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: In a prospect i ve multicenter study , 186 patients with squamous cell esophageal carcinoma , who after evaluation were considered suitable for surgery , were r and omized to 4 treatment groups : Group 1 , surgery alone ; Group 2 , pre-operative chemotherapy ( cisplatin and bleomycin ) and surgery ; Group 3 , pre-operative irradiation ( 35 Gy ) and surgery ; Group 4 , pre-operative chemotherapy , radiotherapy , and surgery .  Three-year survival was significantly higher in the pooled groups receiving radiotherapy as compared with the pooled groups not receiving radiotherapy . Comparison of the groups having pre-operative chemotherapy with those not having chemotherapy showed no significant difference in survival .  Female patients had a significantly better survival than males . The results indicate that pre-operative irradiation had a beneficial effect on intermediate term survival , whereas the chemotherapy regime used did not influence survival . RésuméDans une étude prospect i ve , multicentrique , 186 patients ayant un cancer épidermoïde de l'oesophage ont été r and omisée dans quatre groupes : le groupe 1 a eu la chirurgie seule ; le groupe 2 , une chimiothérapie préopératoire ( cis-platine et bléomycine ) ; le groupe 3 , une radiothérapie préopératoire suivie de chirurgie ; et le groupe 4 , une chimiothérapie et une radiothérapie préopératoires suivies de chirurgie . La survie à trois ans a été supérieure chez l'ensemble des patients ayant reçu la radiothérapie préopératoire par rapport à ceux qui n'en ont pas eu . Aucune différence de survie n'a pu être mise en évidence dans les groupes ayant eu ou pas de chimiothérapie . La survie des femmes a été significativement supérieure à celle des hommes . Ces résultats indiquent que la radiothérapie préopératoire apporte un plus en ce qui concerne la survie à moyen terme , alors que la chimiothérapie n'influence pas la survie . ResumenEn un estudio prospect ivo multicéntrico sobre 186 pacientes con carcinoma escamocelular del esófago c and idatos para cirugía , se constituyeron cuatro grupos para r and omización : Grupo 1 , cirugía solamente ; Grupo 2 , quimioterapia preoperatoria ( cisplatino y bleomicina ) y cirugía ; Grupo 3 , irradiación preoperatoria ( 35 Gy ) y cirugía ; Grupo 4 , quimioterapia preoperatoria , radioterapia y cirugía . La comparación entre el grupo que recibió quimioterapia y el que no la recibió no demostró diferencia significativa en cuanto a supervivencia . Las pacientes femeninas exhibieron una mejor supervivencia que los pacientes masculinos . Los result ados indican que la irradiación preoperatoria tuvo un efecto benéfico sobre la sobrevida a término medio , en tanto que la quimioterapia , en el regimen utilizado , no tuvo influencia sobre la supervivencia Between January 1986 and December 1992 , sixty-nine patients with squamous esophageal cancer were r and omized to one or the other of two treatment groups . Group 1 ( 35 patients ) were scheduled to receive chemotherapy ( cisplatinum and 5-fluorouracil ) and radiation , followed by resection , while group 2 ( 34 patients ) received resection alone . Of the 35 patients entering combined treatment , 26 completed the protocol and 9 received only chemoradiation . A complete response to preoperative therapy was shown by 7 patients , and a partial response by the other 7 patients . Survival rates at one year and five years were slightly better among patients receiving combined treatment than among those undergoing surgery alone , but overall survival did not differ statistically between the two groups . Nor were operative mortality and complications statistical different between the two groups BACKGROUND The role of neoadjuvant chemoradiotherapy in the treatment of patients with esophageal or esophagogastric-junction cancer is not well established . We compared chemoradiotherapy followed by surgery with surgery alone in this patient population . METHODS We r and omly assigned patients with resectable tumors to receive surgery alone or weekly administration of carboplatin ( doses titrated to achieve an area under the curve of 2 mg per milliliter per minute ) and paclitaxel ( 50 mg per square meter of body-surface area ) for 5 weeks and concurrent radiotherapy ( 41.4 Gy in 23 fractions , 5 days per week ) , followed by surgery . RESULTS From March 2004 through December 2008 , we enrolled 368 patients , 366 of whom were included in the analysis : 275 ( 75 % ) had adenocarcinoma , 84 ( 23 % ) had squamous-cell carcinoma , and 7 ( 2 % ) had large-cell undifferentiated carcinoma . Of the 366 patients , 178 were r and omly assigned to chemoradiotherapy followed by surgery  , and 188 to surgery alone . The most common major hematologic toxic effects in the chemoradiotherapy-surgery group were leukopenia ( 6 % ) and neutropenia ( 2 % ) ; the most common major nonhematologic toxic effects were anorexia ( 5 % ) and fatigue ( 3 % ) . Complete resection with no tumor within 1 mm of the resection margins ( R0 ) was achieved in 92 % of patients in the chemoradiotherapy-surgery group versus 69 % in the surgery group ( P<0.001 ) . A pathological complete response was achieved in 47 of 161 patients ( 29 % ) who underwent resection after chemoradiotherapy . Postoperative complications were similar in the two treatment groups , and in-hospital mortality was 4 % in both . Median overall survival was 49.4 months in the chemoradiotherapy-surgery group versus 24.0 months in the surgery group . Overall survival was significantly better in the chemoradiotherapy-surgery group ( hazard ratio , 0.657 ; 95 % confidence interval , 0.495 to 0.871 ; P=0.003 ) . CONCLUSIONS Preoperative chemoradiotherapy improved survival among patients with potentially curable esophageal or esophagogastric-junction cancer . The regimen was associated with acceptable adverse-event rates . ( Funded by the Dutch Cancer Foundation [ KWF Kankerbestrijding ] ; Netherl and s Trial Register number , NTR487 . ) BACKGROUND We conducted a prospect i ve r and omized controlled trial comparing surgery alone ( S ) with concurrent chemoradiotherapy followed by surgery ( CRT-S ) for resectable esophageal squamous cell carcinoma ( SCC ) based on our previous report . PATIENTS AND METHODS One hundred and one patients with stage II/III esophageal SCC were r and omized to receive either S ( 50 patients ) or CRT-S ( 51 patients ) . The chemoradiotherapy ( CRT ) consisted of cisplatin 60 mg/m(2 ) intravenously ( i.v . ) on day 1 , 5-fluorouracil ( 5-FU ) 1000 mg/m(2 ) i.v . on days 2 - 5 , cisplatin 60 mg/m(2 ) i.v . on day 22 combined with radiation therapy ( 45.6 Gy , 1.2 Gy b.i.d . on days 1 - 28 ) . Surgery was performed 3 - 4 weeks after radiotherapy was completed . For patients with disease that was stable or responsive to CRT , three additional cycles of chemotherapy ( cisplatin 60 mg/m(2 ) i.v . on day 1 , 5-FU 1000 mg/m(2 ) on days 2 - 5 every 4 weeks ) were given after surgical resection . RESULTS The median age was 62 years . The toxicity of CRT was acceptable and did not affect the post-operative morbidity and the duration of hospital stay . Clinical response was 86 % including 21 % of complete response ( CR ) rate . Pathological CR was achieved in 43 % [ 95 % confidence interval ( CI ) 27 - 59 ] of the patients who underwent surgery after CRT . At a median follow-up of 25 months , median overall survival ( OS ) was 27.3 months in S and 28.2 months in CRT-S ( P = 0.69 ) . Event-free survival ( EFS ) at 2 years was 51 % in S and 49 % in CRT-S ( P = 0.93 ) . This trial , which was statistically powered to detect a relatively large difference in 2-year survival rate from 30 % to 50 % with 80 % power , was discontinued at interim analysis because of the unexpectedly high drop-out rate for esophagectomy ( 31 % ) and result ant excessive locoregional failure rate in CRT-S arm ( 22 % versus 12 % , P = 0.31 ) , though it was not statistically significant . CONCLUSION Although preoperative CRT induced high clinical and pathological response , there was no statistically significant benefit in OS and EFS Background . Despite well‐established surgical approaches , the prognosis for patients with squamous cell carcinoma of the esophagus remains dismal . To assess the benefit of adjuvant chemotherapy and radiation therapy ( CRT ) , a r and omized trial with and without sequential preoperative CRT was undertaken ; CRT combined 20 Gy and two courses of 5‐FU and cisplatin 130 Background : Based on the JCOG 9907 trial results , neoadjuvant chemotherapy with cisplatin ( CDDP ) plus 5-fluorouracil ( 5-FU ) is considered a st and ard treatment for stage II/III esophageal squamous cell carcinoma ( ESCC ) in Japan . However , patient survival remains unsatisfactory . We conducted a feasibility study of neoadjuvant chemoradiotherapy ( NeoCRT ) with CDDP plus 5-FU and elective nodal irradiation for stage II/III ESCC . METHODS Eligibility criteria included clinical stage II/III ( UICC 6th , non-T4 ) ESCC , PS 0 - 1 , and age 20 - 75 years .  Chemotherapy consisted of 2 courses of 5-FU infusion ( 1000 mg/m2 , days 1 - 4 ) and a 2-h CDDP infusion ( 75 mg/m2 , day 1 ) , with a 4-week interval . Radiotherapy was concurrently administered to a total 41.4 Gy in 23 fractions for primary tumor , metastatic lymph nodes and regional lymph nodes . After completion of CRT , transthoracic esophagectomy with extensive lymphadenectomy ( > D2 ) was performed . The primary endpoint was the completion rate of NeoCRT and R0 resection . RESULTS From July 2010 to June 2011 , 33 patients were enrolled , including 2 ineligibles . In 31 eligible patients , the median age was 63 years ( range , 40 - 73 ) ; male/female : 28/3 ; PS0/1 : 19/12 ; cStage IIA/IIB/III : 2/10/19 . During CRT , the most common grade 3 or 4 toxicities were leukopenia ( 65 % ) , neutropenia ( 65 % ) , anemia ( 13 % ) , thrombocytopenia ( 13 % ) , febrile neutropenia ( 13 % ) , anorexia ( 16 % ) , esophagitis ( 16 % ) , and hyponatremia ( 16 % ) . In total , 31 patients ( 100 % ) underwent CRT and 25 ( 81 % ) underwent surgery ; 1 patient ( 3 % ) did not undergo surgery due to disease progression , and the other 5 patients ( 16 % ) are scheduled for surgery . Among patients who underwent surgery , there was 1 treatment-related death , and the incidence of operative morbidity was similar to that in previous studies . According to RECIST , the overall response rate was 63 % after CRT completion . Pathological complete response was achieved in 11 patients ( 44 % ) who underwent esophagectomy . CONCLUSIONS NeoCRT was well tolerated and appears to be highly promising . The r and omized controlled trial compared with neoadjuvant chemotherapy is needed and will be started AIM To investigate the role of perioperative chemoradiotherapy ( CRT ) in the treatment of locally advanced thoracic esophageal squamous cell carcinoma ( ESCC ) . METHODS Using preoperative computed tomography (CT)-based staging criteria , 238 patients with ESCC ( stage II-III ) were enrolled in this prospect i ve study between January 1997 and June 2004 . With informed consent , patients were r and omized into 3 groups : preoperative CRT ( 80 cases ) , postoperative CRT ( 78 cases ) and surgery alone ( S ) ( 80 cases ) . The 1- , 3- , 5- and 10-year survival were followed up . Progression-free survival ( PFS ) was chosen as the primary endpoint by treatment arm measured from study entry until documented progression of disease or death from any cause . The secondary endpoint was overall survival ( OS ) determined as the time ( in months ) between the date of therapy and the date of death . Other 
    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: In a prospect i ve multicenter study , 186 patients with squamous cell esophageal carcinoma , who after evaluation were considered suitable for surgery , were r and omized to 4 treatment groups : Group 1 , surgery alone ; Group 2 , pre-operative chemotherapy ( cisplatin and bleomycin ) and surgery ; Group 3 , pre-operative irradiation ( 35 Gy ) and surgery ; Group 4 , pre-operative chemotherapy , radiotherapy , and surgery .  Three-year survival was significantly higher in the pooled groups receiving radiotherapy as compared with the pooled groups not receiving radiotherapy . Comparison of the groups having pre-operative chemotherapy with those not having chemotherapy showed no significant difference in survival .  Female patients had a significantly better survival than males . The results indicate that pre-operative irradiation had a beneficial effect on intermediate term survival , whereas the chemotherapy regime used did not influence survival . RésuméDans une étude prospect i ve , multicentrique , 186 patients ayant un cancer épidermoïde de l'oesophage ont été r and omisée dans quatre groupes : le groupe 1 a eu la chirurgie seule ; le groupe 2 , une chimiothérapie préopératoire ( cis-platine et bléomycine ) ; le groupe 3 , une radiothérapie préopératoire suivie de chirurgie ; et le groupe 4 , une chimiothérapie et une radiothérapie préopératoires suivies de chirurgie . La survie à trois ans a été supérieure chez l'ensemble des patients ayant reçu la radiothérapie préopératoire par rapport à ceux qui n'en ont pas eu . Aucune différence de survie n'a pu être mise en évidence dans les groupes ayant eu ou pas de chimiothérapie . La survie des femmes a été significativement supérieure à celle des hommes . Ces résultats indiquent que la radiothérapie préopératoire apporte un plus en ce qui concerne la survie à moyen terme , alors que la chimiothérapie n'influence pas la survie . ResumenEn un estudio prospect ivo multicéntrico sobre 186 pacientes con carcinoma escamocelular del esófago c and idatos para cirugía , se constituyeron cuatro grupos para r and omización : Grupo 1 , cirugía solamente ; Grupo 2 , quimioterapia preoperatoria ( cisplatino y bleomicina ) y cirugía ; Grupo 3 , irradiación preoperatoria ( 35 Gy ) y cirugía ; Grupo 4 , quimioterapia preoperatoria , radioterapia y cirugía . La comparación entre el grupo que recibió quimioterapia y el que no la recibió no demostró diferencia significativa en cuanto a supervivencia . Las pacientes femeninas exhibieron una mejor supervivencia que los pacientes masculinos . Los result ados indican que la irradiación preoperatoria tuvo un efecto benéfico sobre la sobrevida a término medio , en tanto que la quimioterapia , en el regimen utilizado , no tuvo influencia sobre la supervivencia Between January 1986 and December 1992 , sixty-nine patients with squamous esophageal cancer were r and omized to one or the other of two treatment groups . Group 1 ( 35 patients ) were scheduled to receive chemotherapy ( cisplatinum and 5-fluorouracil ) and radiation , followed by resection , while group 2 ( 34 patients ) received resection alone . Of the 35 patients entering combined treatment , 26 completed the protocol and 9 received only chemoradiation . A complete response to preoperative therapy was shown by 7 patients , and a partial response by the other 7 patients . Survival rates at one year and five years were slightly better among patients receiving combined treatment than among those undergoing surgery alone , but overall survival did not differ statistically between the two groups . Nor were operative mortality and complications statistical different between the two groups BACKGROUND The role of neoadjuvant chemoradiotherapy in the treatment of patients with esophageal or esophagogastric-junction cancer is not well established . We compared chemoradiotherapy followed by surgery with surgery alone in this patient population . METHODS We r and omly assigned patients with resectable tumors to receive surgery alone or weekly administration of carboplatin ( doses titrated to achieve an area under the curve of 2 mg per milliliter per minute ) and paclitaxel ( 50 mg per square meter of body-surface area ) for 5 weeks and concurrent radiotherapy ( 41.4 Gy in 23 fractions , 5 days per week ) , followed by surgery . RESULTS From March 2004 through December 2008 , we enrolled 368 patients , 366 of whom were included in the analysis : 275 ( 75 % ) had adenocarcinoma , 84 ( 23 % ) had squamous-cell carcinoma , and 7 ( 2 % ) had large-cell undifferentiated carcinoma . Of the 366 patients , 178 were r and omly assigned to chemoradiotherapy followed by surgery  , and 188 to surgery alone . The most common major hematologic toxic effects in the chemoradiotherapy-surgery group were leukopenia ( 6 % ) and neutropenia ( 2 % ) ; the most common major nonhematologic toxic effects were anorexia ( 5 % ) and fatigue ( 3 % ) . Complete resection with no tumor within 1 mm of the resection margins ( R0 ) was achieved in 92 % of patients in the chemoradiotherapy-surgery group versus 69 % in the surgery group ( P<0.001 ) . A pathological complete response was achieved in 47 of 161 patients ( 29 % ) who underwent resection after chemoradiotherapy . Postoperative complications were similar in the two treatment groups , and in-hospital mortality was 4 % in both . Median overall survival was 49.4 months in the chemoradiotherapy-surgery group versus 24.0 months in the surgery group . Overall survival was significantly better in the chemoradiotherapy-surgery group ( hazard ratio , 0.657 ; 95 % confidence interval , 0.495 to 0.871 ; P=0.003 ) . CONCLUSIONS Preoperative chemoradiotherapy improved survival among patients with potentially curable esophageal or esophagogastric-junction cancer . The regimen was associated with acceptable adverse-event rates . ( Funded by the Dutch Cancer Foundation [ KWF Kankerbestrijding ] ; Netherl and s Trial Register number , NTR487 . ) BACKGROUND We conducted a prospect i ve r and omized controlled trial comparing surgery alone ( S ) with concurrent chemoradiotherapy followed by surgery ( CRT-S ) for resectable esophageal squamous cell carcinoma ( SCC ) based on our previous report . PATIENTS AND METHODS One hundred and one patients with stage II/III esophageal SCC were r and omized to receive either S ( 50 patients ) or CRT-S ( 51 patients ) . The chemoradiotherapy ( CRT ) consisted of cisplatin 60 mg/m(2 ) intravenously ( i.v . ) on day 1 , 5-fluorouracil ( 5-FU ) 1000 mg/m(2 ) i.v . on days 2 - 5 , cisplatin 60 mg/m(2 ) i.v . on day 22 combined with radiation therapy ( 45.6 Gy , 1.2 Gy b.i.d . on days 1 - 28 ) . Surgery was performed 3 - 4 weeks after radiotherapy was completed . For patients with disease that was stable or responsive to CRT , three additional cycles of chemotherapy ( cisplatin 60 mg/m(2 ) i.v . on day 1 , 5-FU 1000 mg/m(2 ) on days 2 - 5 every 4 weeks ) were given after surgical resection . RESULTS The median age was 62 years . The toxicity of CRT was acceptable and did not affect the post-operative morbidity and the duration of hospital stay . Clinical response was 86 % including 21 % of complete response ( CR ) rate . Pathological CR was achieved in 43 % [ 95 % confidence interval ( CI ) 27 - 59 ] of the patients who underwent surgery after CRT . At a median follow-up of 25 months , median overall survival ( OS ) was 27.3 months in S and 28.2 months in CRT-S ( P = 0.69 ) . Event-free survival ( EFS ) at 2 years was 51 % in S and 49 % in CRT-S ( P = 0.93 ) . This trial , which was statistically powered to detect a relatively large difference in 2-year survival rate from 30 % to 50 % with 80 % power , was discontinued at interim analysis because of the unexpectedly high drop-out rate for esophagectomy ( 31 % ) and result ant excessive locoregional failure rate in CRT-S arm ( 22 % versus 12 % , P = 0.31 ) , though it was not statistically significant . CONCLUSION Although preoperative CRT induced high clinical and pathological response , there was no statistically significant benefit in OS and EFS Background . Despite well‐established surgical approaches , the prognosis for patients with squamous cell carcinoma of the esophagus remains dismal . To assess the benefit of adjuvant chemotherapy and radiation therapy ( CRT ) , a r and omized trial with and without sequential preoperative CRT was undertaken ; CRT combined 20 Gy and two courses of 5‐FU and cisplatin 130 Background : Based on the JCOG 9907 trial results , neoadjuvant chemotherapy with cisplatin ( CDDP ) plus 5-fluorouracil ( 5-FU ) is considered a st and ard treatment for stage II/III esophageal squamous cell carcinoma ( ESCC ) in Japan . However , patient survival remains unsatisfactory . We conducted a feasibility study of neoadjuvant chemoradiotherapy ( NeoCRT ) with CDDP plus 5-FU and elective nodal irradiation for stage II/III ESCC . METHODS Eligibility criteria included clinical stage II/III ( UICC 6th , non-T4 ) ESCC , PS 0 - 1 , and age 20 - 75 years .  Chemotherapy consisted of 2 courses of 5-FU infusion ( 1000 mg/m2 , days 1 - 4 ) and a 2-h CDDP infusion ( 75 mg/m2 , day 1 ) , with a 4-week interval . Radiotherapy was concurrently administered to a total 41.4 Gy in 23 fractions for primary tumor , metastatic lymph nodes and regional lymph nodes . After completion of CRT , transthoracic esophagectomy with extensive lymphadenectomy ( > D2 ) was performed . The primary endpoint was the completion rate of NeoCRT and R0 resection . RESULTS From July 2010 to June 2011 , 33 patients were enrolled , including 2 ineligibles . In 31 eligible patients , the median age was 63 years ( range , 40 - 73 ) ; male/female : 28/3 ; PS0/1 : 19/12 ; cStage IIA/IIB/III : 2/10/19 . During CRT , the most common grade 3 or 4 toxicities were leukopenia ( 65 % ) , neutropenia ( 65 % ) , anemia ( 13 % ) , thrombocytopenia ( 13 % ) , febrile neutropenia ( 13 % ) , anorexia ( 16 % ) , esophagitis ( 16 % ) , and hyponatremia ( 16 % ) . In total , 31 patients ( 100 % ) underwent CRT and 25 ( 81 % ) underwent surgery ; 1 patient ( 3 % ) did not undergo surgery due to disease progression , and the other 5 patients ( 16 % ) are scheduled for surgery . Among patients who underwent surgery , there was 1 treatment-related death , and the incidence of operative morbidity was similar to that in previous studies . According to RECIST , the overall response rate was 63 % after CRT completion . Pathological complete response was achieved in 11 patients ( 44 % ) who underwent esophagectomy . CONCLUSIONS NeoCRT was well tolerated and appears to be highly promising . The r and omized controlled trial compared with neoadjuvant chemotherapy is needed and will be started AIM To investigate the role of perioperative chemoradiotherapy ( CRT ) in the treatment of locally advanced thoracic esophageal squamous cell carcinoma ( ESCC ) . METHODS Using preoperative computed tomography (CT)-based staging criteria , 238 patients with ESCC ( stage II-III ) were enrolled in this prospect i ve study between January 1997 and June 2004 . With informed consent , patients were r and omized into 3 groups : preoperative CRT ( 80 cases ) , postoperative CRT ( 78 cases ) and surgery alone ( S ) ( 80 cases ) . The 1- , 3- , 5- and 10-year survival were followed up . Progression-free survival ( PFS ) was chosen as the primary endpoint by treatment arm measured from study entry until documented progression of disease or death from any cause . The secondary endpoint was overall survival ( OS ) determined as the time ( in months ) between the date of therapy and the date of death . Other 
    Output:
    