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 OEO2 is a r and omized , controlled trial of preoperative chemotherapy in patients undergoing radical surgery for esophageal cancer . R and om assignment was to surgery alone ( S ) or to two cycles of combination cisplatin and fluorouracil before surgery ( CS ) . Initial results reported in 2002 demonstrated an advantage for both disease-free and overall survival in the CS group . The analysis has now been up date d after a median follow-up of 6 years . PATIENTS AND METHODS OEO2 recruited 802 patients , 400 on CS and 402 on S. The nature of the first recurrence event and cause of death are detailed . Survival has been determined from Kaplan-Meier curves and treatment comparisons made with the log-rank test . Survival by extent of resection is presented . RESULTS There were 655 deaths , 335 for S and 320 for CS . The survival benefit has been maintained with a hazard ratio ( HR ) of 0.84 ( 95 % CI , 0.72 to 0.98 ; P = .03 ) which in absolute terms is a 5-year survival of 23.0 % for CS compared with 17.1 % for S. The treatment effect is consistent in both adenocarcinoma and squamous cell carcinoma . The first disease-free survival event was macroscopic residual disease from incomplete resection ( R2 ) or no resection in 26.4 % of the S group versus 14.3 % of the CS P < .001 . Three-year survival by type of resection was R0 42.4 % , R1 was 18.0 % , and R2 was 8.6 % . CONCLUSION Long-term follow-up confirms that preoperative chemotherapy improves survival in operable esophageal cancer and should be considered as a st and ard of care BACKGROUND The role of neoadjuvant chemoradiotherapy in the treatment of patients with esophageal or esophagogastric-junction cancer is not well established . We compared chemoradiotherapy followed by surgery with surgery alone in this patient population . METHODS We r and omly assigned patients with resectable tumors to receive surgery alone or weekly administration of carboplatin ( doses titrated to achieve an area under the curve of 2 mg per milliliter per minute ) and paclitaxel ( 50 mg per square meter of body-surface area ) for 5 weeks and concurrent radiotherapy ( 41.4 Gy in 23 fractions , 5 days per week ) , followed by surgery . RESULTS From March 2004 through December 2008 , we enrolled 368 patients , 366 of whom were included in the analysis : 275 ( 75 % ) had adenocarcinoma , 84 ( 23 % ) had squamous-cell carcinoma , and 7 ( 2 % ) had large-cell undifferentiated carcinoma . Of the 366 patients , 178 were r and omly assigned to chemoradiotherapy followed by surgery  , and 188 to surgery alone . The most common major hematologic toxic effects in the chemoradiotherapy-surgery group were leukopenia ( 6 % ) and neutropenia ( 2 % ) ; the most common major nonhematologic toxic effects were anorexia ( 5 % ) and fatigue ( 3 % ) . Complete resection with no tumor within 1 mm of the resection margins ( R0 ) was achieved in 92 % of patients in the chemoradiotherapy-surgery group versus 69 % in the surgery group ( P<0.001 ) . A pathological complete response was achieved in 47 of 161 patients ( 29 % ) who underwent resection after chemoradiotherapy . Postoperative complications were similar in the two treatment groups , and in-hospital mortality was 4 % in both . Median overall survival was 49.4 months in the chemoradiotherapy-surgery group versus 24.0 months in the surgery group . Overall survival was significantly better in the chemoradiotherapy-surgery group ( hazard ratio , 0.657 ; 95 % confidence interval , 0.495 to 0.871 ; P=0.003 ) . CONCLUSIONS Preoperative chemoradiotherapy improved survival among patients with potentially curable esophageal or esophagogastric-junction cancer . The regimen was associated with acceptable adverse-event rates . ( Funded by the Dutch Cancer Foundation [ KWF Kankerbestrijding ] ; Netherl and s Trial Register number , NTR487 . ) BACKGROUND We conducted a prospect i ve r and omized controlled trial comparing surgery alone ( S ) with concurrent chemoradiotherapy followed by surgery ( CRT-S ) for resectable esophageal squamous cell carcinoma ( SCC ) based on our previous report . PATIENTS AND METHODS One hundred and one patients with stage II/III esophageal SCC were r and omized to receive either S ( 50 patients ) or CRT-S ( 51 patients ) . The chemoradiotherapy ( CRT ) consisted of cisplatin 60 mg/m(2 ) intravenously ( i.v . ) on day 1 , 5-fluorouracil ( 5-FU ) 1000 mg/m(2 ) i.v . on days 2 - 5 , cisplatin 60 mg/m(2 ) i.v . on day 22 combined with radiation therapy ( 45.6 Gy , 1.2 Gy b.i.d . on days 1 - 28 ) . Surgery was performed 3 - 4 weeks after radiotherapy was completed . For patients with disease that was stable or responsive to CRT , three additional cycles of chemotherapy ( cisplatin 60 mg/m(2 ) i.v . on day 1 , 5-FU 1000 mg/m(2 ) on days 2 - 5 every 4 weeks ) were given after surgical resection . RESULTS The median age was 62 years . The toxicity of CRT was acceptable and did not affect the post-operative morbidity and the duration of hospital stay . Clinical response was 86 % including 21 % of complete response ( CR ) rate . Pathological CR was achieved in 43 % [ 95 % confidence interval ( CI ) 27 - 59 ] of the patients who underwent surgery after CRT . At a median follow-up of 25 months , median overall survival ( OS ) was 27.3 months in S and 28.2 months in CRT-S ( P = 0.69 ) . Event-free survival ( EFS ) at 2 years was 51 % in S and 49 % in CRT-S ( P = 0.93 ) . This trial , which was statistically powered to detect a relatively large difference in 2-year survival rate from 30 % to 50 % with 80 % power , was discontinued at interim analysis because of the unexpectedly high drop-out rate for esophagectomy ( 31 % ) and result ant excessive locoregional failure rate in CRT-S arm ( 22 % versus 12 % , P = 0.31 ) , though it was not statistically significant . CONCLUSION Although preoperative CRT induced high clinical and pathological response , there was no statistically significant benefit in OS and EFS AIM To investigate the role of perioperative chemoradiotherapy ( CRT ) in the treatment of locally advanced thoracic esophageal squamous cell carcinoma ( ESCC ) . METHODS Using preoperative computed tomography (CT)-based staging criteria , 238 patients with ESCC ( stage II-III ) were enrolled in this prospect i ve study between January 1997 and June 2004 . With informed consent , patients were r and omized into 3 groups : preoperative CRT ( 80 cases ) , postoperative CRT ( 78 cases ) and surgery alone ( S ) ( 80 cases ) . The 1- , 3- , 5- and 10-year survival were followed up . Progression-free survival ( PFS ) was chosen as the primary endpoint by treatment arm measured from study entry until documented progression of disease or death from any cause . The secondary endpoint was overall survival ( OS ) determined as the time ( in months ) between the date of therapy and the date of death . Other objectives were surgical and adjuvant therapy complications . RESULTS With median follow-up of 45 mo for all the enrolled patients , significant differences in the 1- , 3- , 5- , 10-year OS ( 91.3 % , 63.5 % , 43.5 % , 24.5 % vs 91 % , 62.8 % , 42.3 % , 24.4 % vs 87.5 % , 51.3 % , 33.8 % , 12.5 % , P = 0.0176 ) and PFS ( 89.3 % , 61.3 % , 37.5 % , 18.1 % vs 89.1 % , 61.1 % , 37.2 % , 17.8 % vs 84.5 % , 49.3 % , 25.9 % , 6.2 % , P = 0.0151 ) were detected among the 3 arms . There were no significant differences in OS and PFS between the preoperative CRT and postoperative CRT arm ( P > 0.05 ) . For the patients who had radical resection , significant differences in median PFS ( 48 mo vs 61 mo vs 39.5 mo , P = 0.0331 ) and median OS ( 56.5 mo vs 72 mo vs 41.5 mo , P = 0.0153 ) were detected among the 3 arms , but there were no significant differences in OS and PFS between the preoperative CRT and postoperative CRT arm ( P > 0.05 ) . The local recurrence rates in the preoperative CRT , postoperative CRT group and S group were 11.3 % , 14.1 % and 35 % , respectively ( P < 0.05 ) . No significant differences were detected among the 3 groups when comparing complications but tended to be in favor of the postoperative CRT and S groups ( P > 0.05 ) . Toxicities of CRT in the preoperative or postoperative CRT arms were mostly moderate , and could be quickly alleviated by adequate therapy . CONCLUSION Rational application of preoperative or postoperative CRT can provide a benefit in PFS and OS in patients with locally advanced ESCC PURPOSE The primary treatment modality for patients with carcinoma of the esophagus or gastroesophageal junction has been surgery , although primary radiation therapy with concurrent chemotherapy produces similar results . As both have curative potential , there has been great interest in the use of trimodality therapy . To this end , we compared survival , response , and patterns of failure of trimodality therapy to esophagectomy alone in patients with nonmetastatic esophageal cancer . PATIENTS AND METHODS Four hundred seventy-five eligible patients were planned for enrollment . Patients were r and omly assigned to either esophagectomy with node dissection alone or cisplatin 100 mg/m(2 ) and fluorouracil 1,000 mg/m(2)/d for 4 days on weeks 1 and 5 concurrent with radiation therapy ( 50.4 Gy total : 1.8 Gy/fraction over 5.6 weeks ) followed by esophagectomy with node dissection . RESULTS Fifty-six patients were enrolled between October 1997 and March 2000 , when the trial was closed due to poor accrual . Thirty patients were r and omly assigned to trimodality therapy and 26 were assigned to surgery alone . Patient and tumor characteristics were similar between groups . Treatment was generally well tolerated . Median follow-up was 6 years . An intent-to-treat analysis showed a median survival of 4.48 v 1.79 years in favor of trimodality therapy ( exact stratified log-rank , P = .002 ) . Five-year survival was 39 % ( 95 % CI , 21 % to 57 % ) v 16 % ( 95 % CI , 5 % to 33 % ) in favor of trimodality therapy . CONCLUSION The results from this trial reflect a long-term survival advantage with the use of chemoradiotherapy followed by surgery in the treatment of esophageal cancer , and support trimodality therapy as a st and ard of care for patients with this disease The role of neoadjuvant therapy in the treatment of locally advanced esophageal carcinoma still remains controversial . The aim of this study was to evaluate the effects of neoadjuvant radiochemotherapy on pathological staging and prognosis in the patients with locally advanced esophageal squamous cell carcinoma . Between January 1991 and December 2000 , 473 patients with advanced esophageal carcinoma diagnosed by endoscopic biopsy underwent surgical resection in our center . With informed consent , they were r and omized into four groups : neoadjuvant chemotherapy , neoadjuvant radiotherapy , neoadjuvant radiochemotherapy , and surgery alone ( control group ) . The preoperative computed tomography staging criteria were the following : Stage I , the tumor limited to the esophageal lumen or the thickness of the esophageal wall varied between 3 - 5 mm ; Stage II , the thickness exceeds 5 mm but no invasion to the mediastinum or distant metastasis ; Stage III , the tumor invades adjacent mediastinal structure ; and Stage IV , there is distant metastasis . The tumor resection rate , pathological stage , treatment-related complication , and survival among groups were compared . The radical resection rate for the patients 
    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 OEO2 is a r and omized , controlled trial of preoperative chemotherapy in patients undergoing radical surgery for esophageal cancer . R and om assignment was to surgery alone ( S ) or to two cycles of combination cisplatin and fluorouracil before surgery ( CS ) . Initial results reported in 2002 demonstrated an advantage for both disease-free and overall survival in the CS group . The analysis has now been up date d after a median follow-up of 6 years . PATIENTS AND METHODS OEO2 recruited 802 patients , 400 on CS and 402 on S. The nature of the first recurrence event and cause of death are detailed . Survival has been determined from Kaplan-Meier curves and treatment comparisons made with the log-rank test . Survival by extent of resection is presented . RESULTS There were 655 deaths , 335 for S and 320 for CS . The survival benefit has been maintained with a hazard ratio ( HR ) of 0.84 ( 95 % CI , 0.72 to 0.98 ; P = .03 ) which in absolute terms is a 5-year survival of 23.0 % for CS compared with 17.1 % for S. The treatment effect is consistent in both adenocarcinoma and squamous cell carcinoma . The first disease-free survival event was macroscopic residual disease from incomplete resection ( R2 ) or no resection in 26.4 % of the S group versus 14.3 % of the CS P < .001 . Three-year survival by type of resection was R0 42.4 % , R1 was 18.0 % , and R2 was 8.6 % . CONCLUSION Long-term follow-up confirms that preoperative chemotherapy improves survival in operable esophageal cancer and should be considered as a st and ard of care BACKGROUND The role of neoadjuvant chemoradiotherapy in the treatment of patients with esophageal or esophagogastric-junction cancer is not well established . We compared chemoradiotherapy followed by surgery with surgery alone in this patient population . METHODS We r and omly assigned patients with resectable tumors to receive surgery alone or weekly administration of carboplatin ( doses titrated to achieve an area under the curve of 2 mg per milliliter per minute ) and paclitaxel ( 50 mg per square meter of body-surface area ) for 5 weeks and concurrent radiotherapy ( 41.4 Gy in 23 fractions , 5 days per week ) , followed by surgery . RESULTS From March 2004 through December 2008 , we enrolled 368 patients , 366 of whom were included in the analysis : 275 ( 75 % ) had adenocarcinoma , 84 ( 23 % ) had squamous-cell carcinoma , and 7 ( 2 % ) had large-cell undifferentiated carcinoma . Of the 366 patients , 178 were r and omly assigned to chemoradiotherapy followed by surgery  , and 188 to surgery alone . The most common major hematologic toxic effects in the chemoradiotherapy-surgery group were leukopenia ( 6 % ) and neutropenia ( 2 % ) ; the most common major nonhematologic toxic effects were anorexia ( 5 % ) and fatigue ( 3 % ) . Complete resection with no tumor within 1 mm of the resection margins ( R0 ) was achieved in 92 % of patients in the chemoradiotherapy-surgery group versus 69 % in the surgery group ( P<0.001 ) . A pathological complete response was achieved in 47 of 161 patients ( 29 % ) who underwent resection after chemoradiotherapy . Postoperative complications were similar in the two treatment groups , and in-hospital mortality was 4 % in both . Median overall survival was 49.4 months in the chemoradiotherapy-surgery group versus 24.0 months in the surgery group . Overall survival was significantly better in the chemoradiotherapy-surgery group ( hazard ratio , 0.657 ; 95 % confidence interval , 0.495 to 0.871 ; P=0.003 ) . CONCLUSIONS Preoperative chemoradiotherapy improved survival among patients with potentially curable esophageal or esophagogastric-junction cancer . The regimen was associated with acceptable adverse-event rates . ( Funded by the Dutch Cancer Foundation [ KWF Kankerbestrijding ] ; Netherl and s Trial Register number , NTR487 . ) BACKGROUND We conducted a prospect i ve r and omized controlled trial comparing surgery alone ( S ) with concurrent chemoradiotherapy followed by surgery ( CRT-S ) for resectable esophageal squamous cell carcinoma ( SCC ) based on our previous report . PATIENTS AND METHODS One hundred and one patients with stage II/III esophageal SCC were r and omized to receive either S ( 50 patients ) or CRT-S ( 51 patients ) . The chemoradiotherapy ( CRT ) consisted of cisplatin 60 mg/m(2 ) intravenously ( i.v . ) on day 1 , 5-fluorouracil ( 5-FU ) 1000 mg/m(2 ) i.v . on days 2 - 5 , cisplatin 60 mg/m(2 ) i.v . on day 22 combined with radiation therapy ( 45.6 Gy , 1.2 Gy b.i.d . on days 1 - 28 ) . Surgery was performed 3 - 4 weeks after radiotherapy was completed . For patients with disease that was stable or responsive to CRT , three additional cycles of chemotherapy ( cisplatin 60 mg/m(2 ) i.v . on day 1 , 5-FU 1000 mg/m(2 ) on days 2 - 5 every 4 weeks ) were given after surgical resection . RESULTS The median age was 62 years . The toxicity of CRT was acceptable and did not affect the post-operative morbidity and the duration of hospital stay . Clinical response was 86 % including 21 % of complete response ( CR ) rate . Pathological CR was achieved in 43 % [ 95 % confidence interval ( CI ) 27 - 59 ] of the patients who underwent surgery after CRT . At a median follow-up of 25 months , median overall survival ( OS ) was 27.3 months in S and 28.2 months in CRT-S ( P = 0.69 ) . Event-free survival ( EFS ) at 2 years was 51 % in S and 49 % in CRT-S ( P = 0.93 ) . This trial , which was statistically powered to detect a relatively large difference in 2-year survival rate from 30 % to 50 % with 80 % power , was discontinued at interim analysis because of the unexpectedly high drop-out rate for esophagectomy ( 31 % ) and result ant excessive locoregional failure rate in CRT-S arm ( 22 % versus 12 % , P = 0.31 ) , though it was not statistically significant . CONCLUSION Although preoperative CRT induced high clinical and pathological response , there was no statistically significant benefit in OS and EFS AIM To investigate the role of perioperative chemoradiotherapy ( CRT ) in the treatment of locally advanced thoracic esophageal squamous cell carcinoma ( ESCC ) . METHODS Using preoperative computed tomography (CT)-based staging criteria , 238 patients with ESCC ( stage II-III ) were enrolled in this prospect i ve study between January 1997 and June 2004 . With informed consent , patients were r and omized into 3 groups : preoperative CRT ( 80 cases ) , postoperative CRT ( 78 cases ) and surgery alone ( S ) ( 80 cases ) . The 1- , 3- , 5- and 10-year survival were followed up . Progression-free survival ( PFS ) was chosen as the primary endpoint by treatment arm measured from study entry until documented progression of disease or death from any cause . The secondary endpoint was overall survival ( OS ) determined as the time ( in months ) between the date of therapy and the date of death . Other objectives were surgical and adjuvant therapy complications . RESULTS With median follow-up of 45 mo for all the enrolled patients , significant differences in the 1- , 3- , 5- , 10-year OS ( 91.3 % , 63.5 % , 43.5 % , 24.5 % vs 91 % , 62.8 % , 42.3 % , 24.4 % vs 87.5 % , 51.3 % , 33.8 % , 12.5 % , P = 0.0176 ) and PFS ( 89.3 % , 61.3 % , 37.5 % , 18.1 % vs 89.1 % , 61.1 % , 37.2 % , 17.8 % vs 84.5 % , 49.3 % , 25.9 % , 6.2 % , P = 0.0151 ) were detected among the 3 arms . There were no significant differences in OS and PFS between the preoperative CRT and postoperative CRT arm ( P > 0.05 ) . For the patients who had radical resection , significant differences in median PFS ( 48 mo vs 61 mo vs 39.5 mo , P = 0.0331 ) and median OS ( 56.5 mo vs 72 mo vs 41.5 mo , P = 0.0153 ) were detected among the 3 arms , but there were no significant differences in OS and PFS between the preoperative CRT and postoperative CRT arm ( P > 0.05 ) . The local recurrence rates in the preoperative CRT , postoperative CRT group and S group were 11.3 % , 14.1 % and 35 % , respectively ( P < 0.05 ) . No significant differences were detected among the 3 groups when comparing complications but tended to be in favor of the postoperative CRT and S groups ( P > 0.05 ) . Toxicities of CRT in the preoperative or postoperative CRT arms were mostly moderate , and could be quickly alleviated by adequate therapy . CONCLUSION Rational application of preoperative or postoperative CRT can provide a benefit in PFS and OS in patients with locally advanced ESCC PURPOSE The primary treatment modality for patients with carcinoma of the esophagus or gastroesophageal junction has been surgery , although primary radiation therapy with concurrent chemotherapy produces similar results . As both have curative potential , there has been great interest in the use of trimodality therapy . To this end , we compared survival , response , and patterns of failure of trimodality therapy to esophagectomy alone in patients with nonmetastatic esophageal cancer . PATIENTS AND METHODS Four hundred seventy-five eligible patients were planned for enrollment . Patients were r and omly assigned to either esophagectomy with node dissection alone or cisplatin 100 mg/m(2 ) and fluorouracil 1,000 mg/m(2)/d for 4 days on weeks 1 and 5 concurrent with radiation therapy ( 50.4 Gy total : 1.8 Gy/fraction over 5.6 weeks ) followed by esophagectomy with node dissection . RESULTS Fifty-six patients were enrolled between October 1997 and March 2000 , when the trial was closed due to poor accrual . Thirty patients were r and omly assigned to trimodality therapy and 26 were assigned to surgery alone . Patient and tumor characteristics were similar between groups . Treatment was generally well tolerated . Median follow-up was 6 years . An intent-to-treat analysis showed a median survival of 4.48 v 1.79 years in favor of trimodality therapy ( exact stratified log-rank , P = .002 ) . Five-year survival was 39 % ( 95 % CI , 21 % to 57 % ) v 16 % ( 95 % CI , 5 % to 33 % ) in favor of trimodality therapy . CONCLUSION The results from this trial reflect a long-term survival advantage with the use of chemoradiotherapy followed by surgery in the treatment of esophageal cancer , and support trimodality therapy as a st and ard of care for patients with this disease The role of neoadjuvant therapy in the treatment of locally advanced esophageal carcinoma still remains controversial . The aim of this study was to evaluate the effects of neoadjuvant radiochemotherapy on pathological staging and prognosis in the patients with locally advanced esophageal squamous cell carcinoma . Between January 1991 and December 2000 , 473 patients with advanced esophageal carcinoma diagnosed by endoscopic biopsy underwent surgical resection in our center . With informed consent , they were r and omized into four groups : neoadjuvant chemotherapy , neoadjuvant radiotherapy , neoadjuvant radiochemotherapy , and surgery alone ( control group ) . The preoperative computed tomography staging criteria were the following : Stage I , the tumor limited to the esophageal lumen or the thickness of the esophageal wall varied between 3 - 5 mm ; Stage II , the thickness exceeds 5 mm but no invasion to the mediastinum or distant metastasis ; Stage III , the tumor invades adjacent mediastinal structure ; and Stage IV , there is distant metastasis . The tumor resection rate , pathological stage , treatment-related complication , and survival among groups were compared . The radical resection rate for the patients 
    Output:
    