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 The aim of this study was to assess the technical feasibility , efficacy , and complications of CT-guided interstitial brachytherapy for treating inoperable non-small cell lung cancer ( NSCLC ) . MATERIAL S AND METHODS Twenty one patients were included in this prospect i ve study . The median age was 72.6 years ( 57 - 85 ) . Tumors were treated with brachytherapy that was positioned under CT-fluoroscopy . The treatment planning system ( TPS ) was used preoperatively to reconstruct three dimensional images of the tumor and to calculate the estimated seed number and distribution . The median matched peripheral dose ( MPD ) was 130 Gy ( range , 100 - 160 Gy ) . All procedures were performed under local anesthesia . A follow-up CT was performed 6 weeks later and every 3 months post implantation . RESULTS Follow-up period was 2 - 30 months . The mean diameter of the 21 lung tumors was 4.6 cm ( range , 2.8 - 6.5 cm ) . The response rate of pain relief was 83.3 % ( 10/12 ) . The pain-free duration was 0 - 12 months ( median : 6 months ; 95 % CI : 3 - 9 months ) . Overall responding rate ( CR+PR ) for this group of patients was 71.4 % . Local tumor control rate was 85.7 % . Six ( 28.6 % ) patients died as a result of primary tumor progression ; thirteen ( 61.9 % ) patients died of multi-organ failure or other metastases . Two ( 9.5 % ) patients survived to follow-up . At the time of analysis , the median survival time for all patients was 10 months ( 95 % CI : 6.6 - 13.4 months ) , with 1 year and 2 year survival rates were 42.4 % and 6.5 % , respectively . Median survival time for stage II , stage III , and stage IV was 20 months , 9 months , and 8 months , respectively . No major complications were observed . Minor complications ( 19 % ) included mild pneumothorax ( n=1 ) , hemosputum ( n=1 ) , pleural effusion ( n=1 ) , and localized skin erythema ( n=1 ) . None of these complications required further treatment , although hospital discharge was delayed . No (125)I seeds migrated to other tissues or organs . CONCLUSION Minimally invasive CT-guided interstitial brachytherapy is safe , useful , less complicated and considered as a palliative treatment option for inoperable non-small cell lung cancer BACKGROUND Laser debulking and prosthetic stents are useful modalities in the palliative treatment of initial inoperable or recurrent lung cancer . Recently , endobrochial brachytherapy was introduced to extend the duration of palliation and reduce the number of endoscopic treatments . This trial compares Nd-YAG laser alone and associated to high dose rated (HDR)-brachytherapy . PATIENTS AND METHODS From 1995 to 1998 , 29 consecutive patients , with non-small cell lung cancer ( NSCLC ) and central airway involvement , were r and omized in two groups : group 1 ( 15 patients ) received Nd-YAG laser only ;  group 2 ( 14 patients ) underwent a combined Nd-YAG laser/ HDR brachytherapy treatment . RESULTS There was no mortality or morbidity related to the treatment . The period free from symptoms was 2.8 months for group 1 and increased to 8.5 months in group 2 ( P<0.05 ) . The disease 's progression free period grew from 2.2 months of group 1 to 7.5 months of group 2 ( P<0.05 ) and the number of further endoscopic treatment reduced from 15 to 3 ( P<0.05 ) . CONCLUSION The results confirm the potential of brachytherapy to prolong relief from symptoms , lessen disease progression and reduce costs of treatment . A detailed analysis is presented of both groups AIM OF THE STUDY Remote high dose rate brachytherapy is an effective local treatment modality for central lung tumors and has the potential to improve survival time . Optimal dose and fractionation schemes have not been identified yet . We conducted a prospect i ve r and omized study to compare two treatment schedules in terms of survival time , local tumor control , and possible complications . DESIGN Group 1 received 4 brachytherapies with a dose of 3.8 Gy ( at a 10-mm depth ) on a weekly basis , and group 2 received 2 treatments with 7.2 Gy ( at a 10-mm depth ) at a 3-week interval . At a depth of 5 mm , the calculated doses would be 8 and 15 Gy . This study is still ongoing . Here we report interim results . PATIENTS Ninety-three patients with advanced cancer were included in the study ; 44 were in group 1 and 49 , in group 2 . Both groups were comparable regarding age , sex , tumor stage , Karnofsky performance status , and histologic findings . INTERVENTIONS A mean total irradiation dose of 13.4 + /- 5.2 Gy for group 1 and 13.7 + /- 4.4 for group 2 were applied ( calculated at 10 mm from the source axis , equivalent to 27.9 Gy in group 1 and 28.5 Gy in group 2 at a 5-mm depth ) . RESULTS The 1-year survival rate was 11.4 % in group 1 and 20.4 % in group 2 . No significant difference in survival time was found , but mean survival was longer in group 2 ( 49 weeks ) than in group 1 ( 26 weeks ) . Local control after 3 months was comparable in both groups . Fatal hemoptysis occurred at a similar rate in group 1 ( 22.2 % ) and in group 2 ( 21.1 % ) . CONCLUSION High-dose rate brachytherapy with 2 x 7.2 Gy with a 3-week interval is equivalent to a 4 x 3.8-Gy regimen on a weekly basis . The shorter treatment schedule is more convenient for patients , does not cause more side effects , and provides an equal local tumor control PURPOSE To describe a new clinical entity observed in follow-up bronchoscopies in patients who were treated with high dose rate and medium dose rate remote afterloading brachytherapy of the tracheobronchial tree . METHODS AND MATERIAL S Patients treated by protocol with medium dose rate , 47 patients receiving 1000 cGy at a 5 mm depth times three fractions , high dose rate 144 patients receiving 1000 cGy at a 10 mm depth for three fractions and high dose rate 151 patients receiving 750 cGy at a 10 mm depth for three fractions followed by bronchoscopy .  RESULTS Incidence of this entity was 9 % for the first group , 12 % for the second , and 13 % for the third group . Reactions were grade 1 consisting of mild mucosal inflammatory response with a partial whitish circumferential membrane in an asymptomatic patient ; grade 2 , thicker complete white circumferential membrane with cough and /or obstructive problems requiring intervention ; grade 3 , severe inflammatory response with marked membranous exu date and mild fibrotic reaction ; and grade 4 a predominant fibrotic reaction with progressive stenosis . Variables associated with a slightly increased incidence of radiation bronchitis and stenosis included : large cell carcinoma histology , curative intent , prior laser photoresection , and /or concurrent external radiation . Survival was the strongest predictor of the reaction . CONCLUSION Radiation bronchitis and stenosis is a new clinical entity that must be identified in the bronchial brachytherapy patients and treated appropriately BACKGROUND Z4032 was a r and omized study conducted by the American College of Surgeons Oncology Group comparing sublobar resection alone versus sublobar resection with brachytherapy for high-risk operable patients with non-small cell lung cancer ( NSCLC ) . This evaluates early impact of adjuvant brachytherapy on pulmonary function tests , dyspnea , and perioperative ( 30-day ) respiratory complications in this impaired patient population . METHODS Eligible patients with stage I NSCLC tumors 3 cm or smaller were r and omly allocated to undergo sublobar resection with ( SRB group ) or without ( SR group ) brachytherapy . Outcomes measured included the percentage predicted forced expiratory volume in 1 second ( FEV1 % ) , percentage predicted carbon monoxide diffusion capacity ( DLCO% ) , and dyspnea score per the University of California San Diego Shortness of Breath Question naire . Pulmonary morbidity was assessed per the Common Terminology Criteria for Adverse Events version 3.0 . Outcomes were measured at baseline and 3 months . A 10 % change in pulmonary function test or 10-point change in dyspnea score was deemed clinical ly meaningful . RESULTS Z4032 permanently closed to patient accrual in January 2010 at 224 patients . At 3-month follow-up , pulmonary function data are currently available for 148 ( 74 SR and 74 SRB ) patients described in this report . There were no differences in baseline characteristics between arms . In the SR arm , 9 patients ( 12 % ) reported grade 3 respiratory adverse events , compared with 12 ( 16 % ) in the SRB arm ( P = .49 ) . There was no significant change in percentage change in DLCO% or dyspnea score from baseline to 3 months within either arm . In the case of FEV1 % , percentage change from baseline to 3 months was significant within the SR arm ( P = .03 ) , with patients reporting improvement in FEV1 % at month 3 . Multivariable regression analysis ( adjusted for baseline values ) showed no significant impact of treatment arm , tumor location ( upper vs other lobe ) , or surgical approach ( video-assisted thoracoscopic surgery vs thoracotomy ) on 3-month FEV1 % , DLCO% , and dyspnea score . There was no significant difference in incidence of clinical ly meaningful ( 10 % pulmonary function or 10-point dyspnea score change ) change between arms . Twenty-two percent of patients with lower-lobe tumors and 9 % with upper-lobe tumors demonstrated 10 % decline in FEV1 % ( odds ratio , 2.79 ; 95 confidence interval , 1.07 - 7.25 ; P = .04 ) . CONCLUSIONS Adjuvant intraoperative brachytherapy in conjunction with sublobar resection did not significantly worsen pulmonary function or dyspnea at 3 months in a high-risk population with NSCLC , nor was it associated with increased perioperative pulmonary adverse events . Lower-lobe resection was the only factor significantly associated with clinical ly meaningful decline in FEV1 % OBJECTIVE Sublobar resection ( SR ) is commonly used for patients considered high risk for lobectomy . Nonoperative therapies are increasingly being reported for patients with similar risk because of perceived lower morbidity . We report 30- and 90-day adverse events ( AEs ) from American College of Surgeons Oncology Group Z4032 , a multicenter phase III study for high-risk patients with stage I non-small cell lung cancer . METHODS Data from 222 evaluable patients r and omized to SR ( n = 114 ) or SR with brachytherapy ( n = 108 ) are reported . AEs were recorded using the Common Terminology Criteria for Adverse Events , Version 3.0 , at 30 and 90 days after surgery . Risk factors ( age , percent baseline carbon monoxide diffusion in the lung [ DLCO% ] , percent forced expiratory volume in 1 second [ FEV1 % ] , upper lobe vs lower lobe resections , performance status , surgery approach , video-assisted thoracic surgery vs open and extent , and wedge vs segmentectomy ) were analyzed using a multivariable logistic model for their impact on the incidence of grade 3 or higher ( G3 + ) AEs . Respiratory AEs were also specifically analyzed . RESULTS Median age , FEV1 % , and DLCO% were similar in the 2 treatment groups . There was no difference in the location of resection ( upper vs lower lobe ) or the use of segmental or wedge resections . There were no differences between the groups with respect to " respiratory " G3 + AEs ( 30 days : 14.9 % vs 19.4 % , P = .35 ; 0 - 90 days : 19.3 % vs 25 % , P = .31 ) and " any " G3 + AEs ( 30 days : 25.4 % vs 30.6 % , P = .37 ; 0 - 90 days : 29.8 % vs 37 % , P = .25 ) . Further analysis combined the 2 groups . Mortality occurred in 3 patients ( 1.4 % ) by 30 days and in 6 patients ( 2.7 % ) by 90 days . Four of the 6 deaths were thought to be due to surgery . When considered as continuous variables , FEV1 % was associated with " any " G3 + AE at days 0 to 30 ( P = .03 ; odds ratio [ OR ] = 0.98 ) and days 0 to 90 ( P = .05 ; OR = 0.98 ) , and DLCO% was associated with " respiratory " G3 + AE at days 0 to 30 ( P = .03 ; OR = 0.97 ) and days 0 to 90 ( P = .05 ; OR = 0.98 ) . Segmental resection was associated with a higher incidence of any G3 + A 
    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 The aim of this study was to assess the technical feasibility , efficacy , and complications of CT-guided interstitial brachytherapy for treating inoperable non-small cell lung cancer ( NSCLC ) . MATERIAL S AND METHODS Twenty one patients were included in this prospect i ve study . The median age was 72.6 years ( 57 - 85 ) . Tumors were treated with brachytherapy that was positioned under CT-fluoroscopy . The treatment planning system ( TPS ) was used preoperatively to reconstruct three dimensional images of the tumor and to calculate the estimated seed number and distribution . The median matched peripheral dose ( MPD ) was 130 Gy ( range , 100 - 160 Gy ) . All procedures were performed under local anesthesia . A follow-up CT was performed 6 weeks later and every 3 months post implantation . RESULTS Follow-up period was 2 - 30 months . The mean diameter of the 21 lung tumors was 4.6 cm ( range , 2.8 - 6.5 cm ) . The response rate of pain relief was 83.3 % ( 10/12 ) . The pain-free duration was 0 - 12 months ( median : 6 months ; 95 % CI : 3 - 9 months ) . Overall responding rate ( CR+PR ) for this group of patients was 71.4 % . Local tumor control rate was 85.7 % . Six ( 28.6 % ) patients died as a result of primary tumor progression ; thirteen ( 61.9 % ) patients died of multi-organ failure or other metastases . Two ( 9.5 % ) patients survived to follow-up . At the time of analysis , the median survival time for all patients was 10 months ( 95 % CI : 6.6 - 13.4 months ) , with 1 year and 2 year survival rates were 42.4 % and 6.5 % , respectively . Median survival time for stage II , stage III , and stage IV was 20 months , 9 months , and 8 months , respectively . No major complications were observed . Minor complications ( 19 % ) included mild pneumothorax ( n=1 ) , hemosputum ( n=1 ) , pleural effusion ( n=1 ) , and localized skin erythema ( n=1 ) . None of these complications required further treatment , although hospital discharge was delayed . No (125)I seeds migrated to other tissues or organs . CONCLUSION Minimally invasive CT-guided interstitial brachytherapy is safe , useful , less complicated and considered as a palliative treatment option for inoperable non-small cell lung cancer BACKGROUND Laser debulking and prosthetic stents are useful modalities in the palliative treatment of initial inoperable or recurrent lung cancer . Recently , endobrochial brachytherapy was introduced to extend the duration of palliation and reduce the number of endoscopic treatments . This trial compares Nd-YAG laser alone and associated to high dose rated (HDR)-brachytherapy . PATIENTS AND METHODS From 1995 to 1998 , 29 consecutive patients , with non-small cell lung cancer ( NSCLC ) and central airway involvement , were r and omized in two groups : group 1 ( 15 patients ) received Nd-YAG laser only ;  group 2 ( 14 patients ) underwent a combined Nd-YAG laser/ HDR brachytherapy treatment . RESULTS There was no mortality or morbidity related to the treatment . The period free from symptoms was 2.8 months for group 1 and increased to 8.5 months in group 2 ( P<0.05 ) . The disease 's progression free period grew from 2.2 months of group 1 to 7.5 months of group 2 ( P<0.05 ) and the number of further endoscopic treatment reduced from 15 to 3 ( P<0.05 ) . CONCLUSION The results confirm the potential of brachytherapy to prolong relief from symptoms , lessen disease progression and reduce costs of treatment . A detailed analysis is presented of both groups AIM OF THE STUDY Remote high dose rate brachytherapy is an effective local treatment modality for central lung tumors and has the potential to improve survival time . Optimal dose and fractionation schemes have not been identified yet . We conducted a prospect i ve r and omized study to compare two treatment schedules in terms of survival time , local tumor control , and possible complications . DESIGN Group 1 received 4 brachytherapies with a dose of 3.8 Gy ( at a 10-mm depth ) on a weekly basis , and group 2 received 2 treatments with 7.2 Gy ( at a 10-mm depth ) at a 3-week interval . At a depth of 5 mm , the calculated doses would be 8 and 15 Gy . This study is still ongoing . Here we report interim results . PATIENTS Ninety-three patients with advanced cancer were included in the study ; 44 were in group 1 and 49 , in group 2 . Both groups were comparable regarding age , sex , tumor stage , Karnofsky performance status , and histologic findings . INTERVENTIONS A mean total irradiation dose of 13.4 + /- 5.2 Gy for group 1 and 13.7 + /- 4.4 for group 2 were applied ( calculated at 10 mm from the source axis , equivalent to 27.9 Gy in group 1 and 28.5 Gy in group 2 at a 5-mm depth ) . RESULTS The 1-year survival rate was 11.4 % in group 1 and 20.4 % in group 2 . No significant difference in survival time was found , but mean survival was longer in group 2 ( 49 weeks ) than in group 1 ( 26 weeks ) . Local control after 3 months was comparable in both groups . Fatal hemoptysis occurred at a similar rate in group 1 ( 22.2 % ) and in group 2 ( 21.1 % ) . CONCLUSION High-dose rate brachytherapy with 2 x 7.2 Gy with a 3-week interval is equivalent to a 4 x 3.8-Gy regimen on a weekly basis . The shorter treatment schedule is more convenient for patients , does not cause more side effects , and provides an equal local tumor control PURPOSE To describe a new clinical entity observed in follow-up bronchoscopies in patients who were treated with high dose rate and medium dose rate remote afterloading brachytherapy of the tracheobronchial tree . METHODS AND MATERIAL S Patients treated by protocol with medium dose rate , 47 patients receiving 1000 cGy at a 5 mm depth times three fractions , high dose rate 144 patients receiving 1000 cGy at a 10 mm depth for three fractions and high dose rate 151 patients receiving 750 cGy at a 10 mm depth for three fractions followed by bronchoscopy .  RESULTS Incidence of this entity was 9 % for the first group , 12 % for the second , and 13 % for the third group . Reactions were grade 1 consisting of mild mucosal inflammatory response with a partial whitish circumferential membrane in an asymptomatic patient ; grade 2 , thicker complete white circumferential membrane with cough and /or obstructive problems requiring intervention ; grade 3 , severe inflammatory response with marked membranous exu date and mild fibrotic reaction ; and grade 4 a predominant fibrotic reaction with progressive stenosis . Variables associated with a slightly increased incidence of radiation bronchitis and stenosis included : large cell carcinoma histology , curative intent , prior laser photoresection , and /or concurrent external radiation . Survival was the strongest predictor of the reaction . CONCLUSION Radiation bronchitis and stenosis is a new clinical entity that must be identified in the bronchial brachytherapy patients and treated appropriately BACKGROUND Z4032 was a r and omized study conducted by the American College of Surgeons Oncology Group comparing sublobar resection alone versus sublobar resection with brachytherapy for high-risk operable patients with non-small cell lung cancer ( NSCLC ) . This evaluates early impact of adjuvant brachytherapy on pulmonary function tests , dyspnea , and perioperative ( 30-day ) respiratory complications in this impaired patient population . METHODS Eligible patients with stage I NSCLC tumors 3 cm or smaller were r and omly allocated to undergo sublobar resection with ( SRB group ) or without ( SR group ) brachytherapy . Outcomes measured included the percentage predicted forced expiratory volume in 1 second ( FEV1 % ) , percentage predicted carbon monoxide diffusion capacity ( DLCO% ) , and dyspnea score per the University of California San Diego Shortness of Breath Question naire . Pulmonary morbidity was assessed per the Common Terminology Criteria for Adverse Events version 3.0 . Outcomes were measured at baseline and 3 months . A 10 % change in pulmonary function test or 10-point change in dyspnea score was deemed clinical ly meaningful . RESULTS Z4032 permanently closed to patient accrual in January 2010 at 224 patients . At 3-month follow-up , pulmonary function data are currently available for 148 ( 74 SR and 74 SRB ) patients described in this report . There were no differences in baseline characteristics between arms . In the SR arm , 9 patients ( 12 % ) reported grade 3 respiratory adverse events , compared with 12 ( 16 % ) in the SRB arm ( P = .49 ) . There was no significant change in percentage change in DLCO% or dyspnea score from baseline to 3 months within either arm . In the case of FEV1 % , percentage change from baseline to 3 months was significant within the SR arm ( P = .03 ) , with patients reporting improvement in FEV1 % at month 3 . Multivariable regression analysis ( adjusted for baseline values ) showed no significant impact of treatment arm , tumor location ( upper vs other lobe ) , or surgical approach ( video-assisted thoracoscopic surgery vs thoracotomy ) on 3-month FEV1 % , DLCO% , and dyspnea score . There was no significant difference in incidence of clinical ly meaningful ( 10 % pulmonary function or 10-point dyspnea score change ) change between arms . Twenty-two percent of patients with lower-lobe tumors and 9 % with upper-lobe tumors demonstrated 10 % decline in FEV1 % ( odds ratio , 2.79 ; 95 confidence interval , 1.07 - 7.25 ; P = .04 ) . CONCLUSIONS Adjuvant intraoperative brachytherapy in conjunction with sublobar resection did not significantly worsen pulmonary function or dyspnea at 3 months in a high-risk population with NSCLC , nor was it associated with increased perioperative pulmonary adverse events . Lower-lobe resection was the only factor significantly associated with clinical ly meaningful decline in FEV1 % OBJECTIVE Sublobar resection ( SR ) is commonly used for patients considered high risk for lobectomy . Nonoperative therapies are increasingly being reported for patients with similar risk because of perceived lower morbidity . We report 30- and 90-day adverse events ( AEs ) from American College of Surgeons Oncology Group Z4032 , a multicenter phase III study for high-risk patients with stage I non-small cell lung cancer . METHODS Data from 222 evaluable patients r and omized to SR ( n = 114 ) or SR with brachytherapy ( n = 108 ) are reported . AEs were recorded using the Common Terminology Criteria for Adverse Events , Version 3.0 , at 30 and 90 days after surgery . Risk factors ( age , percent baseline carbon monoxide diffusion in the lung [ DLCO% ] , percent forced expiratory volume in 1 second [ FEV1 % ] , upper lobe vs lower lobe resections , performance status , surgery approach , video-assisted thoracic surgery vs open and extent , and wedge vs segmentectomy ) were analyzed using a multivariable logistic model for their impact on the incidence of grade 3 or higher ( G3 + ) AEs . Respiratory AEs were also specifically analyzed . RESULTS Median age , FEV1 % , and DLCO% were similar in the 2 treatment groups . There was no difference in the location of resection ( upper vs lower lobe ) or the use of segmental or wedge resections . There were no differences between the groups with respect to " respiratory " G3 + AEs ( 30 days : 14.9 % vs 19.4 % , P = .35 ; 0 - 90 days : 19.3 % vs 25 % , P = .31 ) and " any " G3 + AEs ( 30 days : 25.4 % vs 30.6 % , P = .37 ; 0 - 90 days : 29.8 % vs 37 % , P = .25 ) . Further analysis combined the 2 groups . Mortality occurred in 3 patients ( 1.4 % ) by 30 days and in 6 patients ( 2.7 % ) by 90 days . Four of the 6 deaths were thought to be due to surgery . When considered as continuous variables , FEV1 % was associated with " any " G3 + AE at days 0 to 30 ( P = .03 ; odds ratio [ OR ] = 0.98 ) and days 0 to 90 ( P = .05 ; OR = 0.98 ) , and DLCO% was associated with " respiratory " G3 + AE at days 0 to 30 ( P = .03 ; OR = 0.97 ) and days 0 to 90 ( P = .05 ; OR = 0.98 ) . Segmental resection was associated with a higher incidence of any G3 + A 
    Output:
    