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: One hundred forty‐two patients with all stages of gastric carcinoma were prospect ively stratified into two divisions according to T.N.M. stage following , but irrespective of the type of surgical procedure . Division I ( T 1‐3 , N 1‐2 , M O ) was r and omized into a control group , and a treatment group who received 2000 rad in 8 fractions over 10 days with intravenous 5 Fluorouracil ( 5 F.U. ) at a dose of 500 mg daily × 4 days preirradiation and then 12.5 mg/kg daily for 5 days every 28 days for six courses . Division II ( T4 or M1 ) was r and omized into three groups ; a control group , a group who received radiotherapy and 5 F.U. in the same schedule as division one and a group who received Thiotepa 45 mg intravenously daily for three days and then every 28 days for 6 months . Four and one‐half years after commencement of the trial 86 % of the patients had died . There was no difference in survival rate between the treatment and control groups , ( p > 0.5 ) in Division I or II . Survival appeared to correlate with the T.N.M. stage of disease and not therapy . Blind assessment of the quality of life showed no difference between the treatment groups and the controls . In the dose schedules used , this form of oncological therapy had no efect on survival or quality of life in patients with gastric carcinoma . Cancer 44:385‐391 , 1979 PURPOSE Taxol ( paclitaxel ) represents a new class of anticancer agent with activity against a wide variety of solid tumors . It has been found to be active in patients with adenocarcinoma and squamous cell carcinoma of the esophagus . To determine its activity against gastric adenocarcinoma , we conducted a phase II trial of Taxol in chemotherapy-naive patients with advanced disease . PATIENTS AND METHODS Patients with measurable , unresectable , metastatic gastric carcinoma with performance status < or = 2 by Zubrod scale were eligible . Patients had to have normal liver , renal , and bone marrow functions . Written informed consent was obtained from all patients . The starting dose of Taxol was 200 mg/m2 infused over either 3 hours ( in the first 15 patients ) or 24 hours ( in the subsequent 18 patients ) . Taxol was repeated every 21 days . Response was evaluated after two courses . RESULTS Thirty-three patients were registered . The median number of courses was two ( range , 1 to 12 ; total , 112 courses ) . Thirty patients were evaluable for response and toxicity . Among the first 15 patients ( two inevaluable ) receiving Taxol over 3 hours , there were one partial response ( PR ) ( one of 13 patients , or 8 % ; 95 % confidence interval , 0 % to 36 % ) and three minor responses ( MRs ) . However , among the 18 patients ( one inevaluable ) receiving Taxol over 24 hours , there were four PRs ( four of 17 patients or 23 % ; 95 % confidence interval , 7 % to 50 % ) and three MRs . The overall PR rate was 17 % ( five of 30 patients ; 95 % confidence interval , 6 % to 35 % ) . The median duration of PR was 6.5 months ( range , 2.3 months to 11.3 + months . There were no treatment-related deaths . Myelosuppression was more severe with the 24-hour schedule than with the 3-hour schedule . CONCLUSIONS Taxol has a modest degree of activity against gastric carcinoma . It is well tolerated by the patients . Further studies of Taxol in combination with other active agents against gastric carcinoma should be considered A phase III r and omised study , comparing treatment with fluorouracil , epidoxorubicin and methotrexate ( FEMTX ) with the best supportive care , was conducted in patients with unresectable or metastatic gastric cancer . During the period from July 1986 to June 1992 , 41 patients were r and omised to receive FEMTX or best supportive care . MTX was given in a dose of 1500 mg m-2 intravenously ( i.v . ) followed after 1 h by 5-FU 1500 mg m-2 i.v . on day 1 ; leucovorin rescue was started after 24 h ( 30 mg orally every 6 h for 48 h ) and epidoxorubicin 60 mg m-2 i.v . was administered on day 15 . In addition both groups received tablets containing vitamins A and E. Response rates for FEMTX were as follows : complete response ( CR ) , 19 % ( 4/21 ) ; partial response ( PR ) , 10 % ( 2/21 ) ; no change ( NC ) , 33 % ( 7/21 ) ; and progressive disease ( PD ) , 24 % ( 5/21 ) . Response rates in the control group were : NC , 20 % ( 4/20 ) ; and PD , 80 % ( 16/20 ) . Increased pain was observed in one patient in the treated group and in 11 patients in the control group within the first 2 months . WHO grade III/IV toxicity in the chemotherapy group was as follows : nausea/vomiting 40 % , diarrhoea 10 % , stomatitis 15 % , leucopenia 50 % and thrombocytopenia 10 % . One possible treatment-related death was due to sepsis . The median time to progression in the FEMTX group was 5.4 months [ 95 % confidence interval ( CI ) 3.1 - 11.7 months ] , but only 1.7 months in the control group ( 95 % CI 1.2 - 2.7 months ) ( P = 0.0013 ) . Similarly , the FEMTX group displayed significantly ( P = 0.0006 ) prolonged survival compared with the control group , i.e. median survival 12.3 months ( 95 % CI 7.1 - 15.6 months ) vs 3.1 months ( 95 % CI 1.6 - 4.6 months ) . In conclusion , FEMTX combined with vitamin A and E is a fairly well-tolerated treatment , giving a response rate of 29 % in patients with advanced gastric cancer , and also prolonging patients ' survival . It can be used as a reference treatment in testing new investigational combinations Background . In an attempt to decrease the toxic effects of fluorouracil , doxorubicin , and methotrexate ( FAMTX ) by reducing the dose of methotrexate from 1500 mg/m2 , according to the original regimen , to 1000 mg/m2 , the authors design ed the modified FAMTX treatment that was evaluated in a prospect i ve Phase II‐III r and omized trial BACKGROUND Chemotherapy may relieve tumor-related symptoms , may improve quality of life and prolong survival in advanced gastrointestinal cancer . The extent of such improvements is unclear despite the extensive use of this treatment modality , and there are no studies concerning the economic cost of any gain achieved in the quantity and quality of life by chemotherapy . PATIENTS AND METHODS Between January 1991 and May 1992 , 61 patients with inoperable cancer ( 18 gastric , 22 pancreatic or biliary , and 21 colorectal ) were r and omized to either primary chemotherapy in addition to best supportive care or to best supportive care . Chemotherapy was allowed in the latter group if the supportive measures did not achieve palliation . All economic costs for medical care were prospect ively recorded , and marginal cost-effectiveness analyses were performed . RESULTS More patients in the primary chemotherapy group ( 19/33 , 58 % ) had improved/prolonged high quality of life ( QoL-patient , minimum duration 4 months ) than in the best supportive care group ( 8/28 , 29 % , p < 0.05 ) . Overall survival and quality -adjusted survival were significantly longer in the primary chemotherapy group ( median 9 vs. 4 months , p < 0.05 ) , and median 7 vs. 2 months , p < 0.05 , respectively ) . When analysed by cancer site , survival was significantly prolonged in gastric cancer patients ( median 10 vs. 4 months , p < 0.02 ) , but not in colorectal ( median 12 vs. 6 months , p = 0.1 ) and pancreatic-biliary cancer patients ( median 8 vs. 5 months , p = 0.8 ) . The average cost for all medical care was approximately 50 % higher in the primary chemotherapy group , but the average cost per day was the same in the two groups . Hospitalization accounted for most of the costs in both groups . The incremental costs per gained year of life was SEK 166,400 ( $ 21,300 ) , per gained quality -adjusted year of life SEK 157,200 ( $ 20,200 ) , and per QoL-patient SEK 160,300 ( $ 20,600 ) . These costs were lower for gastric and colorectal cancer patients , and much higher for pancreatic-biliary cancer patients . CONCLUSIONS The results of this study suggest that palliative chemotherapy is cost-effective in patients with advanced gastric and colorectal cancer . Knowledge about survival and quality of life benefits is still limited in patients suffering from gastric and pancreatic-biliary cancer About one-third of patients with gastric cancer are unresectable at the time of diagnosis . Their median survival is < 6 months , with a grave prognosis . The purpose of this study was to assess the efficacy of a modified FAM ( mFAM ) regimen in advanced gastric cancer . We retrospectively review ed the clinical records of 409 advanced gastric cancer patients who had not received curative surgery . Among 409 patients , 202 patients were treated with an mFAM regimen ( infusional 5-FU + doxorubocin + mitomycin-C )  , and 207 patients received no chemotherapy ( control group ) .  No differences were found in clinical parameters between the two groups . The 1-year survival rates were 34.1 % for the mFAM-treated group and 22.5 % for the control group ( p = 0.0135 ) . In subset analysis , a higher 1-year survival rate was demonstrated in patients with mFAM and palliative surgery . Of the 154 evaluable patients in the mFAM-treated group , the response rate was 17.5 % . In these patients , median response duration was 30 weeks , and progression-free survival was 23 weeks . Overall toxicity of mFAM regimen was relatively tolerable and reversible . In conclusion , FAM combination chemotherapy , which has been used as a st and ard therapy , prolonged survival after modification of the administration schedule and combination with palliative surgery . A prospect i ve r and omized study is warranted to confirm this conclusion from our retrospective study Although 5-fluorouracil remains the mainstay of treatment for advanced gastric cancer ( AGC ) , no st and ard chemotherapy regimen exists . Combinations of irinotecan with folinic acid and infusional 5-fluorouracil ( 5-FU ) ( ILF ) have shown good efficacy with acceptable toxicity in patients with metastatic colorectal cancer . At present , only sparse data on ILF are available for AGC . Therefore we conducted a prospect i ve study of this combination in 25 consecutive patients with metastatic gastric cancer . Median age was 63 years , 10 had received prior chemotherapy and 13 presented initially with peritoneal carcinosis . Treatment consisted of irinotecan 80 mg/m2 , folinic acid 500 mg/m2 and infusional 5-FU 2.0 g/m2 over 24 h , given weekly for 6 weeks followed by a 1-week rest . Grade 3/4 hematologic toxicity occurred in six patients ( anemia = 4 , neutropenia = 1 and leukopenia = 1 ) . Non-hematologic toxicity consisted mainly of nausea/vomiting ( grade 3/4 in six patients ) and diarrhea ( grade 3/4 in 10 patients ) . The overall response rate was 20 % for first- and second-line treatment , with two complete and three partial responses . Another nine patients ( 36 % ) had stable disease , for a tumor control rate of 56 % . Median time to progression was 4 months , median overall survival and survival for patients with tumor control was 7 and 13 months , respectively . We conclude that ILF is a feasible outpatient regimen with manageable toxicity that provides tumor control in a high proportion of patients with advanced gastric cancer , even among those with unfavorable prognostic features BACKGROUND The extent to which chemotherapy may relieve tumour-related symptoms , improve quality of life and prolong survival in patients with gastric cancer is not known in spite of the extensive use of this treatment modality . The aim of this study was to estimate any gain in the quantity and quality of life produced by chemotherapy in these patients . PATIENTS AND METHODS Between January 1991 and February 1995 , 61 patients with gastric cancer were r and omized to either chemotherapy in addition to best supportive care or to best supportive care . Chemotherapy was allowed in the latter group if the supportive measures did not lead to palliation . Chemotherapy was the ELF-regimen consisting of 5-fluorouracil , leucovorin 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: One hundred forty‐two patients with all stages of gastric carcinoma were prospect ively stratified into two divisions according to T.N.M. stage following , but irrespective of the type of surgical procedure . Division I ( T 1‐3 , N 1‐2 , M O ) was r and omized into a control group , and a treatment group who received 2000 rad in 8 fractions over 10 days with intravenous 5 Fluorouracil ( 5 F.U. ) at a dose of 500 mg daily × 4 days preirradiation and then 12.5 mg/kg daily for 5 days every 28 days for six courses . Division II ( T4 or M1 ) was r and omized into three groups ; a control group , a group who received radiotherapy and 5 F.U. in the same schedule as division one and a group who received Thiotepa 45 mg intravenously daily for three days and then every 28 days for 6 months . Four and one‐half years after commencement of the trial 86 % of the patients had died . There was no difference in survival rate between the treatment and control groups , ( p > 0.5 ) in Division I or II . Survival appeared to correlate with the T.N.M. stage of disease and not therapy . Blind assessment of the quality of life showed no difference between the treatment groups and the controls . In the dose schedules used , this form of oncological therapy had no efect on survival or quality of life in patients with gastric carcinoma . Cancer 44:385‐391 , 1979 PURPOSE Taxol ( paclitaxel ) represents a new class of anticancer agent with activity against a wide variety of solid tumors . It has been found to be active in patients with adenocarcinoma and squamous cell carcinoma of the esophagus . To determine its activity against gastric adenocarcinoma , we conducted a phase II trial of Taxol in chemotherapy-naive patients with advanced disease . PATIENTS AND METHODS Patients with measurable , unresectable , metastatic gastric carcinoma with performance status < or = 2 by Zubrod scale were eligible . Patients had to have normal liver , renal , and bone marrow functions . Written informed consent was obtained from all patients . The starting dose of Taxol was 200 mg/m2 infused over either 3 hours ( in the first 15 patients ) or 24 hours ( in the subsequent 18 patients ) . Taxol was repeated every 21 days . Response was evaluated after two courses . RESULTS Thirty-three patients were registered . The median number of courses was two ( range , 1 to 12 ; total , 112 courses ) . Thirty patients were evaluable for response and toxicity . Among the first 15 patients ( two inevaluable ) receiving Taxol over 3 hours , there were one partial response ( PR ) ( one of 13 patients , or 8 % ; 95 % confidence interval , 0 % to 36 % ) and three minor responses ( MRs ) . However , among the 18 patients ( one inevaluable ) receiving Taxol over 24 hours , there were four PRs ( four of 17 patients or 23 % ; 95 % confidence interval , 7 % to 50 % ) and three MRs . The overall PR rate was 17 % ( five of 30 patients ; 95 % confidence interval , 6 % to 35 % ) . The median duration of PR was 6.5 months ( range , 2.3 months to 11.3 + months . There were no treatment-related deaths . Myelosuppression was more severe with the 24-hour schedule than with the 3-hour schedule . CONCLUSIONS Taxol has a modest degree of activity against gastric carcinoma . It is well tolerated by the patients . Further studies of Taxol in combination with other active agents against gastric carcinoma should be considered A phase III r and omised study , comparing treatment with fluorouracil , epidoxorubicin and methotrexate ( FEMTX ) with the best supportive care , was conducted in patients with unresectable or metastatic gastric cancer . During the period from July 1986 to June 1992 , 41 patients were r and omised to receive FEMTX or best supportive care . MTX was given in a dose of 1500 mg m-2 intravenously ( i.v . ) followed after 1 h by 5-FU 1500 mg m-2 i.v . on day 1 ; leucovorin rescue was started after 24 h ( 30 mg orally every 6 h for 48 h ) and epidoxorubicin 60 mg m-2 i.v . was administered on day 15 . In addition both groups received tablets containing vitamins A and E. Response rates for FEMTX were as follows : complete response ( CR ) , 19 % ( 4/21 ) ; partial response ( PR ) , 10 % ( 2/21 ) ; no change ( NC ) , 33 % ( 7/21 ) ; and progressive disease ( PD ) , 24 % ( 5/21 ) . Response rates in the control group were : NC , 20 % ( 4/20 ) ; and PD , 80 % ( 16/20 ) . Increased pain was observed in one patient in the treated group and in 11 patients in the control group within the first 2 months . WHO grade III/IV toxicity in the chemotherapy group was as follows : nausea/vomiting 40 % , diarrhoea 10 % , stomatitis 15 % , leucopenia 50 % and thrombocytopenia 10 % . One possible treatment-related death was due to sepsis . The median time to progression in the FEMTX group was 5.4 months [ 95 % confidence interval ( CI ) 3.1 - 11.7 months ] , but only 1.7 months in the control group ( 95 % CI 1.2 - 2.7 months ) ( P = 0.0013 ) . Similarly , the FEMTX group displayed significantly ( P = 0.0006 ) prolonged survival compared with the control group , i.e. median survival 12.3 months ( 95 % CI 7.1 - 15.6 months ) vs 3.1 months ( 95 % CI 1.6 - 4.6 months ) . In conclusion , FEMTX combined with vitamin A and E is a fairly well-tolerated treatment , giving a response rate of 29 % in patients with advanced gastric cancer , and also prolonging patients ' survival . It can be used as a reference treatment in testing new investigational combinations Background . In an attempt to decrease the toxic effects of fluorouracil , doxorubicin , and methotrexate ( FAMTX ) by reducing the dose of methotrexate from 1500 mg/m2 , according to the original regimen , to 1000 mg/m2 , the authors design ed the modified FAMTX treatment that was evaluated in a prospect i ve Phase II‐III r and omized trial BACKGROUND Chemotherapy may relieve tumor-related symptoms , may improve quality of life and prolong survival in advanced gastrointestinal cancer . The extent of such improvements is unclear despite the extensive use of this treatment modality , and there are no studies concerning the economic cost of any gain achieved in the quantity and quality of life by chemotherapy . PATIENTS AND METHODS Between January 1991 and May 1992 , 61 patients with inoperable cancer ( 18 gastric , 22 pancreatic or biliary , and 21 colorectal ) were r and omized to either primary chemotherapy in addition to best supportive care or to best supportive care . Chemotherapy was allowed in the latter group if the supportive measures did not achieve palliation . All economic costs for medical care were prospect ively recorded , and marginal cost-effectiveness analyses were performed . RESULTS More patients in the primary chemotherapy group ( 19/33 , 58 % ) had improved/prolonged high quality of life ( QoL-patient , minimum duration 4 months ) than in the best supportive care group ( 8/28 , 29 % , p < 0.05 ) . Overall survival and quality -adjusted survival were significantly longer in the primary chemotherapy group ( median 9 vs. 4 months , p < 0.05 ) , and median 7 vs. 2 months , p < 0.05 , respectively ) . When analysed by cancer site , survival was significantly prolonged in gastric cancer patients ( median 10 vs. 4 months , p < 0.02 ) , but not in colorectal ( median 12 vs. 6 months , p = 0.1 ) and pancreatic-biliary cancer patients ( median 8 vs. 5 months , p = 0.8 ) . The average cost for all medical care was approximately 50 % higher in the primary chemotherapy group , but the average cost per day was the same in the two groups . Hospitalization accounted for most of the costs in both groups . The incremental costs per gained year of life was SEK 166,400 ( $ 21,300 ) , per gained quality -adjusted year of life SEK 157,200 ( $ 20,200 ) , and per QoL-patient SEK 160,300 ( $ 20,600 ) . These costs were lower for gastric and colorectal cancer patients , and much higher for pancreatic-biliary cancer patients . CONCLUSIONS The results of this study suggest that palliative chemotherapy is cost-effective in patients with advanced gastric and colorectal cancer . Knowledge about survival and quality of life benefits is still limited in patients suffering from gastric and pancreatic-biliary cancer About one-third of patients with gastric cancer are unresectable at the time of diagnosis . Their median survival is < 6 months , with a grave prognosis . The purpose of this study was to assess the efficacy of a modified FAM ( mFAM ) regimen in advanced gastric cancer . We retrospectively review ed the clinical records of 409 advanced gastric cancer patients who had not received curative surgery . Among 409 patients , 202 patients were treated with an mFAM regimen ( infusional 5-FU + doxorubocin + mitomycin-C )  , and 207 patients received no chemotherapy ( control group ) .  No differences were found in clinical parameters between the two groups . The 1-year survival rates were 34.1 % for the mFAM-treated group and 22.5 % for the control group ( p = 0.0135 ) . In subset analysis , a higher 1-year survival rate was demonstrated in patients with mFAM and palliative surgery . Of the 154 evaluable patients in the mFAM-treated group , the response rate was 17.5 % . In these patients , median response duration was 30 weeks , and progression-free survival was 23 weeks . Overall toxicity of mFAM regimen was relatively tolerable and reversible . In conclusion , FAM combination chemotherapy , which has been used as a st and ard therapy , prolonged survival after modification of the administration schedule and combination with palliative surgery . A prospect i ve r and omized study is warranted to confirm this conclusion from our retrospective study Although 5-fluorouracil remains the mainstay of treatment for advanced gastric cancer ( AGC ) , no st and ard chemotherapy regimen exists . Combinations of irinotecan with folinic acid and infusional 5-fluorouracil ( 5-FU ) ( ILF ) have shown good efficacy with acceptable toxicity in patients with metastatic colorectal cancer . At present , only sparse data on ILF are available for AGC . Therefore we conducted a prospect i ve study of this combination in 25 consecutive patients with metastatic gastric cancer . Median age was 63 years , 10 had received prior chemotherapy and 13 presented initially with peritoneal carcinosis . Treatment consisted of irinotecan 80 mg/m2 , folinic acid 500 mg/m2 and infusional 5-FU 2.0 g/m2 over 24 h , given weekly for 6 weeks followed by a 1-week rest . Grade 3/4 hematologic toxicity occurred in six patients ( anemia = 4 , neutropenia = 1 and leukopenia = 1 ) . Non-hematologic toxicity consisted mainly of nausea/vomiting ( grade 3/4 in six patients ) and diarrhea ( grade 3/4 in 10 patients ) . The overall response rate was 20 % for first- and second-line treatment , with two complete and three partial responses . Another nine patients ( 36 % ) had stable disease , for a tumor control rate of 56 % . Median time to progression was 4 months , median overall survival and survival for patients with tumor control was 7 and 13 months , respectively . We conclude that ILF is a feasible outpatient regimen with manageable toxicity that provides tumor control in a high proportion of patients with advanced gastric cancer , even among those with unfavorable prognostic features BACKGROUND The extent to which chemotherapy may relieve tumour-related symptoms , improve quality of life and prolong survival in patients with gastric cancer is not known in spite of the extensive use of this treatment modality . The aim of this study was to estimate any gain in the quantity and quality of life produced by chemotherapy in these patients . PATIENTS AND METHODS Between January 1991 and February 1995 , 61 patients with gastric cancer were r and omized to either chemotherapy in addition to best supportive care or to best supportive care . Chemotherapy was allowed in the latter group if the supportive measures did not lead to palliation . Chemotherapy was the ELF-regimen consisting of 5-fluorouracil , leucovorin and 
    Output:
    