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: The usefulness of neoadjuvant chemotherapy ( NAC ) regimens has been reported ; however , the effect of NAC for advanced stages ( especially stage III-IVA ) is thought to be insufficient . We conducted a phase I-II study of neoadjuvant chemoradiotherapy consisting of intra-arterial ( i.a . ) infusion of carboplatin and intracavitary brachytherapy in patients with locally advanced cervical cancer to achieve the new NAC method . Sixteen eligible patients included those with previously untreated stage IIB , III or IVA cancer with bulky tumor .  Brachytherapy using iridium-192 was performed with concurrent i.a . chemotherapy with carboplatin ( 200 , 300 and 400 mg/m2 ) . Treatment was repeated every 4 weeks for a total of two cycles . Both hematologic and non-hematologic toxicities were generally mild . Grade 4 hematologic toxicity was observed in 12.5 % and there were no grade III or IV non-hematologic toxicities . The optimal dose of carboplatin was determined to be 400 mg/m2 . Among 16 patients , six showed complete response ( 37.5 % ) and nine showed partial response ( 56.3 % ) , for an overall response rate of 93.8 % . All 15 responding patients underwent radical surgery with a pelvic lymphadenectomy and postoperative radiotherapy . The combination of brachytherapy and i.a . chemotherapy with carboplatin is a promising regimen for NAC in locally advanced cervical cancer PURPOSE To determine whether the addition of cisplatin-based chemotherapy ( CT ) to pelvic radiation therapy ( RT ) will improve the survival of early-stage , high-risk patients with cervical carcinoma . PATIENTS AND METHODS Patients with clinical stage IA(2 ) , IB , and IIA carcinoma of the cervix , initially treated with radical hysterectomy and pelvic lymphadenectomy , and who had positive pelvic lymph nodes and /or positive margins and /or microscopic involvement of the parametrium were eligible for this study . Patients were r and omized to receive RT or RT + CT . Patients in each group received 49.3 GY RT in 29 fractions to a st and ard pelvic field . Chemotherapy consisted of bolus cisplatin 70 mg/m(2 ) and a 96-hour infusion of fluorouracil 1,000 mg/m(2)/d every 3 weeks for four cycles , with the first and second cycles given concurrent to RT . RESULTS Between 1991 and 1996 , 268 patients were entered onto the study . Two hundred forty-three patients were assessable ( 127 RT + CT patients and 116 RT patients ) .  Progression-free and overall survival are significantly improved in the patients receiving CT . The hazard ratios for progression-free survival and overall survival in the RT only arm versus the RT + CT arm are 2.01 ( P = .003 ) and 1.96 ( P = . 007 ) , respectively . The projected progression-free survivals at 4 years is 63 % with RT and 80 % with RT + CT . The projected overall survival rate at 4 years is 71 % with RT and 81 % with RT + CT . Grade s 3 and 4 hematologic and gastrointestinal toxicity were more frequent in the RT + CT group . CONCLUSION The addition of concurrent cisplatin-based CT to RT significantly improves progression-free and overall survival for high-risk , early-stage patients who undergo radical hysterectomy and pelvic lymphadenectomy for carcinoma of the cervix BACKGROUND Stage Ib and IIa cervical carcinoma can be cured by radical surgery or radiotherapy . These two procedures are equally effective , but differ in associated morbidity and type of complications . In this prospect i ve r and omised trial of radiotherapy versus surgery , our aim was to assess the 5-year survival and the rate and pattern of complications and recurrences associated with each treatment . METHODS Between September , 1986 , and December , 1991 , 469 women with newly diagnosed stage Ib and IIa cervical carcinoma were referred to our institute . 343 eligible patients were r and omised : 172 to surgery and 171 to radical radiotherapy . Adjuvant radiotherapy was delivered after surgery for women with surgical stage pT2b or greater , less than 3 mm of safe cervical stroma , cut-through , or positive nodes . The primary outcome measures were 5-year survival and the rate of complications . The analysis of survival and recurrence was by intention to treat and analysis of complications was by treatment delivered . FINDINGS 170 patients in the surgery group and 167 in the radiotherapy group were included in the intention-to-treat analysis ; scheduled treatment was delivered to 169 and 158 women , respectively , 62 of 114 women with cervical diameters of 4 cm or smaller and 46 of 55 with diameters larger than 4 cm received adjuvant therapy . After a median follow-up of 87 ( range 57 - 120 ) months , 5-year overall and disease-free survival were identical in the surgery and radiotherapy groups ( 83 % and 74 % , respectively , for both groups ) , 86 women developed recurrent disease : 42 ( 25 % ) in the surgery group and 44 ( 26 % ) in the radiotherapy group . Significant factors for survival in univariate and multivariate analyses were : cervical diameter , positive lymphangiography , and adeno-carcinomatous histotype . 48 ( 28 % ) surgery-group patients had severe morbidity compared with 19 ( 12 % ) radiotherapy-group patients ( p = 0.0004 ) . INTERPRETATION There is no treatment of choice for early-stage cervical carcinoma in terms of overall or disease-free survival . The combination of surgery and radiotherapy has the worst morbidity , especially urological complications . The optimum therapy for each patient should take account of clinical factors such as menopausal status , age , medical illness , histological type , and cervical diameter to yield the best cure with minimum complications BACKGROUND Concomitant chemoradiation ( CRT ) ( including brachytherapy ) is considered the st and ard management for stage IB2 or II cervical cancer in many countries . Nevertheless , some of them discuss completion surgery ( hysterectomy [ HT ] ) after CRT . The aim of this study was to investigate the therapeutic impact of such surgery . METHODS A r and omized trial was opened in France in 2003 to evaluate the interest in HT after CRT . Inclusion criteria were : ( a ) stage IB2 or II cervical cancer without extrapelvic disease on conventional imaging ; ( b ) pelvic external radiation therapy ( 45 Gy with or without parametrial or nodal boost ) with concomitant cisplatin chemotherapy ( 40 mg/m2 per week ) followed by uterovaginal brachytherapy  ( 15 Gy to the intermediate risk clinical target volume ) ; and ( c ) complete clinical and radiological response 6 - 8 weeks after brachytherapy .  Patients were r and omized between HT ( arm A ) and no HT ( arm B ) . Unfortunately this trial was closed because of poor accrual : 61 patients were enrolled ( in 2003 - 2006 ) and are reported on here . RESULTS Thirty one and 30 patients were enrolled , respectively , in arm A and arm B. Twelve patients recurred ( five of them died ) : respectively , eight and four in arm A and arm B. The 3-year event-free survival rates were 72 % ( st and ard error [ SE ] , 9 % ) and 89 % ( SE , 6 % ) ( not significant [ NS ] ) in arm A and arm B , respectively . The 3-year overall survival rates were 86 % ( SE , 6 % ) and 97 % ( SE , 3 % ) ( NS ) in arm A and arm B , respectively . CONCLUSIONS Results of the current trial seem to suggest that completion HT had no therapeutic impact in patients with clinical and radiological complete response after CRT ( but this conclusion is limited by the lack of power ) Abstract Background We provided a comprehensive analysis of rate , pattern , and severity of early and late postoperative complications in a very large , single-institution series of locally advanced cervical cancer ( LACC ) patients administered CT/RT plus radical surgery ( RS ) . Methods A total of 362 consecutive LACC ( FIGO stage IB2-IVA ) patients were su bmi tted to RS after CT/RT at the Gynecologic Oncology Unit of the Catholic University ( Rome/Campobasso ) . At 4 weeks after CT/RT , patients were evaluated for objective response and triaged to radical hysterectomy and pelvic ± aortic lymphadenectomy . Surgical morbidity was classified according to the Chassagne ’s grading system . Results Most cases underwent type III – IV radical hysterectomy ( N = 313 , 86.5 % ) ; pelvic lymphadenectomy was performed in all patients , while 116 patients ( 32.1 % ) were also su bmi tted to aortic lymphadenectomy . A total of 93 patients ( 25.7 % ) experienced any grade postoperative complications , and 60 ( 16.6 % ) had ≥ grade 2 complications ; grade 3–4 complications occurred in 21 patients ( 5.8 % ) . Of all early postoperative complications ( N = 100 ) , 31 ( 31.0 % ) were urinary , 9 ( 9.0 % ) were gastrointestinal , and 45 ( 45.0 % ) were vascular . Of all late complications ( N = 31 ) , 20 ( 64.5 % ) were urinary , 7 ( 22.6 % ) gastrointestinal , and 2 ( 6.4 % ) were vascular . Multivariate analysis showed that not complete clinical response to treatment retained an independent , unfavorable association with risk of development of postoperative morbidity , while advanced stage , and aortic lymphadenectomy showed only a borderline value . Conclusions Failure to achieve clinical complete response to treatment and , to a lesser extent , more advanced stage , and aortic lymphadenectomy , were associated with a higher risk of developing any grade as well as ≥ grade 2 complications BACKGROUND AND METHODS On behalf of the Gynecologic Oncology Group , we performed a r and omized trial of radiotherapy in combination with three concurrent chemotherapy regimens -- cisplatin alone ; cisplatin , fluorouracil , and hydroxyurea ; and hydroxyurea alone -- in patients with locally advanced cervical cancer . Women with primary untreated invasive squamous-cell carcinoma , adenosquamous carcinoma , or adenocarcinoma of the cervix of stage IIB , III , or IVA , without involvement of the para-aortic lymph nodes , were enrolled . The patients had to have a leukocyte count of at least 3000 per cubic millimeter , a platelet count of at least 100,000 per cubic millimeter , a serum creatinine level no higher than 2 mg per deciliter ( 177 micromol per liter ) , and adequate hepatic function . All patients received external-beam radiotherapy according to a strict protocol . Patients were r and omly assigned to receive one of three chemotherapy regimens : 40 mg of cisplatin per square meter of body-surface area per week for six weeks ( group 1 ) ; 50 mg of cisplatin per square meter on days 1 and 29 , followed by 4 g of fluorouracil per square meter given as a 96-hour infusion on days 1 and 29 , and 2 g of oral hydroxyurea per square meter twice weekly for six weeks ( group 2 ) ; or 3 g of oral hydroxyurea per square meter twice weekly for six weeks ( group 3 ) . RESULTS The analysis included 526 women . The median duration of follow-up was 35 months . Both groups that received cisplatin had a higher rate of progression-free survival than the group that received hydroxyurea alone ( P<0.001 for both comparisons ) . The relative risks of progression of disease or death were 0.57 ( 95 percent confidence interval , 0.42 to 0.78 ) in group 1 and 0.55 ( 95 percent confidence interval , 0.40 to 0.75 ) in group 2 , as compared with group 3 . The overall survival rate was significantly higher in groups 1 and 2 than in group 3 , with relative risks of death of 0.61 ( 95 percent confidence interval , 0.44 to 0.85 ) and 0.58 ( 95 percent confidence interval , 0.41 to 0.81 ) , respectively . CONCLUSIONS Regimens of radiotherapy and chemotherapy that contain cisplatin improve the rates of survival and progression-free survival among women with locally advanced cervical cancer PURPOSE To compare the efficacy of neoadjuvant chemotherapy ( NAC ) followed by radical hysterectomy with that of radiotherapy ( R/T ) for bulky early-stage cervical cancer . PATIENTS AND METHODS Women with previously untreated bulky ( primary tumor > /= 4 cm ) stage IB or IIA non-small-cell carcinoma of the uterine cervix were r and omly assigned 
    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: The usefulness of neoadjuvant chemotherapy ( NAC ) regimens has been reported ; however , the effect of NAC for advanced stages ( especially stage III-IVA ) is thought to be insufficient . We conducted a phase I-II study of neoadjuvant chemoradiotherapy consisting of intra-arterial ( i.a . ) infusion of carboplatin and intracavitary brachytherapy in patients with locally advanced cervical cancer to achieve the new NAC method . Sixteen eligible patients included those with previously untreated stage IIB , III or IVA cancer with bulky tumor .  Brachytherapy using iridium-192 was performed with concurrent i.a . chemotherapy with carboplatin ( 200 , 300 and 400 mg/m2 ) . Treatment was repeated every 4 weeks for a total of two cycles . Both hematologic and non-hematologic toxicities were generally mild . Grade 4 hematologic toxicity was observed in 12.5 % and there were no grade III or IV non-hematologic toxicities . The optimal dose of carboplatin was determined to be 400 mg/m2 . Among 16 patients , six showed complete response ( 37.5 % ) and nine showed partial response ( 56.3 % ) , for an overall response rate of 93.8 % . All 15 responding patients underwent radical surgery with a pelvic lymphadenectomy and postoperative radiotherapy . The combination of brachytherapy and i.a . chemotherapy with carboplatin is a promising regimen for NAC in locally advanced cervical cancer PURPOSE To determine whether the addition of cisplatin-based chemotherapy ( CT ) to pelvic radiation therapy ( RT ) will improve the survival of early-stage , high-risk patients with cervical carcinoma . PATIENTS AND METHODS Patients with clinical stage IA(2 ) , IB , and IIA carcinoma of the cervix , initially treated with radical hysterectomy and pelvic lymphadenectomy , and who had positive pelvic lymph nodes and /or positive margins and /or microscopic involvement of the parametrium were eligible for this study . Patients were r and omized to receive RT or RT + CT . Patients in each group received 49.3 GY RT in 29 fractions to a st and ard pelvic field . Chemotherapy consisted of bolus cisplatin 70 mg/m(2 ) and a 96-hour infusion of fluorouracil 1,000 mg/m(2)/d every 3 weeks for four cycles , with the first and second cycles given concurrent to RT . RESULTS Between 1991 and 1996 , 268 patients were entered onto the study . Two hundred forty-three patients were assessable ( 127 RT + CT patients and 116 RT patients ) .  Progression-free and overall survival are significantly improved in the patients receiving CT . The hazard ratios for progression-free survival and overall survival in the RT only arm versus the RT + CT arm are 2.01 ( P = .003 ) and 1.96 ( P = . 007 ) , respectively . The projected progression-free survivals at 4 years is 63 % with RT and 80 % with RT + CT . The projected overall survival rate at 4 years is 71 % with RT and 81 % with RT + CT . Grade s 3 and 4 hematologic and gastrointestinal toxicity were more frequent in the RT + CT group . CONCLUSION The addition of concurrent cisplatin-based CT to RT significantly improves progression-free and overall survival for high-risk , early-stage patients who undergo radical hysterectomy and pelvic lymphadenectomy for carcinoma of the cervix BACKGROUND Stage Ib and IIa cervical carcinoma can be cured by radical surgery or radiotherapy . These two procedures are equally effective , but differ in associated morbidity and type of complications . In this prospect i ve r and omised trial of radiotherapy versus surgery , our aim was to assess the 5-year survival and the rate and pattern of complications and recurrences associated with each treatment . METHODS Between September , 1986 , and December , 1991 , 469 women with newly diagnosed stage Ib and IIa cervical carcinoma were referred to our institute . 343 eligible patients were r and omised : 172 to surgery and 171 to radical radiotherapy . Adjuvant radiotherapy was delivered after surgery for women with surgical stage pT2b or greater , less than 3 mm of safe cervical stroma , cut-through , or positive nodes . The primary outcome measures were 5-year survival and the rate of complications . The analysis of survival and recurrence was by intention to treat and analysis of complications was by treatment delivered . FINDINGS 170 patients in the surgery group and 167 in the radiotherapy group were included in the intention-to-treat analysis ; scheduled treatment was delivered to 169 and 158 women , respectively , 62 of 114 women with cervical diameters of 4 cm or smaller and 46 of 55 with diameters larger than 4 cm received adjuvant therapy . After a median follow-up of 87 ( range 57 - 120 ) months , 5-year overall and disease-free survival were identical in the surgery and radiotherapy groups ( 83 % and 74 % , respectively , for both groups ) , 86 women developed recurrent disease : 42 ( 25 % ) in the surgery group and 44 ( 26 % ) in the radiotherapy group . Significant factors for survival in univariate and multivariate analyses were : cervical diameter , positive lymphangiography , and adeno-carcinomatous histotype . 48 ( 28 % ) surgery-group patients had severe morbidity compared with 19 ( 12 % ) radiotherapy-group patients ( p = 0.0004 ) . INTERPRETATION There is no treatment of choice for early-stage cervical carcinoma in terms of overall or disease-free survival . The combination of surgery and radiotherapy has the worst morbidity , especially urological complications . The optimum therapy for each patient should take account of clinical factors such as menopausal status , age , medical illness , histological type , and cervical diameter to yield the best cure with minimum complications BACKGROUND Concomitant chemoradiation ( CRT ) ( including brachytherapy ) is considered the st and ard management for stage IB2 or II cervical cancer in many countries . Nevertheless , some of them discuss completion surgery ( hysterectomy [ HT ] ) after CRT . The aim of this study was to investigate the therapeutic impact of such surgery . METHODS A r and omized trial was opened in France in 2003 to evaluate the interest in HT after CRT . Inclusion criteria were : ( a ) stage IB2 or II cervical cancer without extrapelvic disease on conventional imaging ; ( b ) pelvic external radiation therapy ( 45 Gy with or without parametrial or nodal boost ) with concomitant cisplatin chemotherapy ( 40 mg/m2 per week ) followed by uterovaginal brachytherapy  ( 15 Gy to the intermediate risk clinical target volume ) ; and ( c ) complete clinical and radiological response 6 - 8 weeks after brachytherapy .  Patients were r and omized between HT ( arm A ) and no HT ( arm B ) . Unfortunately this trial was closed because of poor accrual : 61 patients were enrolled ( in 2003 - 2006 ) and are reported on here . RESULTS Thirty one and 30 patients were enrolled , respectively , in arm A and arm B. Twelve patients recurred ( five of them died ) : respectively , eight and four in arm A and arm B. The 3-year event-free survival rates were 72 % ( st and ard error [ SE ] , 9 % ) and 89 % ( SE , 6 % ) ( not significant [ NS ] ) in arm A and arm B , respectively . The 3-year overall survival rates were 86 % ( SE , 6 % ) and 97 % ( SE , 3 % ) ( NS ) in arm A and arm B , respectively . CONCLUSIONS Results of the current trial seem to suggest that completion HT had no therapeutic impact in patients with clinical and radiological complete response after CRT ( but this conclusion is limited by the lack of power ) Abstract Background We provided a comprehensive analysis of rate , pattern , and severity of early and late postoperative complications in a very large , single-institution series of locally advanced cervical cancer ( LACC ) patients administered CT/RT plus radical surgery ( RS ) . Methods A total of 362 consecutive LACC ( FIGO stage IB2-IVA ) patients were su bmi tted to RS after CT/RT at the Gynecologic Oncology Unit of the Catholic University ( Rome/Campobasso ) . At 4 weeks after CT/RT , patients were evaluated for objective response and triaged to radical hysterectomy and pelvic ± aortic lymphadenectomy . Surgical morbidity was classified according to the Chassagne ’s grading system . Results Most cases underwent type III – IV radical hysterectomy ( N = 313 , 86.5 % ) ; pelvic lymphadenectomy was performed in all patients , while 116 patients ( 32.1 % ) were also su bmi tted to aortic lymphadenectomy . A total of 93 patients ( 25.7 % ) experienced any grade postoperative complications , and 60 ( 16.6 % ) had ≥ grade 2 complications ; grade 3–4 complications occurred in 21 patients ( 5.8 % ) . Of all early postoperative complications ( N = 100 ) , 31 ( 31.0 % ) were urinary , 9 ( 9.0 % ) were gastrointestinal , and 45 ( 45.0 % ) were vascular . Of all late complications ( N = 31 ) , 20 ( 64.5 % ) were urinary , 7 ( 22.6 % ) gastrointestinal , and 2 ( 6.4 % ) were vascular . Multivariate analysis showed that not complete clinical response to treatment retained an independent , unfavorable association with risk of development of postoperative morbidity , while advanced stage , and aortic lymphadenectomy showed only a borderline value . Conclusions Failure to achieve clinical complete response to treatment and , to a lesser extent , more advanced stage , and aortic lymphadenectomy , were associated with a higher risk of developing any grade as well as ≥ grade 2 complications BACKGROUND AND METHODS On behalf of the Gynecologic Oncology Group , we performed a r and omized trial of radiotherapy in combination with three concurrent chemotherapy regimens -- cisplatin alone ; cisplatin , fluorouracil , and hydroxyurea ; and hydroxyurea alone -- in patients with locally advanced cervical cancer . Women with primary untreated invasive squamous-cell carcinoma , adenosquamous carcinoma , or adenocarcinoma of the cervix of stage IIB , III , or IVA , without involvement of the para-aortic lymph nodes , were enrolled . The patients had to have a leukocyte count of at least 3000 per cubic millimeter , a platelet count of at least 100,000 per cubic millimeter , a serum creatinine level no higher than 2 mg per deciliter ( 177 micromol per liter ) , and adequate hepatic function . All patients received external-beam radiotherapy according to a strict protocol . Patients were r and omly assigned to receive one of three chemotherapy regimens : 40 mg of cisplatin per square meter of body-surface area per week for six weeks ( group 1 ) ; 50 mg of cisplatin per square meter on days 1 and 29 , followed by 4 g of fluorouracil per square meter given as a 96-hour infusion on days 1 and 29 , and 2 g of oral hydroxyurea per square meter twice weekly for six weeks ( group 2 ) ; or 3 g of oral hydroxyurea per square meter twice weekly for six weeks ( group 3 ) . RESULTS The analysis included 526 women . The median duration of follow-up was 35 months . Both groups that received cisplatin had a higher rate of progression-free survival than the group that received hydroxyurea alone ( P<0.001 for both comparisons ) . The relative risks of progression of disease or death were 0.57 ( 95 percent confidence interval , 0.42 to 0.78 ) in group 1 and 0.55 ( 95 percent confidence interval , 0.40 to 0.75 ) in group 2 , as compared with group 3 . The overall survival rate was significantly higher in groups 1 and 2 than in group 3 , with relative risks of death of 0.61 ( 95 percent confidence interval , 0.44 to 0.85 ) and 0.58 ( 95 percent confidence interval , 0.41 to 0.81 ) , respectively . CONCLUSIONS Regimens of radiotherapy and chemotherapy that contain cisplatin improve the rates of survival and progression-free survival among women with locally advanced cervical cancer PURPOSE To compare the efficacy of neoadjuvant chemotherapy ( NAC ) followed by radical hysterectomy with that of radiotherapy ( R/T ) for bulky early-stage cervical cancer . PATIENTS AND METHODS Women with previously untreated bulky ( primary tumor > /= 4 cm ) stage IB or IIA non-small-cell carcinoma of the uterine cervix were r and omly assigned 
    Output:
    