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: Peritoneal carcinomatosis ( PC ) in contrast to lymph nodes and liver metastases was assumed as a terminal condition with no curative treatment options having a 5 to 9 months median survival rate until recently . Today , in properly selected patients , curative surgical treatment of PC is possible like resection of lymph nodes and liver metastases . Between 1996 and 2005 , 29 patients who underwent cytoreductive surgery combined with intraperitoneal chemotherapy for PC originated from colorectal cancer ( CRC ) were analysed prospect ively at the Department of Surgery in Dokuz Eylul University Hospital . Mean age was 54 year ( range , 23 - 75 years ) . There was no peroperative mortality in 29 patients . The morbidity rate was 41 % ( 12/29 ) and 6 ( 20 % ) patients required reoperation(s ) for major complications . Mean and median survival time was 34 and 21 months , respectively . The overall 1-year , 3-year , and 5-year survival rates were 72 % , 13 % , and 7 % , respectively . Mean survival time was 56 months in patients with peritoneal cancer index ( PCI ) < 10 , and 22 months in patients with PCI > 10 ( P = 0.075 ) . The mean survival time was 62 months in patients with complete cytoreduction (CC)-0 score , 21 months in patients with CC-1 score , and 7 months in patients with CC-2 and 3 scores . Patients who had CC-0 score had better survival than patients having CC-1 and CC-2 scores ( P = 0.003 and P = 0.000 , respectively ) . Patients who had CC-0 and 1 scores had better survival than patients with CC-2 score ( P = 0.000 ) . The overall 1-year , 3-year , and 5-year survival rates for patients with CC-0 score were 87 % , 37 % , and 25 % , respectively . There was a positive correlation between the PCI and CC score ( P = 0.001 , correlation coefficient = 0.585 with correlation is significant at level 0.01 ) . Cytoreductive approach combined with intraperitoneal chemotherapy and systemic chemotherapy prolongs survival in selected patients with PC of CRC with acceptable morbidity and mortality . Prognosis is better in patients with limited disease and in whom complete cytoreduction is achieved . In patients with PC of CRC , the key issue is to select the patients in whom complete cytoreduction is feasible . Better patient assessment with new diagnostic tools such as (PET)-CT or PET-magnetic resonance imaging will be used to detect more precisely the patients with low tumor burden in the new feature Background Cytoreductive surgery ( CS ) combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) for treatment of peritoneal carcinomatosis ( PC ) traditionally involves high perioperative morbidity and mortality . We report our experience performing CS-HIPEC in a high-volume regional perfusion program design ed to limit morbidity and mortality . Methods A total of 122 patients underwent 124 CS-HIPEC procedures . Common tumors treated with CS-HIPEC included appendiceal ( 38.5 % ) , colorectal ( 24.6 % ) , and ovarian cancers ( 13.1 % ) , and peritoneal mesothelioma ( 12.3 % ) . Complete cytoreduction was performed in all patients , with organ resections performed as necessary . Results R0 resection was achieved in 28.7 % of cases , R1 in 54.9 % , and R2 in 16.4 % . Median operative time was 460 minutes ( range , 250–840 minutes ) , and median blood loss was 1150 mL ( range , 10–14,000 mL ) . Median hospital and intensive care unit stays were 12 days ( range , 6–50 days ) and 3 days ( range , 0–41 days ) , respectively . Grade 3 or 4 morbidity by National Cancer Institute criteria ( major morbidity ) was seen in 29.8 % of cases , with overall morbidity 56.5 % . Independent prognostic variables for major morbidity included number of anastomoses and degree of cytoreduction . In-hospital and 30-day mortality rates were 0 % and 1.6 % , respectively . The most favorable diagnosis was appendiceal cancer , for which 2-year survival was 66.7 % , with lower- grade histologic subtypes of appendiceal cancer reaching 85.7 % 2-year survival . Colorectal cancer had 2-year survival of 36.7 % . Conclusions In a high-volume center with extensive experience treating peritoneal malignancies , perioperative mortality can be lowered to nearly zero , although morbidity remains high . CS-HIPEC procedures should be studied further in a controlled manner to help define their important role in the care of patients with PC Objective A treatment plan to be used in patients with peritoneal carcinomatosis was devised and tested as a Phase II study . Background Background carcinomatosis from appendical or colorectal cancer has been regarded as a fatal clinical entity . Treatment protocol s have not been reported previously . Methods The authors used cytoreductive surgery and intraperitoneal chemotherapy to treat 181 consecutive patients with peritoneal carcinomatosis . There were 51 patients with colorectal cancer and 130 patients with appendiceal cancer . Mean follow-up is 24 months , with a range of 0 to 149 months . Results Results features that showed prognostic significance included appendiceal versus colorectal primary tumors ( p = 0.0001 ) , grade 1 versus grade s 2 and 3 histopathology ( p = 0.0003 ) , complete versus incomplete cytoreductions ( p = 0.0001 ) , lymph node-negative versus lymph node-positive primary tumors ( p = 0.0001 ) , and volume of peritoneal carcinomatosis present preoperatively for colon cancer ( p = 0.0006 ) . Features with no statistical prognostic significance included preoperative tumor volume for appendiceal cancer , age , sex , number of cycles of chemotherapy , operative time , complications , blood loss , and institution providing treatment . From these prognostic features , four prognostic groups were identified , and 3-year survival was estimated by the product-limit survival method . Group I patients ( n = 76 ) were those with grade 1 histology , no lymph node metastases , and complete cytoreductions ( survival at 3 years = 99 % ) . Group II patients ( n = 23 ) were those with grade 2 or 3 histology , no lymph node metastases , and complete cytoreductions ( 65 % ) . Group III patients ( n = 24 ) had any histology , lymph node metastases , and complete cytoreductions ( 66 % ) . Group IV patients ( n = 58 ) had incomplete cytoreductions ( 20 % ) . Conclusions Conclusions cacinomatosis is a treatable condition in selected patients with the possibility for longterm , disease-free survival Background Cytoreductive surgery ( CRS ) combined with perioperative intraperitoneal chemotherapy ( PIC ) has been suggested as a treatment strategy for peritoneal carcinomatosis . The objective of this data analysis was to study treatment failure after complete cytoreduction for peritoneal dissemination from appendiceal mucinous neoplasms . Methods Before June 2006 , a total of 402 patients with peritoneal dissemination from appendiceal mucinous neoplasms underwent complete cytoreduction and PIC at the Washington Cancer Institute . Patient characteristics , pathologic features , and treatment-related data were obtained from a prospect i ve data base . Survival analyses were performed by the Kaplan-Meier method and the Cox regression model . Results After a median follow-up of 66 months , the 5- and 10-year progression-free survival rates for these 402 patients were 70 % and 67 % , respectively . Disease progression was the only independent risk factor for a reduced overall survival . One hundred eleven patients ( 28 % ) developed progressive disease . Of these , 98 patients underwent second-time and 26 patients third-time CRS and PIC . Complete cytoreduction after repeat surgery was the only independent prognostic factor for improved survival . The most common sites of treatment failure were on the small bowel and in the pelvis . Conclusions The present study reported the patterns of treatment failure after complete cytoreduction and demonstrated that a disease-free state is important for long-term survival in peritoneal dissemination from appendiceal mucinous neoplasms . Repeat complete cytoreduction should be pursued when possible and is associated with improved overall survival in patients with recurrent disease Background Peritoneal carcinomatosis ( PC ) , which has hitherto been regarded as a lethal entity , can now be cured with surgery ( treating macroscopic tumor seeding ) combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) ( treating residual microscopic disease ) . The purpose of this study was to analyze the morbidity and mortality of a particular approach associating optimal ( R0–R1 ) cytoreduction , optimal HIPEC combining oxaliplatin and irinotecan , and an optimal homogeneous intraperitoneal temperature of 43 ° C . Methods A total of 106 consecutive patients were included in this prospect i ve phase 2 study . After complete resection of the PC , HIPEC was performed by the Coliseum technique with oxaliplatin ( 360 mg/m2 ) combined with irinotecan ( 360 mg/m2 ) in 2 L/m2 of 5 % dextrose , over 30 minutes at a real intraperitoneal temperature of 43 ° C . During the hour preceding HIPEC , patients received 5-fluorouracil ( 400 mg/m2 ) and leucovorin ( 20 mg/m2 ) intravenously , result ing in tritherapy . Results Postoperative mortality and morbidity rates were 4 % and 66 % , respectively . The most frequent complications were digestive fistula ( 24 % ) , lung infection ( 16 % ) , and severe hematological toxicity ( 11 % ) . Statistical correlation was evidence d between morbidity and the carcinomatosis score ( P = .0008 ) , the number of resected organs ( P = .0001 ) , the duration of surgery ( P = .0001 ) , and blood loss ( P = .0001 ) . Conclusions This new approach , optimized in three respects ( complete cytoreduction , combination oxaliplatin with irinotecan , and high temperature ) has result ed in a relatively high but acceptable incidence of adverse events considering the expected advantage for survival Abstract Background : Hyperthermic intraoperative intraperitoneal chemotherapy ( HIIC ) has been recently proposed to treat peritoneal carcinomatosis arising from colon adenocarcinoma , which is usually regarded as a lethal clinical entity . The purpose of this study was to evaluate the clinical outcome of this combined treatment . Methods : A retrospective study of 46 patients treated for peritoneal carcinomatosis from colon adenocarcinoma was performed . Thirty-four patients were treated with complete cytoreductive surgery immediately followed by intraoperative HIIC with mitomycin C and cisplatin . The clinical outcome of these 34 patients was analyzed ; the median follow-up period was 14.5 months . Results : No postoperative deaths were reported . The postoperative morbidity rate was 35 % . No severe locoregional or systemic toxicity was observed . The 2-year overall survival was 31 % , and the median survival time and the median time to local disease progression were 18 and 13 months , respectively . Survival and local disease control in patients with well- and moderately differentiated colon adenocarcinoma were significantly better than in those with poorly differentiated tumors . Conclusions : Considering the dismal prognosis of this condition , HIIC seems to achieve encouraging results in a selected group of patients affected with resectable peritoneal carcinomatosis arising from colon adenocarcinoma . These findings support the conduction of formal phase III r and omized trials Background Chemohyperthermic peritoneal perfusion ( CHPP ) after extensive cytoreductive surgery is a possible choice as a regional treatment for peritoneal carcinomatosis ( PC ) . The multicentric France EVOCAPE 1 study demonstrated that the median overall survival of patients with colon peritoneal carcinomatosis subjected to conventional surgical and /or chemotherapeutic treatment was 5.2 months . Historically , mitomycin C is the drug of choice in the treatment of intraperitoneal carcinomatosis from colon cancer . Methods Twenty-five patients affected by stage IV colon cancer with only peritoneal involvement and a prior completion of at least a partial first cycle of systemic chemotherapeutic and /or surgical treatment ( 24 patients ) were enrolled . Immediately following extensive cytoreductive surgery , early postoperative closed abdomen CHPP was performed . Results Complete surgical cytoreduction ( CC0–CC1 ) was obtained in 22 patients . Postoperative mortality was 1 out of 25 ( 4 % ) . Major postoperative morbidity was 6 out of 25 ( 24 % ) . Median overall survival estimated by Kaplan – Meier curve was 30.3 months . Locoregional progression-free survival was 17.3 months . Of all the 
    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: Peritoneal carcinomatosis ( PC ) in contrast to lymph nodes and liver metastases was assumed as a terminal condition with no curative treatment options having a 5 to 9 months median survival rate until recently . Today , in properly selected patients , curative surgical treatment of PC is possible like resection of lymph nodes and liver metastases . Between 1996 and 2005 , 29 patients who underwent cytoreductive surgery combined with intraperitoneal chemotherapy for PC originated from colorectal cancer ( CRC ) were analysed prospect ively at the Department of Surgery in Dokuz Eylul University Hospital . Mean age was 54 year ( range , 23 - 75 years ) . There was no peroperative mortality in 29 patients . The morbidity rate was 41 % ( 12/29 ) and 6 ( 20 % ) patients required reoperation(s ) for major complications . Mean and median survival time was 34 and 21 months , respectively . The overall 1-year , 3-year , and 5-year survival rates were 72 % , 13 % , and 7 % , respectively . Mean survival time was 56 months in patients with peritoneal cancer index ( PCI ) < 10 , and 22 months in patients with PCI > 10 ( P = 0.075 ) . The mean survival time was 62 months in patients with complete cytoreduction (CC)-0 score , 21 months in patients with CC-1 score , and 7 months in patients with CC-2 and 3 scores . Patients who had CC-0 score had better survival than patients having CC-1 and CC-2 scores ( P = 0.003 and P = 0.000 , respectively ) . Patients who had CC-0 and 1 scores had better survival than patients with CC-2 score ( P = 0.000 ) . The overall 1-year , 3-year , and 5-year survival rates for patients with CC-0 score were 87 % , 37 % , and 25 % , respectively . There was a positive correlation between the PCI and CC score ( P = 0.001 , correlation coefficient = 0.585 with correlation is significant at level 0.01 ) . Cytoreductive approach combined with intraperitoneal chemotherapy and systemic chemotherapy prolongs survival in selected patients with PC of CRC with acceptable morbidity and mortality . Prognosis is better in patients with limited disease and in whom complete cytoreduction is achieved . In patients with PC of CRC , the key issue is to select the patients in whom complete cytoreduction is feasible . Better patient assessment with new diagnostic tools such as (PET)-CT or PET-magnetic resonance imaging will be used to detect more precisely the patients with low tumor burden in the new feature Background Cytoreductive surgery ( CS ) combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) for treatment of peritoneal carcinomatosis ( PC ) traditionally involves high perioperative morbidity and mortality . We report our experience performing CS-HIPEC in a high-volume regional perfusion program design ed to limit morbidity and mortality . Methods A total of 122 patients underwent 124 CS-HIPEC procedures . Common tumors treated with CS-HIPEC included appendiceal ( 38.5 % ) , colorectal ( 24.6 % ) , and ovarian cancers ( 13.1 % ) , and peritoneal mesothelioma ( 12.3 % ) . Complete cytoreduction was performed in all patients , with organ resections performed as necessary . Results R0 resection was achieved in 28.7 % of cases , R1 in 54.9 % , and R2 in 16.4 % . Median operative time was 460 minutes ( range , 250–840 minutes ) , and median blood loss was 1150 mL ( range , 10–14,000 mL ) . Median hospital and intensive care unit stays were 12 days ( range , 6–50 days ) and 3 days ( range , 0–41 days ) , respectively . Grade 3 or 4 morbidity by National Cancer Institute criteria ( major morbidity ) was seen in 29.8 % of cases , with overall morbidity 56.5 % . Independent prognostic variables for major morbidity included number of anastomoses and degree of cytoreduction . In-hospital and 30-day mortality rates were 0 % and 1.6 % , respectively . The most favorable diagnosis was appendiceal cancer , for which 2-year survival was 66.7 % , with lower- grade histologic subtypes of appendiceal cancer reaching 85.7 % 2-year survival . Colorectal cancer had 2-year survival of 36.7 % . Conclusions In a high-volume center with extensive experience treating peritoneal malignancies , perioperative mortality can be lowered to nearly zero , although morbidity remains high . CS-HIPEC procedures should be studied further in a controlled manner to help define their important role in the care of patients with PC Objective A treatment plan to be used in patients with peritoneal carcinomatosis was devised and tested as a Phase II study . Background Background carcinomatosis from appendical or colorectal cancer has been regarded as a fatal clinical entity . Treatment protocol s have not been reported previously . Methods The authors used cytoreductive surgery and intraperitoneal chemotherapy to treat 181 consecutive patients with peritoneal carcinomatosis . There were 51 patients with colorectal cancer and 130 patients with appendiceal cancer . Mean follow-up is 24 months , with a range of 0 to 149 months . Results Results features that showed prognostic significance included appendiceal versus colorectal primary tumors ( p = 0.0001 ) , grade 1 versus grade s 2 and 3 histopathology ( p = 0.0003 ) , complete versus incomplete cytoreductions ( p = 0.0001 ) , lymph node-negative versus lymph node-positive primary tumors ( p = 0.0001 ) , and volume of peritoneal carcinomatosis present preoperatively for colon cancer ( p = 0.0006 ) . Features with no statistical prognostic significance included preoperative tumor volume for appendiceal cancer , age , sex , number of cycles of chemotherapy , operative time , complications , blood loss , and institution providing treatment . From these prognostic features , four prognostic groups were identified , and 3-year survival was estimated by the product-limit survival method . Group I patients ( n = 76 ) were those with grade 1 histology , no lymph node metastases , and complete cytoreductions ( survival at 3 years = 99 % ) . Group II patients ( n = 23 ) were those with grade 2 or 3 histology , no lymph node metastases , and complete cytoreductions ( 65 % ) . Group III patients ( n = 24 ) had any histology , lymph node metastases , and complete cytoreductions ( 66 % ) . Group IV patients ( n = 58 ) had incomplete cytoreductions ( 20 % ) . Conclusions Conclusions cacinomatosis is a treatable condition in selected patients with the possibility for longterm , disease-free survival Background Cytoreductive surgery ( CRS ) combined with perioperative intraperitoneal chemotherapy ( PIC ) has been suggested as a treatment strategy for peritoneal carcinomatosis . The objective of this data analysis was to study treatment failure after complete cytoreduction for peritoneal dissemination from appendiceal mucinous neoplasms . Methods Before June 2006 , a total of 402 patients with peritoneal dissemination from appendiceal mucinous neoplasms underwent complete cytoreduction and PIC at the Washington Cancer Institute . Patient characteristics , pathologic features , and treatment-related data were obtained from a prospect i ve data base . Survival analyses were performed by the Kaplan-Meier method and the Cox regression model . Results After a median follow-up of 66 months , the 5- and 10-year progression-free survival rates for these 402 patients were 70 % and 67 % , respectively . Disease progression was the only independent risk factor for a reduced overall survival . One hundred eleven patients ( 28 % ) developed progressive disease . Of these , 98 patients underwent second-time and 26 patients third-time CRS and PIC . Complete cytoreduction after repeat surgery was the only independent prognostic factor for improved survival . The most common sites of treatment failure were on the small bowel and in the pelvis . Conclusions The present study reported the patterns of treatment failure after complete cytoreduction and demonstrated that a disease-free state is important for long-term survival in peritoneal dissemination from appendiceal mucinous neoplasms . Repeat complete cytoreduction should be pursued when possible and is associated with improved overall survival in patients with recurrent disease Background Peritoneal carcinomatosis ( PC ) , which has hitherto been regarded as a lethal entity , can now be cured with surgery ( treating macroscopic tumor seeding ) combined with hyperthermic intraperitoneal chemotherapy ( HIPEC ) ( treating residual microscopic disease ) . The purpose of this study was to analyze the morbidity and mortality of a particular approach associating optimal ( R0–R1 ) cytoreduction , optimal HIPEC combining oxaliplatin and irinotecan , and an optimal homogeneous intraperitoneal temperature of 43 ° C . Methods A total of 106 consecutive patients were included in this prospect i ve phase 2 study . After complete resection of the PC , HIPEC was performed by the Coliseum technique with oxaliplatin ( 360 mg/m2 ) combined with irinotecan ( 360 mg/m2 ) in 2 L/m2 of 5 % dextrose , over 30 minutes at a real intraperitoneal temperature of 43 ° C . During the hour preceding HIPEC , patients received 5-fluorouracil ( 400 mg/m2 ) and leucovorin ( 20 mg/m2 ) intravenously , result ing in tritherapy . Results Postoperative mortality and morbidity rates were 4 % and 66 % , respectively . The most frequent complications were digestive fistula ( 24 % ) , lung infection ( 16 % ) , and severe hematological toxicity ( 11 % ) . Statistical correlation was evidence d between morbidity and the carcinomatosis score ( P = .0008 ) , the number of resected organs ( P = .0001 ) , the duration of surgery ( P = .0001 ) , and blood loss ( P = .0001 ) . Conclusions This new approach , optimized in three respects ( complete cytoreduction , combination oxaliplatin with irinotecan , and high temperature ) has result ed in a relatively high but acceptable incidence of adverse events considering the expected advantage for survival Abstract Background : Hyperthermic intraoperative intraperitoneal chemotherapy ( HIIC ) has been recently proposed to treat peritoneal carcinomatosis arising from colon adenocarcinoma , which is usually regarded as a lethal clinical entity . The purpose of this study was to evaluate the clinical outcome of this combined treatment . Methods : A retrospective study of 46 patients treated for peritoneal carcinomatosis from colon adenocarcinoma was performed . Thirty-four patients were treated with complete cytoreductive surgery immediately followed by intraoperative HIIC with mitomycin C and cisplatin . The clinical outcome of these 34 patients was analyzed ; the median follow-up period was 14.5 months . Results : No postoperative deaths were reported . The postoperative morbidity rate was 35 % . No severe locoregional or systemic toxicity was observed . The 2-year overall survival was 31 % , and the median survival time and the median time to local disease progression were 18 and 13 months , respectively . Survival and local disease control in patients with well- and moderately differentiated colon adenocarcinoma were significantly better than in those with poorly differentiated tumors . Conclusions : Considering the dismal prognosis of this condition , HIIC seems to achieve encouraging results in a selected group of patients affected with resectable peritoneal carcinomatosis arising from colon adenocarcinoma . These findings support the conduction of formal phase III r and omized trials Background Chemohyperthermic peritoneal perfusion ( CHPP ) after extensive cytoreductive surgery is a possible choice as a regional treatment for peritoneal carcinomatosis ( PC ) . The multicentric France EVOCAPE 1 study demonstrated that the median overall survival of patients with colon peritoneal carcinomatosis subjected to conventional surgical and /or chemotherapeutic treatment was 5.2 months . Historically , mitomycin C is the drug of choice in the treatment of intraperitoneal carcinomatosis from colon cancer . Methods Twenty-five patients affected by stage IV colon cancer with only peritoneal involvement and a prior completion of at least a partial first cycle of systemic chemotherapeutic and /or surgical treatment ( 24 patients ) were enrolled . Immediately following extensive cytoreductive surgery , early postoperative closed abdomen CHPP was performed . Results Complete surgical cytoreduction ( CC0–CC1 ) was obtained in 22 patients . Postoperative mortality was 1 out of 25 ( 4 % ) . Major postoperative morbidity was 6 out of 25 ( 24 % ) . Median overall survival estimated by Kaplan – Meier curve was 30.3 months . Locoregional progression-free survival was 17.3 months . Of all the 
    Output:
    