human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background This retrospective study aims to assess the usefulness of SUVmax from FDG-PET imaging as a prognosticator for primary biopsy-proven stage I NSCLC treated with SBRT .  Methods This study includes 95 patients of median age 77 years , with primary , biopsy-confirmed peripheral stage IA/IB NSCLC . All patients were treated with 60Gy in 3 fractions with a median treatment time of six days . Local , regional , and distant failures were evaluated independently according to the terms of RTOG1021 . Local , regional , and distant control , overall- and progression-free survival were estimated by the Kaplan-Meier method . Cox proportional hazards regression was performed to determine whether SUVmax , age , KPS , gender , tumor size/T stage , or smoking history influenced outcomes . SUVmax was evaluated as both a continuous and as a dichotomous variable using a cutoff of < 5 and ≥5 . Results Median follow-up for the cohort was 16 months . Median OS and PFS were 25.3 and 40.3 months , respectively . SUV with a cutoff value of 5 predicted for OS and PFS ( p = .024 for each ) but did not achieve significance for LC ( p = .256 ) . On Cox univariate regression analysis , SUV as a dichotomous variable predicted for both OS and PFS ( p = .027 and p = .030 , respectively ) . Defined as a continuous variable , SUVmax continued to predict for OS and PFS ( p = .032 and p = .003 ) , but also predicted LC ( p = .045 ) and trended toward significance for DC ( p = .059).SUVmax did not predict for OS as a dichotomous or continuous variable . It did , however , predict for PFS as a continuous variable ( p = .008 ) , neared significance for local control ( p = .057 ) and trended towards , significance for distant control ( p = .092 ) . Conclusions SUVmax appears to be a statistically and clinical ly significant independent prognostic marker for progression-free survival in patients with stage I NSCLC treated with SBRT .  Prospect i ve studies to more accurately define the role of tumor FDG uptake in the prognosis of NSCLC are warranted Abstract Introduction . Stereotactic body radiation therapy ( SBRT ) for early stage non-small cell lung cancer ( NSCLC ) is now an accepted and patient friendly treatment , but still controversy exists about its comparability to conventional radiation therapy ( RT ) . The purpose of this single-institutional report is to describe survival outcome for medically inoperable patients with early stage NSCLC treated with SBRT compared with high dose conventional RT . Material and methods . From August 2005 to June 2012 , 100 medically inoperable patients were treated with SBRT at Odense University Hospital . The thoracic RT consisted of 3 fractions ( F ) of 15–22 Gy delivered in nine days . For comparison a group of 32 medically inoperable patients treated with conventional RT with 80 Gy/35–40  F ( 5 F/week ) in the period of July 1998 to August 2011 were analyzed . All tumors had histological or cytological proven NSCLC T1 - 2N0M0 . Results . The median overall survival was 36.1 months versus 24.4 months for SBRT and conventional RT , respectively ( p = 0.015 ) . Local failure-free survival rates at one year were in SBRT group 93 % versus 89 % in the conventional RT group and at five years 69 % versus 66 % , SBRT and conventional RT respectively ( p = 0.99 ) . On multivariate analysis , female gender and performance status of 0–1 and SBRT predicted improved prognosis . Conclusion . In a cohort of patients with NSCLC there was a significant difference in overall survival  favoring SBRT . Performance status of 0–1 , female gender and SBRT predicted improved prognosis . However , staging procedure , confirmation procedure of recurrence and technical improvements of radiation treatment is likely to influence outcomes . However , SBRT seems to be as efficient as conventional RT and is a more convenient treatment for the patients Objectives : Medically inoperable lung cancer patients often have comorbidities that preclude pathologic diagnosis from being attained . We perform a multi-institutional analysis to determine if unbiopsied early-stage lung carcinoma can be safely and effectively treated with stereotactic body radiation therapy ( SBRT ) . Material s and Methods : Thirty-four patients with unbiopsied lung cancer were treated with SBRT at the University of Louisville or University of Virginia . Patients had computed tomography ( CT ) and positron emission tomography ( PET ) imaging clinical ly consistent with lung malignancy . Median SBRT dose was 50 Gy ( range , 30 to 55 Gy ) in a median of 5 fractions ( range , 3 to 10 fractions ) with static field SBRT or volumetric modulated arc therapy . Results : Median follow-up is 16.7 months . Primary tumors had a median longest dimension on the original CT of 1.6 cm ( range , 0.5 to 3.3 cm ) and posttreatment CT scan of 1.25 cm ( range , 0.0 to 4.5 cm ) ( P=0.025 ) . Median pretreatment st and ard uptake value on initial PET scan is 4.6 mg/mL ( range , 0.0 to 16.2 mg/mL ) , and at a median of 7.6 months after SBRT , decreased to 2.25 mg/mL ( range , 0.0 to 10.9 mg/mL ) on posttreatment PET ( P=0.002 ) . Crude local control is 97.1 % . The estimated 2-year regional control is 80 % , distant control 85 % , and overall survival 85 % . There were no grade 3 or greater acute toxicities and only 3 grade 3 chronic treatment-related toxicitities . Discussion : In medically inoperable patients with unbiopsied lung cancer , local control can be achieved with minimal toxicity with the use of SBRT . The use of SBRT for unbiopsied early-stage lung cancer patients should be performed in a multidisciplinary setting and after detailed discussion with the patient about the risks and benefits of SBRT PURPOSE To evaluate the efficacy and toxicity of hypofractionated stereotactic body radiotherapy in patients with Stage I/II non-small-cell lung cancer . METHODS AND MATERIAL S Forty-three patients with inoperable Stage I/II non-small-cell lung cancer underwent treatment prospect ively using the stereotactic gamma-ray whole-body therapeutic system ( body gamma-knife radiosurgery ) with 30 rotary conical-surface Co(60 ) sources focused on the target volume . Low-speed computed tomography simulation was conducted , which was followed by three-dimensional conformal radiotherapy planning . A total dose of 50 Gy was delivered at 5 Gy/fraction to the 50 % isodose line covering the planning target volume , whereas a total dose of 70 Gy was delivered at 7 Gy/fraction to the gross target volume . The median follow-up duration was 27 months . RESULTS Three to 6 months after treatment , the complete response rate for body-gamma knife radiosurgery was 63 % , and the overall response rate was 95 % . The 1-year , 2-year , and 3-year local control rates were all 95 % in all patients . The 1-year , 2-year , and 3-year overall survival rates were 100 % , 91 % , and 91 % , respectively , in patients with Stage I disease and 73 % , 64 % , and 64 % , respectively , in those with Stage II disease . Only 2.3 % ( 1/43 ) of the patients had Grade 3 pneumonitis . CONCLUSION Our highly focused stereotactic body radiotherapy method result ed in promising local control and survival with minimal toxicity PURPOSE The 50-month results of a prospect i ve Phase II trial of stereotactic body radiation therapy ( SBRT ) in medically inoperable patients are reported . METHODS AND MATERIAL S A total of 70 medically inoperable patients had clinical ly staged T1 ( 34 patients ) or T2 ( 36 patients ) ( < or = 7 cm ) , N0 , M0 , biopsy-confirmed non-small-cell lung carcinoma ( NSCLC ) and received SBRT as per our previously published reports . The SBRT treatment dose of 60 - 66 Gy was prescribed to the 80 % isodose volume in three fractions . RESULTS Median follow-up was 50.2 months ( range , 1.4 - 64.8 months ) . Kaplan-Meier local control at 3 years was 88.1 % . Regional ( nodal ) and distant recurrence occurred in 6 ( 8.6 % ) and 9 ( 12.9 % ) patients , respectively . Median survival ( MS ) was 32.4 months and 3-year overall survival ( OS ) was 42.7 % ( 95 % confidence interval [ 95 % CI ] , 31.1 - 54.3 % ) . Cancer-specific survival at 3 years was 81.7 % ( 95 % CI , 70.0 - 93.4 % ) . For patients with T1 tumors , MS was 38.7 months ( 95 % CI , 25.3 - 50.2 ) and for T2 tumors MS was 24.5 months ( 95 % CI , 18.5 - 37.4 ) ( p = 0.194 ) . Tumor volume ( < or = 5 cc , 5 - 10 cc , 10 - 20 cc , > 20 cc ) did not significantly impact survival : MS was 36.9 months ( 95 % CI , 18.1 - 42.9 ) , 34.0 ( 95 % CI , 16.9 - 57.1 ) , 32.8 ( 95 % CI , 21.3 - 57.8 ) , and 21.4 months ( 95 % CI , 17.8 - 41.6 ) , respectively ( p = 0.712 ) . There was no significant survival difference between patients with peripheral vs. central tumors ( MS 33.2 vs. 24.4 months , p = 0.697 ) . Grade 3 to 5 toxicity occurred in 5 of 48 patients with peripheral lung tumors ( 10.4 % ) and in 6 of 22 patients ( 27.3 % ) with central tumors ( Fisher 's exact test , p = 0.088 ) . CONCLUSION Based on our study results , use of SBRT results in high rates of local control in medically inoperable patients with Stage I NSCLC Objective To report serial 18F-fluorodeoxyglucose ( 18F-FDG ) positron emission tomography (PET)/computed tomography ( CT ) tumor response following CyberKnife radiosurgery for stage IA non-small cell lung cancer ( NSCLC ) . Methods Patients with biopsy-proven inoperable stage IA NSCLC were enrolled into this IRB-approved study . Targeting was based on 3 - 5 gold fiducial markers implanted in or near tumors . Gross tumor volumes ( GTVs ) were contoured using lung windows ; margins were exp and ed by 5 mm to establish the planning treatment volumes ( PTVs ) . Doses ranged from 42 - 60 Gy in 3 equal fractions . 18F-FDG PET/CT was performed prior to and at 3 - 6-month , 9 - 15 months and 18 - 24 months following treatment . The tumor maximum st and ardized uptake value ( SUVmax ) was recorded for each time point . Results Twenty patients with an average maximum tumor diameter of 2.2 cm were treated over a 3-year period . A mean dose of 51 Gy was delivered to the PTV in 3 to 11 days ( mean , 7 days ) . The 30-Gy isodose contour extended an average of 2 cm from the GTV . At a median follow-up of 43 months , the 2-year Kaplan-Meier overall survival estimate was 90 % and the local control estimate was 95 % . Mean tumor SUVmax before treatment was 6.2 ( range , 2.0 to 10.7 ) . During early follow-up the mean tumor SUVmax remained at 2.3 ( range , 1.0 to 5.7 ) , despite transient elevations in individual tumor SUVmax levels attributed to peritumoral radiation-induced pneumonitis visible on CT imaging . At 18 - 24 months the mean tumor SUVmax for controlled tumors was 2.0 , witha narrow range of values ( range , 1.5 to 2.8 ) . A single local failure was confirmed at 24 months in a patient with an elevated tumor SUVmax of 8.4 . Conclusion Local control and survival following CyberKnife radiosurgery for stage IA NSCLC is exceptional . Early transient increases in tumor SUVmax are likely related to radiation-induced pneumonitis . Tumor SUVmaxvalues return to background levels at 18 - 24 months , enhancing 18F-FDG PET/CT detection of local failure . The value of 18F-FDG PET/CT imaging for surveillance following lung SBRT deserves further study Background Stereotactic ablative radiotherapy ( SABR ) can achieve excellent local control rates in early-stage non-small cell lung cancer ( NSCLC ) and has emerged as a st and ard treatment option for patients who can not undergo surgery or those with isolated recurr 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background This retrospective study aims to assess the usefulness of SUVmax from FDG-PET imaging as a prognosticator for primary biopsy-proven stage I NSCLC treated with SBRT .  Methods This study includes 95 patients of median age 77 years , with primary , biopsy-confirmed peripheral stage IA/IB NSCLC . All patients were treated with 60Gy in 3 fractions with a median treatment time of six days . Local , regional , and distant failures were evaluated independently according to the terms of RTOG1021 . Local , regional , and distant control , overall- and progression-free survival were estimated by the Kaplan-Meier method . Cox proportional hazards regression was performed to determine whether SUVmax , age , KPS , gender , tumor size/T stage , or smoking history influenced outcomes . SUVmax was evaluated as both a continuous and as a dichotomous variable using a cutoff of < 5 and ≥5 . Results Median follow-up for the cohort was 16 months . Median OS and PFS were 25.3 and 40.3 months , respectively . SUV with a cutoff value of 5 predicted for OS and PFS ( p = .024 for each ) but did not achieve significance for LC ( p = .256 ) . On Cox univariate regression analysis , SUV as a dichotomous variable predicted for both OS and PFS ( p = .027 and p = .030 , respectively ) . Defined as a continuous variable , SUVmax continued to predict for OS and PFS ( p = .032 and p = .003 ) , but also predicted LC ( p = .045 ) and trended toward significance for DC ( p = .059).SUVmax did not predict for OS as a dichotomous or continuous variable . It did , however , predict for PFS as a continuous variable ( p = .008 ) , neared significance for local control ( p = .057 ) and trended towards , significance for distant control ( p = .092 ) . Conclusions SUVmax appears to be a statistically and clinical ly significant independent prognostic marker for progression-free survival in patients with stage I NSCLC treated with SBRT .  Prospect i ve studies to more accurately define the role of tumor FDG uptake in the prognosis of NSCLC are warranted Abstract Introduction . Stereotactic body radiation therapy ( SBRT ) for early stage non-small cell lung cancer ( NSCLC ) is now an accepted and patient friendly treatment , but still controversy exists about its comparability to conventional radiation therapy ( RT ) . The purpose of this single-institutional report is to describe survival outcome for medically inoperable patients with early stage NSCLC treated with SBRT compared with high dose conventional RT . Material and methods . From August 2005 to June 2012 , 100 medically inoperable patients were treated with SBRT at Odense University Hospital . The thoracic RT consisted of 3 fractions ( F ) of 15–22 Gy delivered in nine days . For comparison a group of 32 medically inoperable patients treated with conventional RT with 80 Gy/35–40  F ( 5 F/week ) in the period of July 1998 to August 2011 were analyzed . All tumors had histological or cytological proven NSCLC T1 - 2N0M0 . Results . The median overall survival was 36.1 months versus 24.4 months for SBRT and conventional RT , respectively ( p = 0.015 ) . Local failure-free survival rates at one year were in SBRT group 93 % versus 89 % in the conventional RT group and at five years 69 % versus 66 % , SBRT and conventional RT respectively ( p = 0.99 ) . On multivariate analysis , female gender and performance status of 0–1 and SBRT predicted improved prognosis . Conclusion . In a cohort of patients with NSCLC there was a significant difference in overall survival  favoring SBRT . Performance status of 0–1 , female gender and SBRT predicted improved prognosis . However , staging procedure , confirmation procedure of recurrence and technical improvements of radiation treatment is likely to influence outcomes . However , SBRT seems to be as efficient as conventional RT and is a more convenient treatment for the patients Objectives : Medically inoperable lung cancer patients often have comorbidities that preclude pathologic diagnosis from being attained . We perform a multi-institutional analysis to determine if unbiopsied early-stage lung carcinoma can be safely and effectively treated with stereotactic body radiation therapy ( SBRT ) . Material s and Methods : Thirty-four patients with unbiopsied lung cancer were treated with SBRT at the University of Louisville or University of Virginia . Patients had computed tomography ( CT ) and positron emission tomography ( PET ) imaging clinical ly consistent with lung malignancy . Median SBRT dose was 50 Gy ( range , 30 to 55 Gy ) in a median of 5 fractions ( range , 3 to 10 fractions ) with static field SBRT or volumetric modulated arc therapy . Results : Median follow-up is 16.7 months . Primary tumors had a median longest dimension on the original CT of 1.6 cm ( range , 0.5 to 3.3 cm ) and posttreatment CT scan of 1.25 cm ( range , 0.0 to 4.5 cm ) ( P=0.025 ) . Median pretreatment st and ard uptake value on initial PET scan is 4.6 mg/mL ( range , 0.0 to 16.2 mg/mL ) , and at a median of 7.6 months after SBRT , decreased to 2.25 mg/mL ( range , 0.0 to 10.9 mg/mL ) on posttreatment PET ( P=0.002 ) . Crude local control is 97.1 % . The estimated 2-year regional control is 80 % , distant control 85 % , and overall survival 85 % . There were no grade 3 or greater acute toxicities and only 3 grade 3 chronic treatment-related toxicitities . Discussion : In medically inoperable patients with unbiopsied lung cancer , local control can be achieved with minimal toxicity with the use of SBRT . The use of SBRT for unbiopsied early-stage lung cancer patients should be performed in a multidisciplinary setting and after detailed discussion with the patient about the risks and benefits of SBRT PURPOSE To evaluate the efficacy and toxicity of hypofractionated stereotactic body radiotherapy in patients with Stage I/II non-small-cell lung cancer . METHODS AND MATERIAL S Forty-three patients with inoperable Stage I/II non-small-cell lung cancer underwent treatment prospect ively using the stereotactic gamma-ray whole-body therapeutic system ( body gamma-knife radiosurgery ) with 30 rotary conical-surface Co(60 ) sources focused on the target volume . Low-speed computed tomography simulation was conducted , which was followed by three-dimensional conformal radiotherapy planning . A total dose of 50 Gy was delivered at 5 Gy/fraction to the 50 % isodose line covering the planning target volume , whereas a total dose of 70 Gy was delivered at 7 Gy/fraction to the gross target volume . The median follow-up duration was 27 months . RESULTS Three to 6 months after treatment , the complete response rate for body-gamma knife radiosurgery was 63 % , and the overall response rate was 95 % . The 1-year , 2-year , and 3-year local control rates were all 95 % in all patients . The 1-year , 2-year , and 3-year overall survival rates were 100 % , 91 % , and 91 % , respectively , in patients with Stage I disease and 73 % , 64 % , and 64 % , respectively , in those with Stage II disease . Only 2.3 % ( 1/43 ) of the patients had Grade 3 pneumonitis . CONCLUSION Our highly focused stereotactic body radiotherapy method result ed in promising local control and survival with minimal toxicity PURPOSE The 50-month results of a prospect i ve Phase II trial of stereotactic body radiation therapy ( SBRT ) in medically inoperable patients are reported . METHODS AND MATERIAL S A total of 70 medically inoperable patients had clinical ly staged T1 ( 34 patients ) or T2 ( 36 patients ) ( < or = 7 cm ) , N0 , M0 , biopsy-confirmed non-small-cell lung carcinoma ( NSCLC ) and received SBRT as per our previously published reports . The SBRT treatment dose of 60 - 66 Gy was prescribed to the 80 % isodose volume in three fractions . RESULTS Median follow-up was 50.2 months ( range , 1.4 - 64.8 months ) . Kaplan-Meier local control at 3 years was 88.1 % . Regional ( nodal ) and distant recurrence occurred in 6 ( 8.6 % ) and 9 ( 12.9 % ) patients , respectively . Median survival ( MS ) was 32.4 months and 3-year overall survival ( OS ) was 42.7 % ( 95 % confidence interval [ 95 % CI ] , 31.1 - 54.3 % ) . Cancer-specific survival at 3 years was 81.7 % ( 95 % CI , 70.0 - 93.4 % ) . For patients with T1 tumors , MS was 38.7 months ( 95 % CI , 25.3 - 50.2 ) and for T2 tumors MS was 24.5 months ( 95 % CI , 18.5 - 37.4 ) ( p = 0.194 ) . Tumor volume ( < or = 5 cc , 5 - 10 cc , 10 - 20 cc , > 20 cc ) did not significantly impact survival : MS was 36.9 months ( 95 % CI , 18.1 - 42.9 ) , 34.0 ( 95 % CI , 16.9 - 57.1 ) , 32.8 ( 95 % CI , 21.3 - 57.8 ) , and 21.4 months ( 95 % CI , 17.8 - 41.6 ) , respectively ( p = 0.712 ) . There was no significant survival difference between patients with peripheral vs. central tumors ( MS 33.2 vs. 24.4 months , p = 0.697 ) . Grade 3 to 5 toxicity occurred in 5 of 48 patients with peripheral lung tumors ( 10.4 % ) and in 6 of 22 patients ( 27.3 % ) with central tumors ( Fisher 's exact test , p = 0.088 ) . CONCLUSION Based on our study results , use of SBRT results in high rates of local control in medically inoperable patients with Stage I NSCLC Objective To report serial 18F-fluorodeoxyglucose ( 18F-FDG ) positron emission tomography (PET)/computed tomography ( CT ) tumor response following CyberKnife radiosurgery for stage IA non-small cell lung cancer ( NSCLC ) . Methods Patients with biopsy-proven inoperable stage IA NSCLC were enrolled into this IRB-approved study . Targeting was based on 3 - 5 gold fiducial markers implanted in or near tumors . Gross tumor volumes ( GTVs ) were contoured using lung windows ; margins were exp and ed by 5 mm to establish the planning treatment volumes ( PTVs ) . Doses ranged from 42 - 60 Gy in 3 equal fractions . 18F-FDG PET/CT was performed prior to and at 3 - 6-month , 9 - 15 months and 18 - 24 months following treatment . The tumor maximum st and ardized uptake value ( SUVmax ) was recorded for each time point . Results Twenty patients with an average maximum tumor diameter of 2.2 cm were treated over a 3-year period . A mean dose of 51 Gy was delivered to the PTV in 3 to 11 days ( mean , 7 days ) . The 30-Gy isodose contour extended an average of 2 cm from the GTV . At a median follow-up of 43 months , the 2-year Kaplan-Meier overall survival estimate was 90 % and the local control estimate was 95 % . Mean tumor SUVmax before treatment was 6.2 ( range , 2.0 to 10.7 ) . During early follow-up the mean tumor SUVmax remained at 2.3 ( range , 1.0 to 5.7 ) , despite transient elevations in individual tumor SUVmax levels attributed to peritumoral radiation-induced pneumonitis visible on CT imaging . At 18 - 24 months the mean tumor SUVmax for controlled tumors was 2.0 , witha narrow range of values ( range , 1.5 to 2.8 ) . A single local failure was confirmed at 24 months in a patient with an elevated tumor SUVmax of 8.4 . Conclusion Local control and survival following CyberKnife radiosurgery for stage IA NSCLC is exceptional . Early transient increases in tumor SUVmax are likely related to radiation-induced pneumonitis . Tumor SUVmaxvalues return to background levels at 18 - 24 months , enhancing 18F-FDG PET/CT detection of local failure . The value of 18F-FDG PET/CT imaging for surveillance following lung SBRT deserves further study Background Stereotactic ablative radiotherapy ( SABR ) can achieve excellent local control rates in early-stage non-small cell lung cancer ( NSCLC ) and has emerged as a st and ard treatment option for patients who can not undergo surgery or those with isolated recurr 
    Output:
    