method . Median follow-up was 3.3 years for all and 5.2 years for surviving patients . To assess the quality of life , the EORTC QLQ-C 30 question naire and the H&N35 module question naire were sent to the patients surviving with no evidence of disease or second primary tumors ; they were answered by 15/23 ( 67 % ) . Results Overall survival was 37 % at 5 years , whereas disease-specific survival was 59 % . Twenty-three patients died from uncontrolled head and neck cancer . Second primary tumors were observed in 13 patients , most frequently in the lung . Local control without salvage surgery was 74 % at 5 years for all subsites and stages , and loco-regional disease-free survival was 72 % . Eleven patients developed distant metastases , which was the only site of failure in 6 cases . Salvage surgery was successful in 2 cases . The actuarial estimates of ≥ grade -3 late toxicity was 4 % for the m and ibular bone and 23 % for dysphagia , and 50 % of the patients experienced a permanent xerostomy . Self-reported global quality of life in surviving patients was good ( mean 68 points on a scale 0 to 100 ) ; consequences of impaired salivary function had most impact on nutritional and social aspects . Conclusions Hyperfractionated RT with concomitant CDDP is well tolerated and highly efficient in controlling moderately advanced to advanced cancers of the head and neck . Second primary tumors are the main cause of death after 3 years and were observed outside of the irradiated area , most frequently in the lung . Even after RT of large volumes to a high dose , salvage surgery can be successfully performed in individual cases . Self-reported quality of life of surviving patients is good , despite xerostomy-associated nutritional difficulties . ZusammenfassungZielAnalyse der Überlebensrate , des krankheitsspezifischen Überlebens , des Rezidivmusters , der Spättoxizität sowie der subjektiven Lebensqualität nach hyperfraktionierter Radiotherapie ( RT ) und gleichzeitiger Cisplatin-Chemotherapie ( CDDP ) bei Patienten mit mindestens zwei Jahren Beobachtungszeit i m Rahmen einer prospektiven Phase-II-Studie . Patienten und Method eIm Rahmen einer Pilotstudie ( 1988 bis 1994 ) wurden 64 Patienten ( medianes Alter 55,5 Jahre ) mit Stadium III oder IV kombiniert beh and elt :  RT 1,2 Gy zweimal täglich bis 74,4 Gy , CDDP 20 mg/m2 täglich an den Tagen 1 bis 5 der ersten und fünften Woche . Die Überlebenskurven sowie die Toxizität wurden aktuariell berechnet . Die mediane Beobachtungszeit war 3,3 Jahre für alle respektive 5,2 Jahre für die überlebenden Patienten . Zur Einschätzung 
    Output:
    