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: Twenty-seven patients with cervical metastases from squamous cell head and neck tumours were treated with hyperfractionated XRT ( total dose 69.60 - 76.80 Gy , 1.2 Gy b.i.d . five times a week ) combined with a total of two to six sessions of superficial external HT .  Acute local toxicity was mild ; as major acute side effects , only one ulceration was recorded . No severe late side effects were observed . Late toxicity was similar to that observed in our previous studies with the combination of heat and radiation . Nodal complete response was observed in 77 % of patients , partial response was observed in 15 % of patients and no change was observed in 8 % of patients . Five-year actuarial nodal control was 64.5 + /- 19 % and 5-year actuarial survival was 24 + /- 10 % . The treatment of nodal metastases from head and neck tumours with the combination of HT and hyperfractionated XRT is feasible with an acceptable acute and late toxicity profile Purpose : The purpose of this research was to evaluate toxicity , response , and changes in oxygenation ( pO2 ) in patients with locally advanced breast cancer ( LABC ) treated with concurrent taxol , hyperthermia ( HT ) , and radiation therapy ( RT ) followed by mastectomy . Experimental Design : Eighteen patients with LABC were enrolled from October 1995 through February 1999 . Treatment consisted of taxol ( 175 mg/m2 ) given every 3 weeks for three cycles . Radiation therapy included the breast and regional nodes with a dose of 50 Gy , followed by a boost to 60–65 Gy for those not undergoing surgery . Mastectomy was performed for patients deemed resectable after this neoadjuvant program . HT was administered twice per week . Oxygenation was measured before the first HT treatment and 24 h after the first HT treatment . Results : Fifteen of 18 patients responded , 6 with a clinical complete response , 9 with a partial clinical response , and 3 nonresponders . Thirteen underwent mastectomy with 3 pathological complete responses . Tumor hypoxia was present in 8 of 13 patients ( pO2 = 4.7 ± 1.2 mmHg ) . Five patients had well-oxygenated tumors ( pO2 = 27.6 ± 7.8 mmHg ) . Patients with well-oxygenated tumors before treatment as well as those with significant reoxygenation had a favorable clinical response . Tumor reoxygenation appeared to be temperature dependent and associated with the lower thermal doses . Conclusions : This novel therapeutic program result ed in a high response rate in patients with LABC . Hyperthermia may offer a strategy for improving tumor reoxygenation with consequent treatment response . However , the effect of hyperthermia on tumor reoxygenation appears to depend on thermal dose and requires additional investigation BACKGROUND Head and neck cancer is the leading cause of male mortality due to cancer in India . Surgery , radiation alone or in combination has been the backbone of treatment strategies . Chemo-radiation has emerged as the st and ard of care in most types of head and neck cancer . This strategy has the advantage of maintaining both structure and functions , albeit with increased acute and delayed side effects . Radiation with hyperthermia can achieve the same objective without additional toxicities . MATERIAL S AND METHODS A total of 56 patients were r and omized to radiation therapy ( RT ) alone or RT-hyperthermia ( RT-HT ) arm . Twenty-six patients were included in RT alone arm and 28 patients in the RT-HT arm . Both groups were evenly matched for age , sex , and stage . Patients in both the arms received radiation to a dose of 66 - 70 Gy in 6.5 - 7 weeks . Patients in the study group received weekly HT . HT was started after impedance matching to last for 30 minutes . RESULTS Complete response was seen in 42.4 % of RT alone group compare to 78.6 % in the HT group . The difference was statistically significant ( < 0.05 ) . Kaplan-Meir analysis of survival also showed a significant improvement in favor of RT-HT . No dose limiting thermal burns and excessive mucosal or thermal toxicity were recorded . CONCLUSION Radiofrequency ( RF ) based heating and radical radiation of head and neck cancers is better than in RT alone group . HT should be considered as a valid option wherever the facility for HT is available . This report should infuse greater confidence in radiation Oncologists to practice HT as an adjuvant treatment modality Seventy-two patients with Stages III and IV ( TNM , UICC , 1987 ) squamous-cell carcinoma of the oropharynx and hypopharynx ( oro-hypopharyngeal cancer ) were treated with external irradiation , or irradiation plus 13.56 MHz radiofrequency ( RF ) capacitive hyperthermia from 1989 to 1995 . This study compared initial response , histological effect and 5-year survival rate of  thermoradiotherapy ( TRT ) group with those of radiotherapy alone ( RT ) group . In the TRT group , 15 patients were treated definitively , and 18 patients preoperatively . In the RT group , 15 patients were treated definitively , and 24 patients preoperatively . With definitive irradiation , the complete response rate of the primary lesions was 73 % in the TRT group and 27 % in the RT group ( p = 0.009 ) and the complete response rate of the metastatic lymph nodes was 80 % in the TRT group and 27 % in the RT group ( p = 0.005 ) . With preoperative irradiation , the pathological CR ( No residual cancerous cells ) rate of the primary lesions was 56 % in the TRT group and 8 % in the RT group ( p = 0.01 ) , and the pathological CR rate of the lymph nodes was 72 % in the TRT group and 21 % in the RT group ( p = 0.001 ) . The 5-year survival rates with definitive irradiation were 47.6 % in the TRT group and 18.7 % in the RT group ( p = 0.025 ) . Thus TRT was more effective than RT for advanced oro-hypopharyngeal cancer Purpose : It is unknown whether a thermal dose should be administered using a few large fractions with higher temperatures or a larger number of fractions with lower temperatures . To evaluate this we assessed the effect of administering the same total thermal dose , approximately 30 CEM43T90 , in one versus three to four fractions per week , over 5 weeks . Material s and methods : Canine sarcomas were r and omised to receive one of the hyperthermia fractionation schemes along with fractionated radiotherapy .  Tumour response was based on changes in tumour volume , oxygenation , water diffusion quantified using MRI , and a panel of histological and immunohistochemical end points . Results : There was a greater reduction in tumour volume and water diffusion at the end of therapy in tumours receiving one hyperthermia fraction per week . There was a weak but significant association between improved tumour oxygenation 24 h after the first hyperthermia treatment and extent of volume reduction at the end of therapy . Finally , the direction of change of HIF-1α and CA-IX immunoreactivity after the first hyperthermia fraction was similar and there was an inverse relationship between temperature and the direction of change of CA-IX . There were no significant changes in interstitial fluid pressure , VEGF , vWF , apoptosis or necrosis as a function of treatment group or temperature . Conclusions : We did not identify an advantage to a three to four per week hyperthermia prescription , and response data pointed to a one per week prescription being superior Sixty-five patients were included in a r and omized clinical study to evaluate the efficacy of local hyperthermia as a concomitant agent to radiotherapy in the treatment of carcinoma of the head and neck region . Local hyperthermia at 42 - 43 degrees C was generated by a 27 x 12 MHz radiofrequency diathermy unit and was used before radiotherapy in 33 patients ; the remaining 32 patients were subjected to radiotherapy alone . The response in patients with early lesions ( Stage I and II ) was similar for both the groups , while in patients with advanced disease ( Stage III and IV ) a significantly better tumour control was obtained by the use of the combined treatment OBJECTIVE To evaluate if pretreatment HPV titers in cancer cervix could predict radiation response and survival outcomes . METHODS Twenty-one patients of cancer cervix were treated by radiotherapy ( RT ) alone .  HPV titers were estimated using DNA Hybrid Capture II test . Loco-regional response at 1 month of RT -- complete or partial response ( CR and PR respectively ) and survival outcomes --local disease-free ( LDFS ) , disease-free ( DFS ) and overall ( OS ) survivals were evaluated against pre- and posttreatment HPV titers . RESULTS Pretreatment HPV titers ranged from 0.81 to 3966.10 RLU/cut off ( mean + /- SD : 1264.39 + /- 1148.22 , median : 1129.98 ) . Of the demographic features evaluated , mean HPV titers were significantly different only for patients achieving CR or PR at completion of RT ( mean + /- SD for CR vs. PR : 1616.31 + /- 1146.86 vs. 384.57 + /- 538.80 , P = 0.022 ) . HPV titers at end of RT ranged from 0.12 to 487.42 RLU/cut off ( mean + /- SD : 37.31 + /- 108.60 , median : 2.33 ) . Patients with higher pretreatment HPV titers ( > 1000 RLU/cutoff ) had a higher CR ( P = 0.022 ) and better survival compared to those with < or = 1000 RLU/cutoff ( LDFS , P = 0.004 ; DFS , P = 0.005 ; OS , P = 0.012 ) . At completion of RT , those having > or = 99.5 % fall in HPV had superior survival outcomes than those with < 99.5 % reduction ( LDFS , P = 0.002 ; DFS , P = 0.002 ; OS , P = 0.004 ) . CONCLUSIONS Higher pretreatment HPV titers ( > 1000 RLU/cutoff ) could be considered as a predictor of radiotherapy response and survival in cancer cervix . A reduction in these titers to 99.5 % of their baseline values at end of radiotherapy is also associated with better survival outcomes OBJECTIVE To investigate the impact of HPV status in patients with locally advanced head and neck squamous cell carcinoma ( HNSCC ) , who received surgery and cisplatin-based postoperative radiochemotherapy .  MATERIAL S AND METHODS For 221 patients with locally advanced squamous cell carcinoma of the hypopharynx , oropharynx or oral cavity treated at the 8 partner sites of the German Cancer Consortium , the impact of HPV DNA , p16 overexpression and p53 expression on outcome were retrospectively analysed . The primary endpoint was loco-regional tumour control ; secondary endpoints were distant metastases and overall survival . RESULTS In the total patient population , univariate analyses revealed a significant impact of HPV16 DNA positivity , p16 overexpression , p53 positivity and tumour site on loco-regional tumour control . Multivariate analysis stratified for tumour site showed that positive HPV 16 DNA status correlated with loco-regional tumour control in patients with oropharyngeal carcinoma ( p=0.02 ) but not in the oral cavity carcinoma group . Multivariate evaluation of the secondary endpoints in the total population revealed a significant association of HPV16 DNA positivity with overall survival ( p<0.01 ) but not with distant metastases . CONCLUSIONS HPV16 DNA status appears to be a strong prognosticator of loco-regional tumour control after postoperative cisplatin-based radiochemotherapy of locally advanced oropharyngeal carcinoma and is now being explored in a prospect i ve validation trial Between September 1985 and December 1986 , 44 N3 ( TNM-UICC ) metastatic squamous cell cervical lymph-nodes were r and omized to receive conventionally fractionated radical irradiation ( RT ) to a total dose of 64 - 70 Gy , or conventionally fractionated radical irradiation plus twice a week local microwave hyperthermia ( Ht ) . The two major end points of this study were ( a ) local control rates evaluated at 3 months after the end of combined therapy and ( b ) incidence of acute local toxicity .  Thirty-six nodes ( 82 % ) were evaluable as of December 1986 , at which time there was a premature closure of this study due to ethical reasons . An interim analysis had revealed a statistically significant difference in complete response rates in favor of the combined arm ( p = 0.0152 ) . The complete response rates were 82.3 % ( 14/17 ) for the combined treatment arm versus 36.8 % ( 7/19 ) for the control irradiation arm , leading to an iso-dose thermal enhancement ratio ( TER ) value of 2.23 . Both arms are comparable in average total RT dose delivered ( RT : 67.05 Gy ; RT + Ht : 67.85 Gy ) and in average maximum node diameter ( RT arm : 4 
    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: Twenty-seven patients with cervical metastases from squamous cell head and neck tumours were treated with hyperfractionated XRT ( total dose 69.60 - 76.80 Gy , 1.2 Gy b.i.d . five times a week ) combined with a total of two to six sessions of superficial external HT .  Acute local toxicity was mild ; as major acute side effects , only one ulceration was recorded . No severe late side effects were observed . Late toxicity was similar to that observed in our previous studies with the combination of heat and radiation . Nodal complete response was observed in 77 % of patients , partial response was observed in 15 % of patients and no change was observed in 8 % of patients . Five-year actuarial nodal control was 64.5 + /- 19 % and 5-year actuarial survival was 24 + /- 10 % . The treatment of nodal metastases from head and neck tumours with the combination of HT and hyperfractionated XRT is feasible with an acceptable acute and late toxicity profile Purpose : The purpose of this research was to evaluate toxicity , response , and changes in oxygenation ( pO2 ) in patients with locally advanced breast cancer ( LABC ) treated with concurrent taxol , hyperthermia ( HT ) , and radiation therapy ( RT ) followed by mastectomy . Experimental Design : Eighteen patients with LABC were enrolled from October 1995 through February 1999 . Treatment consisted of taxol ( 175 mg/m2 ) given every 3 weeks for three cycles . Radiation therapy included the breast and regional nodes with a dose of 50 Gy , followed by a boost to 60–65 Gy for those not undergoing surgery . Mastectomy was performed for patients deemed resectable after this neoadjuvant program . HT was administered twice per week . Oxygenation was measured before the first HT treatment and 24 h after the first HT treatment . Results : Fifteen of 18 patients responded , 6 with a clinical complete response , 9 with a partial clinical response , and 3 nonresponders . Thirteen underwent mastectomy with 3 pathological complete responses . Tumor hypoxia was present in 8 of 13 patients ( pO2 = 4.7 ± 1.2 mmHg ) . Five patients had well-oxygenated tumors ( pO2 = 27.6 ± 7.8 mmHg ) . Patients with well-oxygenated tumors before treatment as well as those with significant reoxygenation had a favorable clinical response . Tumor reoxygenation appeared to be temperature dependent and associated with the lower thermal doses . Conclusions : This novel therapeutic program result ed in a high response rate in patients with LABC . Hyperthermia may offer a strategy for improving tumor reoxygenation with consequent treatment response . However , the effect of hyperthermia on tumor reoxygenation appears to depend on thermal dose and requires additional investigation BACKGROUND Head and neck cancer is the leading cause of male mortality due to cancer in India . Surgery , radiation alone or in combination has been the backbone of treatment strategies . Chemo-radiation has emerged as the st and ard of care in most types of head and neck cancer . This strategy has the advantage of maintaining both structure and functions , albeit with increased acute and delayed side effects . Radiation with hyperthermia can achieve the same objective without additional toxicities . MATERIAL S AND METHODS A total of 56 patients were r and omized to radiation therapy ( RT ) alone or RT-hyperthermia ( RT-HT ) arm . Twenty-six patients were included in RT alone arm and 28 patients in the RT-HT arm . Both groups were evenly matched for age , sex , and stage . Patients in both the arms received radiation to a dose of 66 - 70 Gy in 6.5 - 7 weeks . Patients in the study group received weekly HT . HT was started after impedance matching to last for 30 minutes . RESULTS Complete response was seen in 42.4 % of RT alone group compare to 78.6 % in the HT group . The difference was statistically significant ( < 0.05 ) . Kaplan-Meir analysis of survival also showed a significant improvement in favor of RT-HT . No dose limiting thermal burns and excessive mucosal or thermal toxicity were recorded . CONCLUSION Radiofrequency ( RF ) based heating and radical radiation of head and neck cancers is better than in RT alone group . HT should be considered as a valid option wherever the facility for HT is available . This report should infuse greater confidence in radiation Oncologists to practice HT as an adjuvant treatment modality Seventy-two patients with Stages III and IV ( TNM , UICC , 1987 ) squamous-cell carcinoma of the oropharynx and hypopharynx ( oro-hypopharyngeal cancer ) were treated with external irradiation , or irradiation plus 13.56 MHz radiofrequency ( RF ) capacitive hyperthermia from 1989 to 1995 . This study compared initial response , histological effect and 5-year survival rate of  thermoradiotherapy ( TRT ) group with those of radiotherapy alone ( RT ) group . In the TRT group , 15 patients were treated definitively , and 18 patients preoperatively . In the RT group , 15 patients were treated definitively , and 24 patients preoperatively . With definitive irradiation , the complete response rate of the primary lesions was 73 % in the TRT group and 27 % in the RT group ( p = 0.009 ) and the complete response rate of the metastatic lymph nodes was 80 % in the TRT group and 27 % in the RT group ( p = 0.005 ) . With preoperative irradiation , the pathological CR ( No residual cancerous cells ) rate of the primary lesions was 56 % in the TRT group and 8 % in the RT group ( p = 0.01 ) , and the pathological CR rate of the lymph nodes was 72 % in the TRT group and 21 % in the RT group ( p = 0.001 ) . The 5-year survival rates with definitive irradiation were 47.6 % in the TRT group and 18.7 % in the RT group ( p = 0.025 ) . Thus TRT was more effective than RT for advanced oro-hypopharyngeal cancer Purpose : It is unknown whether a thermal dose should be administered using a few large fractions with higher temperatures or a larger number of fractions with lower temperatures . To evaluate this we assessed the effect of administering the same total thermal dose , approximately 30 CEM43T90 , in one versus three to four fractions per week , over 5 weeks . Material s and methods : Canine sarcomas were r and omised to receive one of the hyperthermia fractionation schemes along with fractionated radiotherapy .  Tumour response was based on changes in tumour volume , oxygenation , water diffusion quantified using MRI , and a panel of histological and immunohistochemical end points . Results : There was a greater reduction in tumour volume and water diffusion at the end of therapy in tumours receiving one hyperthermia fraction per week . There was a weak but significant association between improved tumour oxygenation 24 h after the first hyperthermia treatment and extent of volume reduction at the end of therapy . Finally , the direction of change of HIF-1α and CA-IX immunoreactivity after the first hyperthermia fraction was similar and there was an inverse relationship between temperature and the direction of change of CA-IX . There were no significant changes in interstitial fluid pressure , VEGF , vWF , apoptosis or necrosis as a function of treatment group or temperature . Conclusions : We did not identify an advantage to a three to four per week hyperthermia prescription , and response data pointed to a one per week prescription being superior Sixty-five patients were included in a r and omized clinical study to evaluate the efficacy of local hyperthermia as a concomitant agent to radiotherapy in the treatment of carcinoma of the head and neck region . Local hyperthermia at 42 - 43 degrees C was generated by a 27 x 12 MHz radiofrequency diathermy unit and was used before radiotherapy in 33 patients ; the remaining 32 patients were subjected to radiotherapy alone . The response in patients with early lesions ( Stage I and II ) was similar for both the groups , while in patients with advanced disease ( Stage III and IV ) a significantly better tumour control was obtained by the use of the combined treatment OBJECTIVE To evaluate if pretreatment HPV titers in cancer cervix could predict radiation response and survival outcomes . METHODS Twenty-one patients of cancer cervix were treated by radiotherapy ( RT ) alone .  HPV titers were estimated using DNA Hybrid Capture II test . Loco-regional response at 1 month of RT -- complete or partial response ( CR and PR respectively ) and survival outcomes --local disease-free ( LDFS ) , disease-free ( DFS ) and overall ( OS ) survivals were evaluated against pre- and posttreatment HPV titers . RESULTS Pretreatment HPV titers ranged from 0.81 to 3966.10 RLU/cut off ( mean + /- SD : 1264.39 + /- 1148.22 , median : 1129.98 ) . Of the demographic features evaluated , mean HPV titers were significantly different only for patients achieving CR or PR at completion of RT ( mean + /- SD for CR vs. PR : 1616.31 + /- 1146.86 vs. 384.57 + /- 538.80 , P = 0.022 ) . HPV titers at end of RT ranged from 0.12 to 487.42 RLU/cut off ( mean + /- SD : 37.31 + /- 108.60 , median : 2.33 ) . Patients with higher pretreatment HPV titers ( > 1000 RLU/cutoff ) had a higher CR ( P = 0.022 ) and better survival compared to those with < or = 1000 RLU/cutoff ( LDFS , P = 0.004 ; DFS , P = 0.005 ; OS , P = 0.012 ) . At completion of RT , those having > or = 99.5 % fall in HPV had superior survival outcomes than those with < 99.5 % reduction ( LDFS , P = 0.002 ; DFS , P = 0.002 ; OS , P = 0.004 ) . CONCLUSIONS Higher pretreatment HPV titers ( > 1000 RLU/cutoff ) could be considered as a predictor of radiotherapy response and survival in cancer cervix . A reduction in these titers to 99.5 % of their baseline values at end of radiotherapy is also associated with better survival outcomes OBJECTIVE To investigate the impact of HPV status in patients with locally advanced head and neck squamous cell carcinoma ( HNSCC ) , who received surgery and cisplatin-based postoperative radiochemotherapy .  MATERIAL S AND METHODS For 221 patients with locally advanced squamous cell carcinoma of the hypopharynx , oropharynx or oral cavity treated at the 8 partner sites of the German Cancer Consortium , the impact of HPV DNA , p16 overexpression and p53 expression on outcome were retrospectively analysed . The primary endpoint was loco-regional tumour control ; secondary endpoints were distant metastases and overall survival . RESULTS In the total patient population , univariate analyses revealed a significant impact of HPV16 DNA positivity , p16 overexpression , p53 positivity and tumour site on loco-regional tumour control . Multivariate analysis stratified for tumour site showed that positive HPV 16 DNA status correlated with loco-regional tumour control in patients with oropharyngeal carcinoma ( p=0.02 ) but not in the oral cavity carcinoma group . Multivariate evaluation of the secondary endpoints in the total population revealed a significant association of HPV16 DNA positivity with overall survival ( p<0.01 ) but not with distant metastases . CONCLUSIONS HPV16 DNA status appears to be a strong prognosticator of loco-regional tumour control after postoperative cisplatin-based radiochemotherapy of locally advanced oropharyngeal carcinoma and is now being explored in a prospect i ve validation trial Between September 1985 and December 1986 , 44 N3 ( TNM-UICC ) metastatic squamous cell cervical lymph-nodes were r and omized to receive conventionally fractionated radical irradiation ( RT ) to a total dose of 64 - 70 Gy , or conventionally fractionated radical irradiation plus twice a week local microwave hyperthermia ( Ht ) . The two major end points of this study were ( a ) local control rates evaluated at 3 months after the end of combined therapy and ( b ) incidence of acute local toxicity .  Thirty-six nodes ( 82 % ) were evaluable as of December 1986 , at which time there was a premature closure of this study due to ethical reasons . An interim analysis had revealed a statistically significant difference in complete response rates in favor of the combined arm ( p = 0.0152 ) . The complete response rates were 82.3 % ( 14/17 ) for the combined treatment arm versus 36.8 % ( 7/19 ) for the control irradiation arm , leading to an iso-dose thermal enhancement ratio ( TER ) value of 2.23 . Both arms are comparable in average total RT dose delivered ( RT : 67.05 Gy ; RT + Ht : 67.85 Gy ) and in average maximum node diameter ( RT arm : 4 
    Output:
    