human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Combined treatment involving peritonectomy procedures , multivisceral resections , and hyperthermic intraperitoneal chemotherapy ( HIPEC ) has reportedly result ed in survival benefit for peritoneal surface malignancies , including diffuse malignant peritoneal mesothelioma ( DMPM ) . Many unanswered questions remain regarding the surgical options in the management of DMPM . The aim of this case – control study was to assess the impact of the type and extent of parietal peritonectomy on survival and operative outcomes . Methods Thirty patients with DMPM undergoing selective parietal peritonectomy ( SPP ) of macroscopically involved regions , and 30 matched patients undergoing routine complete parietal peritonectomy ( CPP ) , regardless of disease distribution , were retrospectively identified from a prospect i ve data base . Results Groups were comparable for all characteristics , except for a higher proportion of patients treated before July 2003 and undergoing preoperative systemic chemotherapy in the SPP group . Median follow-up was 86.2 months in the SPP group and 50.3 months in the CPP group . Median overall survival was 29.6 months in the SPP group and not reached in the CPP group ; 5-year overall survival was 40.0 % and 63.9 % , respectively ( P = 0.0269 ) . At multivariate analysis , CPP versus SPP was recognized as an independent predictor of better prognosis , along with complete cytoreduction , negative lymph nodes , epithelial histology , and lower MIB-1 labelling index . Morbidity and reoperation rates were not different between groups . No operative mortality occurred . In 12 of 24 patients undergoing CPP , pathologic examination detected disease involvement on parietal surfaces with no evident tumor at surgical exploration . Conclusions CPP improved survival in patients with DMPM undergoing combined treatment . This information may contribute to st and ardize surgical options for DMPM and other peritoneal malignancies BACKGROUND To date , few large studies have been reported of patients with peritoneal mesothelioma , and treatment of this disease has been largely extrapolated from the treatment of pleural disease . Hence , it was considered important to study and report on this specific patient population . Before the regulatory approval of pemetrexed , an exp and ed access program ( EAP ) provided access to eligible patients with malignant pleural or peritoneal mesothelioma . PATIENTS AND METHODS Patients received pemetrexed 500 mg/m2 alone or in combination with cisplatin 75 mg/m2 once every 21 days for > or = 6 cycles . All patients received folic acid , vitamin B12 , and steroid prophylaxis .  Serious adverse events ( SAEs ) were compiled in a pharmacovigilance data base , which included all patients in the EAP with pleural or peritoneal mesothelioma . From June 12 , 2002 to February 18 , 2004 , 1056 patients with malignant mesothelioma were enrolled and received > or = 1 dose of treatment at 462 sites in the United States . Of these patients , 98 ( 9.3 % ) had peritoneal mesothelioma ( 57 previously treated , 38 chemotherapy-naive , and 3 with missing data ) . RESULTS Response data were available for 73 patients ( 43 previously treated , 28 chemotherapy-naive , and 2 not classified ) , indicating response rates of 23.3 % for previously treated patients ( 0 complete responses [ CRs ] , 10 partial responses [ PRs ] , 21 cases of stable disease [ SDs ] , 12 cases of progressive disease [ PDs ] ) and 25 % for chemotherapy-naive patients ( 3 CRs , 4 PRs , 12 SDs , and 9 PDs ) . Median survival was 13.1 months for previously treated patients and has not been reached for chemotherapy-naive patients . The most commonly reported SAEs for the total EAP were dehydration ( 7.2 % ) , nausea ( 5.2 % ) , and vomiting ( 4.9 % ) . CONCLUSION Pemetrexed with or without cisplatin had a favorable safety profile , and the disease control rate ( CR + PR + SD ) of 71.2 % in the subset of patients with peritoneal mesothelioma indicated activity in this patient population Background Peritoneal mesothelioma is a rare disease with few therapeutic options . Recently , the combination of cytoreductive surgery with intraperitoneal hyperthermic chemotherapy ( HIPEC ) has shown promising results . Methods Fifteen patients with peritoneal mesothelioma who were treated by cytoreductive surgery and HIPEC between 1989 and 2004 were identified from a prospect i ve data base .  HIPEC was performed with cisplatin and mitomycin C for 90 minutes by using the closed-abdomen technique . Results All patients but one ( multicystic ) had malignant disease of the following pathologic types : 12 epithelial and 2 biphasic . After surgical resection , 11 patients were considered to have a CC-0 or CC-1 resection ( macroscopic complete resection or diameter of residual nodules < 2.5 mm ) . No postoperative death occurred , and six postoperative complications were recorded . All but one patient had resolution of ascites . The overall median survival for the 14 patients with malignant mesothelioma was 35.6 months . The median survival was 37.8 months for patients treated with a CC-0 or CC-1 resection , whereas it was 6.5 months for those treated with a CC-2 or CC-3 resection ( diameter of residual nodules > 2.5 mm ; P < .001 ) . In a univariate analysis , the only other significant prognostic factor was the carcinomatosis extent ( P = .02 ) . Conclusions A therapeutic strategy combining cytoreductive surgery with HIPEC seems to provide an adequate and efficient locoregional treatment for peritoneal mesothelioma . It is associated with acceptable morbidity when performed by an experienced surgical team . The completeness of cytoreduction is the major determinant of survival Background Although many reports regarding morbidity and mortality of cytoreductive surgery plus perioperative intraperitoneal chemotherapy are available , there are no prospect i ve data on morbidity and mortality limited to patients with diffuse malignant peritoneal mesothelioma ( DMPM ) . Methods This prospect i ve morbidity and mortality assessment was performed on 70 consecutive cytoreductive procedures with perioperative intraperitoneal chemotherapy for DMPM . Forty-seven adverse events by eight categories were rated from grade s I to IV with increasing severity . Grade I morbidity was self-limiting ; grade II required medical treatments ; grade III required an invasive intervention ; grade IV required returning to the operating room or intensive care management . Risk factors for grade s III and IV morbidity were determined . Results The perioperative mortality rate was 3 % . The grade s III and IV morbidity rates were 27 and 14 % , respectively . Primary colonic anastomosis ( P = 0.028 ) , more than four peritonectomy procedures ( P = 0.015 ) , duration of the operation of more than 7 h ( P = 0.027 ) were the risk factors for grade IV morbidity . Survival analysis of these 70 patients was provided . Conclusions The morbidity and mortality results for cytoreductive surgery and perioperative intraperitoneal chemotherapy for patients with DMPM were within the acceptable range for major gastrointestinal surgery . Grade IV morbidity was associated with more extensive cytoreduction Abstract Background : Primary peritoneal mesothelioma is a locally aggressive disease that is difficult to treat or even palliate . Continuous hyperthermic peritoneal perfusion ( CHPP ) with cisplatin ( CDDP ) allows uniform , high regional delivery of chemotherapeutics and hyperthermia to the peritoneal surface for the treatment of peritoneal tumors . This article summarizes the results of 18 patients with peritoneal mesothelioma treated with CHPP . Methods : From June 1993 through April 1998 , 18 patients with primary peritoneal mesothelioma ( 13 male , 5 female ; median age , 51 years ) underwent surgical exploration and tumor debulking followed by a 90-minute CHPP with CDDP and hyperthermia as part of three consecutive phase I trials conducted at the National Cancer Institute . Seventeen of 18 patients had malignant peritoneal mesothelioma , 13 with associated ascites . One patient had a symptomatic , multiply recurrent , benign , cystic peritoneal mesothelioma . Three patients who had a recurrence after a prolonged progression-free interval ( > 6 months ) after CHPP underwent re-treatment . CHPP parameters included median cisplatin dose of 530 mg ( range , 187–816 ) , perfusate volume 6.0 liter ( range , 4–9 ) , flow 1.5 liter/min ( range , 1–2 ) , intraperitoneal temperature 41 ° C ( range , 38.7–43.2 ) , and central temperature 38.6 ° C ( range , 36.8–39.7 ) . Results : Median follow-up after CHPP is 19 months ( range , 2–56 ) with no operative or treatment-related mortality . Overall operative morbidity was 24 % and included two patients with superficial wound infection and one patient each with atrial fibrillation , pancreatitis , fascial dehiscence , ileus , line sepsis , and clostridium difficile colitis . The major treatment-related toxicity was systemic renal toxicity at doses above what was defined as the maximum tolerated dose of cisplatin . Nine of 10 patients had resolution of their ascites postoperatively . Three patients who developed recurrent ascites ( 27 , 22 , and 10 months after initial treatment ) were re-treated and had resolution of their ascites with ongoing responses at 24 , 6 , and 4 months after the second perfusion . The median progression-free survival was 26 months , and the overall 2-year survival was 80 % . The median overall survival has not been reached . Conclusions : CHPP with cisplatin can be performed safely with no mortality and minimal morbidity . In selected patients , successful palliation in the abdomen and long-term survival , compared with historical controls , can be achieved with aggressive surgical debulking and CHPP . Re-treatment after initial response can result in a second long-term response Background Inducing oxidative stress under hyperthermic conditions significantly decreases tumor cell growth in a murine model of human colon cancer carcinomatosis . This phase I study examines the safety and pharmacokinetics of induced oxidative stress by the addition of hydrogen peroxide ( H2O2 ) to the perfusate in patients undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy ( HIPEC ) for advanced abdominal-only malignancies . Methods Patients with advanced colon or appendiceal malignancies underwent maximal cytoreduction followed by HIPEC with mitomycin C ( MMC ) . In addition , H2O2 was added to the perfusate at three concentrations ( n = 3/level , 0.05 , 0.075 , 0.1 % ) . A control group consisted of patients perfused with MMC alone ( n = 3 ) . Perfusate , serum MMC , and H2O2 levels were measured , as were tissue levels of MMC . Results Twelve patients were enrolled onto this trial . The median ( range ) peritoneal carcinomatosis index was 13 ( 3–20 ) requiring a median operative time of 6.3 ( 4–8.5 ) h. The median postoperative length of stay was 9 ( 5–34 ) days , with six patients requiring readmission within 30 days . Similar complications were observed at all three H2O2 levels , as well as in the control group . One patient required reexploration for a colon perforation ( control group ) , and three patients developed enterocutaneous fistulas ( 0.075 % H2O2 , 0.1 % H2O2 and control group ) . There were no operative mortalities . Conclusions Hyperthermic intraperitoneal chemotherapy with induced oxidative stress after maximal cytoreduction is well tolerated . On the basis of the encouraging toxicity profile after cytoreduction and HIPEC with induced oxidative stress , a phase II trial to verify activity is indicated PURPOSE Peritoneal mesothelioma remains a difficult therapeutic challenge . Aggressive debulking combined with continuous hyperthermic peritoneal perfusion ( CHPP ) using cisplatin ( CDDP ) is a novel strategy for the treatment of peritoneal mesothelioma , allowing high regional delivery of chemotherapeutics and hyperthermia while minimizing systemic toxicity . PATIENTS AND METHODS From June 1993 to May 1996 , 10 patients with peritoneal mesothelioma ( six men , four women ; mean age 40 years , range 15 - 57 ) underwent tumor debulking followed by a 90-minute CHPP . CHPP parameters included mean initial CDDP of 120 micrograms/mL ( range 81 - 166 ) , perfusate volume 5.2 L ( range 4 - 7 ) , flow 1.5 L/min , intraperitoneal temperature at three locations-41.5 degrees C , 40.5 degrees C ,  
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Combined treatment involving peritonectomy procedures , multivisceral resections , and hyperthermic intraperitoneal chemotherapy ( HIPEC ) has reportedly result ed in survival benefit for peritoneal surface malignancies , including diffuse malignant peritoneal mesothelioma ( DMPM ) . Many unanswered questions remain regarding the surgical options in the management of DMPM . The aim of this case – control study was to assess the impact of the type and extent of parietal peritonectomy on survival and operative outcomes . Methods Thirty patients with DMPM undergoing selective parietal peritonectomy ( SPP ) of macroscopically involved regions , and 30 matched patients undergoing routine complete parietal peritonectomy ( CPP ) , regardless of disease distribution , were retrospectively identified from a prospect i ve data base . Results Groups were comparable for all characteristics , except for a higher proportion of patients treated before July 2003 and undergoing preoperative systemic chemotherapy in the SPP group . Median follow-up was 86.2 months in the SPP group and 50.3 months in the CPP group . Median overall survival was 29.6 months in the SPP group and not reached in the CPP group ; 5-year overall survival was 40.0 % and 63.9 % , respectively ( P = 0.0269 ) . At multivariate analysis , CPP versus SPP was recognized as an independent predictor of better prognosis , along with complete cytoreduction , negative lymph nodes , epithelial histology , and lower MIB-1 labelling index . Morbidity and reoperation rates were not different between groups . No operative mortality occurred . In 12 of 24 patients undergoing CPP , pathologic examination detected disease involvement on parietal surfaces with no evident tumor at surgical exploration . Conclusions CPP improved survival in patients with DMPM undergoing combined treatment . This information may contribute to st and ardize surgical options for DMPM and other peritoneal malignancies BACKGROUND To date , few large studies have been reported of patients with peritoneal mesothelioma , and treatment of this disease has been largely extrapolated from the treatment of pleural disease . Hence , it was considered important to study and report on this specific patient population . Before the regulatory approval of pemetrexed , an exp and ed access program ( EAP ) provided access to eligible patients with malignant pleural or peritoneal mesothelioma . PATIENTS AND METHODS Patients received pemetrexed 500 mg/m2 alone or in combination with cisplatin 75 mg/m2 once every 21 days for > or = 6 cycles . All patients received folic acid , vitamin B12 , and steroid prophylaxis .  Serious adverse events ( SAEs ) were compiled in a pharmacovigilance data base , which included all patients in the EAP with pleural or peritoneal mesothelioma . From June 12 , 2002 to February 18 , 2004 , 1056 patients with malignant mesothelioma were enrolled and received > or = 1 dose of treatment at 462 sites in the United States . Of these patients , 98 ( 9.3 % ) had peritoneal mesothelioma ( 57 previously treated , 38 chemotherapy-naive , and 3 with missing data ) . RESULTS Response data were available for 73 patients ( 43 previously treated , 28 chemotherapy-naive , and 2 not classified ) , indicating response rates of 23.3 % for previously treated patients ( 0 complete responses [ CRs ] , 10 partial responses [ PRs ] , 21 cases of stable disease [ SDs ] , 12 cases of progressive disease [ PDs ] ) and 25 % for chemotherapy-naive patients ( 3 CRs , 4 PRs , 12 SDs , and 9 PDs ) . Median survival was 13.1 months for previously treated patients and has not been reached for chemotherapy-naive patients . The most commonly reported SAEs for the total EAP were dehydration ( 7.2 % ) , nausea ( 5.2 % ) , and vomiting ( 4.9 % ) . CONCLUSION Pemetrexed with or without cisplatin had a favorable safety profile , and the disease control rate ( CR + PR + SD ) of 71.2 % in the subset of patients with peritoneal mesothelioma indicated activity in this patient population Background Peritoneal mesothelioma is a rare disease with few therapeutic options . Recently , the combination of cytoreductive surgery with intraperitoneal hyperthermic chemotherapy ( HIPEC ) has shown promising results . Methods Fifteen patients with peritoneal mesothelioma who were treated by cytoreductive surgery and HIPEC between 1989 and 2004 were identified from a prospect i ve data base .  HIPEC was performed with cisplatin and mitomycin C for 90 minutes by using the closed-abdomen technique . Results All patients but one ( multicystic ) had malignant disease of the following pathologic types : 12 epithelial and 2 biphasic . After surgical resection , 11 patients were considered to have a CC-0 or CC-1 resection ( macroscopic complete resection or diameter of residual nodules < 2.5 mm ) . No postoperative death occurred , and six postoperative complications were recorded . All but one patient had resolution of ascites . The overall median survival for the 14 patients with malignant mesothelioma was 35.6 months . The median survival was 37.8 months for patients treated with a CC-0 or CC-1 resection , whereas it was 6.5 months for those treated with a CC-2 or CC-3 resection ( diameter of residual nodules > 2.5 mm ; P < .001 ) . In a univariate analysis , the only other significant prognostic factor was the carcinomatosis extent ( P = .02 ) . Conclusions A therapeutic strategy combining cytoreductive surgery with HIPEC seems to provide an adequate and efficient locoregional treatment for peritoneal mesothelioma . It is associated with acceptable morbidity when performed by an experienced surgical team . The completeness of cytoreduction is the major determinant of survival Background Although many reports regarding morbidity and mortality of cytoreductive surgery plus perioperative intraperitoneal chemotherapy are available , there are no prospect i ve data on morbidity and mortality limited to patients with diffuse malignant peritoneal mesothelioma ( DMPM ) . Methods This prospect i ve morbidity and mortality assessment was performed on 70 consecutive cytoreductive procedures with perioperative intraperitoneal chemotherapy for DMPM . Forty-seven adverse events by eight categories were rated from grade s I to IV with increasing severity . Grade I morbidity was self-limiting ; grade II required medical treatments ; grade III required an invasive intervention ; grade IV required returning to the operating room or intensive care management . Risk factors for grade s III and IV morbidity were determined . Results The perioperative mortality rate was 3 % . The grade s III and IV morbidity rates were 27 and 14 % , respectively . Primary colonic anastomosis ( P = 0.028 ) , more than four peritonectomy procedures ( P = 0.015 ) , duration of the operation of more than 7 h ( P = 0.027 ) were the risk factors for grade IV morbidity . Survival analysis of these 70 patients was provided . Conclusions The morbidity and mortality results for cytoreductive surgery and perioperative intraperitoneal chemotherapy for patients with DMPM were within the acceptable range for major gastrointestinal surgery . Grade IV morbidity was associated with more extensive cytoreduction Abstract Background : Primary peritoneal mesothelioma is a locally aggressive disease that is difficult to treat or even palliate . Continuous hyperthermic peritoneal perfusion ( CHPP ) with cisplatin ( CDDP ) allows uniform , high regional delivery of chemotherapeutics and hyperthermia to the peritoneal surface for the treatment of peritoneal tumors . This article summarizes the results of 18 patients with peritoneal mesothelioma treated with CHPP . Methods : From June 1993 through April 1998 , 18 patients with primary peritoneal mesothelioma ( 13 male , 5 female ; median age , 51 years ) underwent surgical exploration and tumor debulking followed by a 90-minute CHPP with CDDP and hyperthermia as part of three consecutive phase I trials conducted at the National Cancer Institute . Seventeen of 18 patients had malignant peritoneal mesothelioma , 13 with associated ascites . One patient had a symptomatic , multiply recurrent , benign , cystic peritoneal mesothelioma . Three patients who had a recurrence after a prolonged progression-free interval ( > 6 months ) after CHPP underwent re-treatment . CHPP parameters included median cisplatin dose of 530 mg ( range , 187–816 ) , perfusate volume 6.0 liter ( range , 4–9 ) , flow 1.5 liter/min ( range , 1–2 ) , intraperitoneal temperature 41 ° C ( range , 38.7–43.2 ) , and central temperature 38.6 ° C ( range , 36.8–39.7 ) . Results : Median follow-up after CHPP is 19 months ( range , 2–56 ) with no operative or treatment-related mortality . Overall operative morbidity was 24 % and included two patients with superficial wound infection and one patient each with atrial fibrillation , pancreatitis , fascial dehiscence , ileus , line sepsis , and clostridium difficile colitis . The major treatment-related toxicity was systemic renal toxicity at doses above what was defined as the maximum tolerated dose of cisplatin . Nine of 10 patients had resolution of their ascites postoperatively . Three patients who developed recurrent ascites ( 27 , 22 , and 10 months after initial treatment ) were re-treated and had resolution of their ascites with ongoing responses at 24 , 6 , and 4 months after the second perfusion . The median progression-free survival was 26 months , and the overall 2-year survival was 80 % . The median overall survival has not been reached . Conclusions : CHPP with cisplatin can be performed safely with no mortality and minimal morbidity . In selected patients , successful palliation in the abdomen and long-term survival , compared with historical controls , can be achieved with aggressive surgical debulking and CHPP . Re-treatment after initial response can result in a second long-term response Background Inducing oxidative stress under hyperthermic conditions significantly decreases tumor cell growth in a murine model of human colon cancer carcinomatosis . This phase I study examines the safety and pharmacokinetics of induced oxidative stress by the addition of hydrogen peroxide ( H2O2 ) to the perfusate in patients undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy ( HIPEC ) for advanced abdominal-only malignancies . Methods Patients with advanced colon or appendiceal malignancies underwent maximal cytoreduction followed by HIPEC with mitomycin C ( MMC ) . In addition , H2O2 was added to the perfusate at three concentrations ( n = 3/level , 0.05 , 0.075 , 0.1 % ) . A control group consisted of patients perfused with MMC alone ( n = 3 ) . Perfusate , serum MMC , and H2O2 levels were measured , as were tissue levels of MMC . Results Twelve patients were enrolled onto this trial . The median ( range ) peritoneal carcinomatosis index was 13 ( 3–20 ) requiring a median operative time of 6.3 ( 4–8.5 ) h. The median postoperative length of stay was 9 ( 5–34 ) days , with six patients requiring readmission within 30 days . Similar complications were observed at all three H2O2 levels , as well as in the control group . One patient required reexploration for a colon perforation ( control group ) , and three patients developed enterocutaneous fistulas ( 0.075 % H2O2 , 0.1 % H2O2 and control group ) . There were no operative mortalities . Conclusions Hyperthermic intraperitoneal chemotherapy with induced oxidative stress after maximal cytoreduction is well tolerated . On the basis of the encouraging toxicity profile after cytoreduction and HIPEC with induced oxidative stress , a phase II trial to verify activity is indicated PURPOSE Peritoneal mesothelioma remains a difficult therapeutic challenge . Aggressive debulking combined with continuous hyperthermic peritoneal perfusion ( CHPP ) using cisplatin ( CDDP ) is a novel strategy for the treatment of peritoneal mesothelioma , allowing high regional delivery of chemotherapeutics and hyperthermia while minimizing systemic toxicity . PATIENTS AND METHODS From June 1993 to May 1996 , 10 patients with peritoneal mesothelioma ( six men , four women ; mean age 40 years , range 15 - 57 ) underwent tumor debulking followed by a 90-minute CHPP . CHPP parameters included mean initial CDDP of 120 micrograms/mL ( range 81 - 166 ) , perfusate volume 5.2 L ( range 4 - 7 ) , flow 1.5 L/min , intraperitoneal temperature at three locations-41.5 degrees C , 40.5 degrees C ,  
    Output:
    