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: Purpose : To investigate the strength of correlation between measured saliva flow rates and various toxicity endpoints commonly used in head and neck cancer ( HNC ) treatment . Material s and Methods : All patients enrolled in a phase II study using intensity modulated radiotherapy ( IMRT ) for HNC treatment underwent whole mouth saliva flow measurements ( stimulated and unstimulated ) . They were also assessed for salivary gl and toxicity using  Radiation Therapy Oncology Group ( RTOG ) late toxicity grading and 9 items  representing  patient-  grade d  toxicities  from 2 question naires ( Xerostomia question naire and University of Washington quality of life ) . For each patient , saliva flow rates and quality of life ( QOL ) data were collected preradiotherapy ( RT ) and at 3 intervals post-RT ( 3 , 6 , and 12 months ) . Results : A total of 188 sets of coregistered data were obtained for 47 patients over a period of approximately 4 years .  Saliva production and mean QOL dropped significantly immediately after RT , but there was a statistically significant recovery in both parameters between 3- and 12-month post-RT . By 12 months , post-RT the mean QOL scores had returned to pre-RT baseline , although mean stimulated saliva production remained 58 % below baseline . Conclusion : Patients with HNC treated with IMRT  experienced a small drop in QOL which recovered to baseline by 12 months post-RT . There was no statistically significant correlation seen between global health-related QOL scores and stimulated saliva production rates in the post-RT period Aim To evaluate the influence of clinical , treatment- and dose-dependent factors on posttreatment swallowing function after induction chemotherapy and definitive chemoradiotherapy in a group of homogeneously treated laryngopharyngeal cancer patients . Methods From 28 May 2008 to 15 February 2013 , 45 patients with borderline inoperable laryngopharyngeal cancer that had responded well to induction chemotherapy were treated with definitive chemoradiotherapy .  Median follow-up was 22 months . Swallowing function and clinical data were prospect ively analyzed using the EORTC QLQ-C30 question naire . Swallowing structures were retrospectively delineated on the original treatment planning CT .  Dose – volume histograms were calculated for swallowing structures and Dmean , Dmax and V50–V64 values ( in 2 Gy increments ) were determined for each patient . Tumor volume and infiltration of the swallowing apparatus was defined by CT before induction chemotherapy . Results Of the 45 patients , 26 ( 57.8 % ) fully regained swallowing function after chemoradiotherapy . A further 12 patients ( 26.7 % ) were able to manage soft , pureed and /or liquid foods ; the remaining 7 ( 15.6 % ) were completely dependent on percutaneous endoscopic gastrostomy ( PEG ) . Posttreatment swallowing function was significantly influenced by Dmean to the superior pharyngeal constrictor muscle ( PCM , p = 0.041 ) . Correlations between late dysphagia and dose – volume relationships in the superior PCM and soft palate were also observed , which were significant from V60 ( p = 0.043 ) and V58 for the soft palate and superior PCM , respectively . Of the evaluated clinical and tumor-related factors , only alcohol abuse ( p = 0.024 ) had an influence on posttreatment swallowing function . Conclusion Almost 50 % of patients had deterioration of swallowing function after definitive chemoradiotherapy for laryngopharyngeal cancer . The dose to anatomical structures responsible for swallowing function appears to play a role . Therefore , in selected patients , target volume delineation for radiotherapy of laryngopharyngeal cancer should be optimized on an individual basis to spare the swallowing apparatus . ZusammenfassungZielEvaluation von klinischen , therapie- und dosisabhängigen Faktoren in Bezug auf die posttherapeutische Schluckfunktion nach Induktionschemotherapie und definitiver Radiochemotherapie bei einem homogen beh and elten Patientenkollektiv mit laryngopharyngealen Tumoren . Method enIm Zeitraum vom 28 . Mai 2008 bis 15 . Februar 2013 erhielten 45 Patienten mit grenzwertig inoperablen Kopf-Hals-Tumoren nach gutem Ansprechen auf eine Induktionschemotherapie eine Radiochemotherapie . Das mediane Follow-up betrug 22 Monate . Die Schluckfunktion und die klinischen Date n wurden prospektiv mittels des EORTC-QLQ-C30-Fragebogens sowie klinisch evaluiert . Die Schluckstrukturen wurden retrospektiv in die Originalbestrahlungspläne der CT- Date nsätze eingezeichnet . Es wurden die Dosis-Volumen-Histogramme ( DVH ) für die Schluckstrukturen berechnet sowie jeweils Dmean , Dmax und die V50- bis V64-Werte bestimmt . Das Tumorvolumen und die Tumorinfiltration von Teilen des Schluckapparats wurden i m CT vor Induktionschemotherapie definiert . ErgebnisseInsgesamt 26 der 45 Patienten ( 57,8 % ) wiesen eine vollständige gute Schluckfunktion nach Radiochemotherapie auf . Weitere 12 Patienten ( 26,7 % ) konnten weiche , pürierte oder flüssige Kost zu sich nehmen . Die verbleibenden 7 ( 15,6 % ) Patienten wurden ausschließlich über die PEG ( „ percutaneous endoscopic gastrostomy “ ) ernährt . Die Schluckfunktion nach Radiochemotherapie wurde signifikant von der applizierten Dmean i m oberen Konstriktormuskel ( „ pharyngeal constrictor muscle “ , PCM ; p = 0,041 ) beeinflusst . Zudem konnte eine Korrelation der Spätdysphagie mit den Dosis-Volumen-Parametern i m oberen PCM und weichen Gaumen gezeigt werden , welche ab einer V60 i m weichen Gaumen ( p = 0,043 ) und ab einer V58 i m oberen PCM ( p = 0,012 ) signifikant waren . Von den getesteten klinischen und tumorspezifischen Faktoren hatte lediglich ein stattgehabter Alkoholabusus ( p = 0,024 ) einen Einfluss auf das posttherapeutische Schlucken nach TherapieSchlussfolgerungFast 50 % der Patienten können nach definitiver Radiochemotherapie aufgrund eines laryngopharyngealen Tumors nicht vollständig schlucken . Ein Grund hierfür scheint in der applizierten Dosis in Teilen des Schluckapparats zu liegen . Daher sollte bei ausgewählten Patienten zukünftig eine individuelle Optimierung der Zielvolumendefinition i m Kopf-Hals-Bereich zur Schonung des Schluckapparats erfolgen Background and purpose To compare early ( 3 and 6 month ) and later ( 12 and 24 month ) functional outcomes of stage III and IV ( M0 ) oropharyngeal squamous cancer patients treated in sequential cohorts with 3D conformal ( 3DCRT ) or intensity modulated radiotherapy ( IMRT ) . Patients and methods 200 patients in sequential population based cohorts of 83 and 117 patients treated at a single institution with 3DCRT and then IMRT respectively were prospect ively assessed at pre-treatment and 3 , 6 , 12 and 24 months post treatment . A st and ard functional outcomes protocol including performance status ( KPS , ECOG ) , 3 Performance Status scales for Head and Neck ( PSS-HN ) , the Royal Brisbane Hospital Outcome Measure for Swallowing ( RBHOMS ) , Voice H and icap Index-10 ( VHI-10 ) and self-rated xerostomia  were applied . Results Mean age at diagnosis was 59 years . The primary site was base of tongue in 77 and tonsil or soft palate in 123 patients . Median follow up was 2.5 years for the second cohort . Concomitant therapy was used in 159 ( 79.5 % ) . Overall survival at 3 years was 75.6 % and 71.5 % for IMRT and 3DCRT cohorts respectively ( not significant ) . A multiple imputation technique was used to estimate missing values in order to avoid a healthy patient bias . KPS and ECOG reached nadirs at 3 to 6 months but approached baseline values at 12 to 24 months and did not differ by treatment . The 3 PSS-HN scales , Eating in Public ( p < 0.001 ) , Underst and ability of Speech ( p = 0.009 ) and Oral Diet Texture ( p = 0.002 ) and all showed significantly better outcomes in favor of IMRT . The RBHOMS showed a difference in favor of  IMRT  which appeared during 3 to 6 months ( p < 0.001 ) . The VHI-10 also showed a difference in favor of IMRT ( p = 0.015 ) . Self-rated xerostomia did not differ at 3 and 6 months but was significantly better in favor of IMRT after 12 months p = 0.005 Conclusions A prospect ively administered functional outcomes protocol showed meaningful differences in favor of IMRT over 3DCRT early ( 3–6 months ) and later ( 12–24 months ) in the treatment of oropharyngeal carcinoma with equivalent survival . These data support the adoption of IMRT as the st and ard radiation treatment method for patients with stage III and IV ( M0 ) oropharyngeal squamous carcinoma .  KPS and ECOG may not be sensitive to oropharyngeal cancer patients ’ functional outcomes by treatment The aim of this study was to assess the effect of ( preventive ) rehabilitation on swallowing and mouth opening  after concomitant chemoradiotherapy ( CCRT ) . Forty-nine patients with advanced oral cavity , oropharynx , hypopharynx and larynx , or nasopharynx cancer treated with CCRT  were r and omized into a st and ard ( S ) or an experimental ( E ) preventive rehabilitation arm . Structured multidimensional assessment ( i.e. ,  videofluoroscopy , mouth-opening measurement , structured question naires ) was performed before and 10 weeks after CCRT . In both S and E arms , feasibility was good ( all patients could execute the exercises within a week ) and compliance was satisfactory ( mean days practice d per week was 4 ) . Nevertheless , mouth opening , oral intake , and weight decreased significantly . Compared to similar CCRT studies at our institute , however , fewer patients were still tube-dependent after CCRT . Furthermore , some functional outcomes seemed less affected than those of studies in the literature that did not incorporate rehabilitation exercises . Patients in the E arm practice d significantly fewer days in total and per week , but they obtained results comparable to the S arm patients . Preventive rehabilitation ( regardless of the approach , i.e. , experimental or st and ard ) in head and neck cancer patients , despite advanced stage and burdensome treatment , is feasible , and compared with historical controls , it seems helpful in reducing the extent and /or severity of various functional short-term effects of CCRT This study evaluated and compared the Therabite Jaw Motion Rehabilitation System ( Therabite Corporation , Bryn Mawr , PA ) to tongue blades as a technique for maintaining and /or improving m and ibular range of motion in post-irradiated patients . Three groups of patients were evaluated and compared : 1 ) unassisted exercise , 2 ) mechanically assisted m and ibular mobilization with stacked tongue depressors combined with unassisted exercise , and 3 ) the Therabite System combined with unassisted exercise . The initial average maximum incisal opening ( MIO ) for the study population was 21.6 mm , and did not vary significantly among the groups . Measurements were recorded at 2-week intervals for 10 weeks . At week 6 and thereafter , the net increase in MIO of group 3 ( 13.6 mm [ + /- 1.6 mm ] ) was significantly greater than group 1 ( 6.0 mm [ + /- 1.8 mm ] ) and group 2 ( 4.4 mm [ + /- 2.1 mm ] ) ( P < .05 ) . The rate of improvement leveled after 4 week in group 1 and group 2 . However , the rate of gain in MIO in the Therabite group ( group 3 ) remained constant at 10 weeks . There was no statistical difference between groups 1 and 2 Concurrent chemoradiotherapy ( CCRT ) for advanced head and neck cancer ( HNC ) is associated with substantial early and late side effects , most notably regarding swallowing function , but also regarding voice quality and quality of life ( QoL ) . Despite increased awareness/knowledge on acute dysphagia in HNC survivors , long-term ( i.e. , beyond 5 years ) prospect ively collected data on objective and subjective treatment-induced functional outcomes ( and their impact on QoL ) still are scarce . The objective of this study was the assessment of long-term CCRT-induced results on swallowing function and voice quality in advanced HNC patients . The study was conducted as a r and omized controlled trial on preventive swallowing rehabilitation ( 2006–2008 ) in a tertiary comprehensive HNC center with twenty-two disease-free and evaluable HNC patients as participants . Multidimensional assessment of functional sequels was performed with videofluoroscopy , mouth opening measurements , Functional Oral Intake Scale , acoustic voice parameters , and ( study specific , SWAL-QoL , and VHI ) question naires . Outcome measures at 6 years post-treatment were compared with results at baseline and 
    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: Purpose : To investigate the strength of correlation between measured saliva flow rates and various toxicity endpoints commonly used in head and neck cancer ( HNC ) treatment . Material s and Methods : All patients enrolled in a phase II study using intensity modulated radiotherapy ( IMRT ) for HNC treatment underwent whole mouth saliva flow measurements ( stimulated and unstimulated ) . They were also assessed for salivary gl and toxicity using  Radiation Therapy Oncology Group ( RTOG ) late toxicity grading and 9 items  representing  patient-  grade d  toxicities  from 2 question naires ( Xerostomia question naire and University of Washington quality of life ) . For each patient , saliva flow rates and quality of life ( QOL ) data were collected preradiotherapy ( RT ) and at 3 intervals post-RT ( 3 , 6 , and 12 months ) . Results : A total of 188 sets of coregistered data were obtained for 47 patients over a period of approximately 4 years .  Saliva production and mean QOL dropped significantly immediately after RT , but there was a statistically significant recovery in both parameters between 3- and 12-month post-RT . By 12 months , post-RT the mean QOL scores had returned to pre-RT baseline , although mean stimulated saliva production remained 58 % below baseline . Conclusion : Patients with HNC treated with IMRT  experienced a small drop in QOL which recovered to baseline by 12 months post-RT . There was no statistically significant correlation seen between global health-related QOL scores and stimulated saliva production rates in the post-RT period Aim To evaluate the influence of clinical , treatment- and dose-dependent factors on posttreatment swallowing function after induction chemotherapy and definitive chemoradiotherapy in a group of homogeneously treated laryngopharyngeal cancer patients . Methods From 28 May 2008 to 15 February 2013 , 45 patients with borderline inoperable laryngopharyngeal cancer that had responded well to induction chemotherapy were treated with definitive chemoradiotherapy .  Median follow-up was 22 months . Swallowing function and clinical data were prospect ively analyzed using the EORTC QLQ-C30 question naire . Swallowing structures were retrospectively delineated on the original treatment planning CT .  Dose – volume histograms were calculated for swallowing structures and Dmean , Dmax and V50–V64 values ( in 2 Gy increments ) were determined for each patient . Tumor volume and infiltration of the swallowing apparatus was defined by CT before induction chemotherapy . Results Of the 45 patients , 26 ( 57.8 % ) fully regained swallowing function after chemoradiotherapy . A further 12 patients ( 26.7 % ) were able to manage soft , pureed and /or liquid foods ; the remaining 7 ( 15.6 % ) were completely dependent on percutaneous endoscopic gastrostomy ( PEG ) . Posttreatment swallowing function was significantly influenced by Dmean to the superior pharyngeal constrictor muscle ( PCM , p = 0.041 ) . Correlations between late dysphagia and dose – volume relationships in the superior PCM and soft palate were also observed , which were significant from V60 ( p = 0.043 ) and V58 for the soft palate and superior PCM , respectively . Of the evaluated clinical and tumor-related factors , only alcohol abuse ( p = 0.024 ) had an influence on posttreatment swallowing function . Conclusion Almost 50 % of patients had deterioration of swallowing function after definitive chemoradiotherapy for laryngopharyngeal cancer . The dose to anatomical structures responsible for swallowing function appears to play a role . Therefore , in selected patients , target volume delineation for radiotherapy of laryngopharyngeal cancer should be optimized on an individual basis to spare the swallowing apparatus . ZusammenfassungZielEvaluation von klinischen , therapie- und dosisabhängigen Faktoren in Bezug auf die posttherapeutische Schluckfunktion nach Induktionschemotherapie und definitiver Radiochemotherapie bei einem homogen beh and elten Patientenkollektiv mit laryngopharyngealen Tumoren . Method enIm Zeitraum vom 28 . Mai 2008 bis 15 . Februar 2013 erhielten 45 Patienten mit grenzwertig inoperablen Kopf-Hals-Tumoren nach gutem Ansprechen auf eine Induktionschemotherapie eine Radiochemotherapie . Das mediane Follow-up betrug 22 Monate . Die Schluckfunktion und die klinischen Date n wurden prospektiv mittels des EORTC-QLQ-C30-Fragebogens sowie klinisch evaluiert . Die Schluckstrukturen wurden retrospektiv in die Originalbestrahlungspläne der CT- Date nsätze eingezeichnet . Es wurden die Dosis-Volumen-Histogramme ( DVH ) für die Schluckstrukturen berechnet sowie jeweils Dmean , Dmax und die V50- bis V64-Werte bestimmt . Das Tumorvolumen und die Tumorinfiltration von Teilen des Schluckapparats wurden i m CT vor Induktionschemotherapie definiert . ErgebnisseInsgesamt 26 der 45 Patienten ( 57,8 % ) wiesen eine vollständige gute Schluckfunktion nach Radiochemotherapie auf . Weitere 12 Patienten ( 26,7 % ) konnten weiche , pürierte oder flüssige Kost zu sich nehmen . Die verbleibenden 7 ( 15,6 % ) Patienten wurden ausschließlich über die PEG ( „ percutaneous endoscopic gastrostomy “ ) ernährt . Die Schluckfunktion nach Radiochemotherapie wurde signifikant von der applizierten Dmean i m oberen Konstriktormuskel ( „ pharyngeal constrictor muscle “ , PCM ; p = 0,041 ) beeinflusst . Zudem konnte eine Korrelation der Spätdysphagie mit den Dosis-Volumen-Parametern i m oberen PCM und weichen Gaumen gezeigt werden , welche ab einer V60 i m weichen Gaumen ( p = 0,043 ) und ab einer V58 i m oberen PCM ( p = 0,012 ) signifikant waren . Von den getesteten klinischen und tumorspezifischen Faktoren hatte lediglich ein stattgehabter Alkoholabusus ( p = 0,024 ) einen Einfluss auf das posttherapeutische Schlucken nach TherapieSchlussfolgerungFast 50 % der Patienten können nach definitiver Radiochemotherapie aufgrund eines laryngopharyngealen Tumors nicht vollständig schlucken . Ein Grund hierfür scheint in der applizierten Dosis in Teilen des Schluckapparats zu liegen . Daher sollte bei ausgewählten Patienten zukünftig eine individuelle Optimierung der Zielvolumendefinition i m Kopf-Hals-Bereich zur Schonung des Schluckapparats erfolgen Background and purpose To compare early ( 3 and 6 month ) and later ( 12 and 24 month ) functional outcomes of stage III and IV ( M0 ) oropharyngeal squamous cancer patients treated in sequential cohorts with 3D conformal ( 3DCRT ) or intensity modulated radiotherapy ( IMRT ) . Patients and methods 200 patients in sequential population based cohorts of 83 and 117 patients treated at a single institution with 3DCRT and then IMRT respectively were prospect ively assessed at pre-treatment and 3 , 6 , 12 and 24 months post treatment . A st and ard functional outcomes protocol including performance status ( KPS , ECOG ) , 3 Performance Status scales for Head and Neck ( PSS-HN ) , the Royal Brisbane Hospital Outcome Measure for Swallowing ( RBHOMS ) , Voice H and icap Index-10 ( VHI-10 ) and self-rated xerostomia  were applied . Results Mean age at diagnosis was 59 years . The primary site was base of tongue in 77 and tonsil or soft palate in 123 patients . Median follow up was 2.5 years for the second cohort . Concomitant therapy was used in 159 ( 79.5 % ) . Overall survival at 3 years was 75.6 % and 71.5 % for IMRT and 3DCRT cohorts respectively ( not significant ) . A multiple imputation technique was used to estimate missing values in order to avoid a healthy patient bias . KPS and ECOG reached nadirs at 3 to 6 months but approached baseline values at 12 to 24 months and did not differ by treatment . The 3 PSS-HN scales , Eating in Public ( p < 0.001 ) , Underst and ability of Speech ( p = 0.009 ) and Oral Diet Texture ( p = 0.002 ) and all showed significantly better outcomes in favor of IMRT . The RBHOMS showed a difference in favor of  IMRT  which appeared during 3 to 6 months ( p < 0.001 ) . The VHI-10 also showed a difference in favor of IMRT ( p = 0.015 ) . Self-rated xerostomia did not differ at 3 and 6 months but was significantly better in favor of IMRT after 12 months p = 0.005 Conclusions A prospect ively administered functional outcomes protocol showed meaningful differences in favor of IMRT over 3DCRT early ( 3–6 months ) and later ( 12–24 months ) in the treatment of oropharyngeal carcinoma with equivalent survival . These data support the adoption of IMRT as the st and ard radiation treatment method for patients with stage III and IV ( M0 ) oropharyngeal squamous carcinoma .  KPS and ECOG may not be sensitive to oropharyngeal cancer patients ’ functional outcomes by treatment The aim of this study was to assess the effect of ( preventive ) rehabilitation on swallowing and mouth opening  after concomitant chemoradiotherapy ( CCRT ) . Forty-nine patients with advanced oral cavity , oropharynx , hypopharynx and larynx , or nasopharynx cancer treated with CCRT  were r and omized into a st and ard ( S ) or an experimental ( E ) preventive rehabilitation arm . Structured multidimensional assessment ( i.e. ,  videofluoroscopy , mouth-opening measurement , structured question naires ) was performed before and 10 weeks after CCRT . In both S and E arms , feasibility was good ( all patients could execute the exercises within a week ) and compliance was satisfactory ( mean days practice d per week was 4 ) . Nevertheless , mouth opening , oral intake , and weight decreased significantly . Compared to similar CCRT studies at our institute , however , fewer patients were still tube-dependent after CCRT . Furthermore , some functional outcomes seemed less affected than those of studies in the literature that did not incorporate rehabilitation exercises . Patients in the E arm practice d significantly fewer days in total and per week , but they obtained results comparable to the S arm patients . Preventive rehabilitation ( regardless of the approach , i.e. , experimental or st and ard ) in head and neck cancer patients , despite advanced stage and burdensome treatment , is feasible , and compared with historical controls , it seems helpful in reducing the extent and /or severity of various functional short-term effects of CCRT This study evaluated and compared the Therabite Jaw Motion Rehabilitation System ( Therabite Corporation , Bryn Mawr , PA ) to tongue blades as a technique for maintaining and /or improving m and ibular range of motion in post-irradiated patients . Three groups of patients were evaluated and compared : 1 ) unassisted exercise , 2 ) mechanically assisted m and ibular mobilization with stacked tongue depressors combined with unassisted exercise , and 3 ) the Therabite System combined with unassisted exercise . The initial average maximum incisal opening ( MIO ) for the study population was 21.6 mm , and did not vary significantly among the groups . Measurements were recorded at 2-week intervals for 10 weeks . At week 6 and thereafter , the net increase in MIO of group 3 ( 13.6 mm [ + /- 1.6 mm ] ) was significantly greater than group 1 ( 6.0 mm [ + /- 1.8 mm ] ) and group 2 ( 4.4 mm [ + /- 2.1 mm ] ) ( P < .05 ) . The rate of improvement leveled after 4 week in group 1 and group 2 . However , the rate of gain in MIO in the Therabite group ( group 3 ) remained constant at 10 weeks . There was no statistical difference between groups 1 and 2 Concurrent chemoradiotherapy ( CCRT ) for advanced head and neck cancer ( HNC ) is associated with substantial early and late side effects , most notably regarding swallowing function , but also regarding voice quality and quality of life ( QoL ) . Despite increased awareness/knowledge on acute dysphagia in HNC survivors , long-term ( i.e. , beyond 5 years ) prospect ively collected data on objective and subjective treatment-induced functional outcomes ( and their impact on QoL ) still are scarce . The objective of this study was the assessment of long-term CCRT-induced results on swallowing function and voice quality in advanced HNC patients . The study was conducted as a r and omized controlled trial on preventive swallowing rehabilitation ( 2006–2008 ) in a tertiary comprehensive HNC center with twenty-two disease-free and evaluable HNC patients as participants . Multidimensional assessment of functional sequels was performed with videofluoroscopy , mouth opening measurements , Functional Oral Intake Scale , acoustic voice parameters , and ( study specific , SWAL-QoL , and VHI ) question naires . Outcome measures at 6 years post-treatment were compared with results at baseline and 
    Output:
    