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: 15025 Background : In the past years the concept of neoadjuvant chemotherapy and interval laparotomy has emerged for patients with advanced ovarian cancer and unfavorable prognosis ( e.g. diffuse peritoneal carcinosis ) . In a recent study on neoadjuvant chemotherapy higher tumor resection rates and longer median survival were demonstrated in patients with advanced ovarian carcinoma and ascites > 500ml . Most studies use three cycles of preoperative chemotherapy . However , chemoresistant tumorclones may be induced by increasing number of preoperative chemotherapy cycles . The purpose of this study is to evaluate the optimal number of cycles prior to interval laparotomy . METHODS 67/73 patients with advanced serous ovarian carcinoma ( FIGO IIIc n = 48 , FIGO IV n = 19 ) and ascites > 500ml were r and omized into two arms , receiving either 2 ( n = 33 ) or 3 ( n = 34 ) cycles of Carboplatin ( AUC5 ) and Docetaxel ( 75mg/m2 ) before interval laparotomy . Postoperatively , they received either 4 or 3 additional cycles . Response rate and postoperative residual tumor were evaluated . RESULTS Surgical response was assessed during interval laparotomy . At present 32 patients underwent tumordebulking . Partial remission was observed in 28/32 patients irrespective of the number of preoperative chemotherapy cycles . Two patients in each arm showed stable disease . Optimal cytoreduction was achieved in 25/32 patients . No severe adverse events were reported . Six of 73 patients were not eligible . Two patients were excluded due to therapy-unrelated events . In 4 patients ovarian cancer was excluded by laparoscopy prior to neoadjuvant chemotherapy . CONCLUSIONS Neoadjuvant chemotherapy followed by interval laparotomy was safe and well tolerated . Diagnostic laparoscopy prior to neoadjuvant chemotherapy allowed differentiation of primary ovarian cancers from tumors of other origin . In these cases laparotomy could be circumvented . Optimal tumor reduction was achieved in a significant number of patients . Response rate and postoperative residual tumor were essentially the same in both arms . Our data indicate that two cycles of preoperative chemotherapy may be the preferential choice of therapy for future studies . No significant financial relationships to disclose The results of the treatment of 75 patients with ovarian carcinoma of epithelial origin are reported . The authors give a r and omised clinical comparison of the efficacy of two schemes of complex treatment of 54 patients with ascitic ovarian carcinoma and 21 patients with non-ascitic ovarian carcinoma . The first scheme included cytoxan chemotherapy plus surgery plus polychemotherapy ( 25 patients ) ; the second -- surgery plus polychemotherapy ( 29 patients ) . Patients with non-ascitic carcinoma ( 21 ) received the second type of treatment . Polychemotherapy consisted of two alternating schedules : 5 fluorouracil plus cyclophosphamide and hexamethylamine plus cyclophosphamide after a two week interval . Better results were obtained in the group of patients treated surgically at the initial stage of treatment Background To achieve anti-ovarian tumor responses similar to those obtained with high-dose chemotherapy but with milder side effects , we developed a treatment protocol in which semi-high dose multi-cycle neoadjuvant chemotherapy was supported by autologous peripheral blood stem-cell transplantation ( auto-PBSCT ) . Methods Seventeen patients with advanced ovarian cancer were enrolled in this study . Two cycles of semi-high dose neoadjuvant chemotherapy , using carboplatin ( AUC , 8.75 ; average dose , 621 mg/m2 ) and etoposide ( average dose , 960 mg/m2 ) were supported by auto-PBSCT and followed by cytoreductive surgery and further chemotherapy . Each patient was followed for at least 5 years . Results This treatment schedule achieved an overall response rate of 70.6 % in 17 patients with stage III or stage IV ovarian cancer .  The 5-year disease-free survival rate was 52.9 % ( 95 % confidence interval , 29.2%–76.6 % ) and the median survival time was 63 months ( 95 % confidence interval , 16–79 months ) . Thus , we obtained superior treatment outcomes in these 17 patients in comparison with published conventional protocol s. Conclusion Cyclic semi-high dose neoadjuvant chemotherapy supported by auto-PBSCT may be tolerable and favorable for patients with advanced ovarian cancer AIM This study was performed to evaluate the efficacy of neoadjuvant chemotherapy ( NAC ) with paclitaxel and cisplatin in patients with advanced epithelial ovarian cancer who were inadequate for primary optimal surgery . METHODS Patients with histologically confirmed epithelial ovarian cancer at International Federation of Gynecology and Obstetrics stages IIIc/IV that was unresectable according to computed tomography findings were eligible for this study . Three cycles of paclitaxel plus cisplatin NAC were administered and the response was evaluated . Patients were then selected for interval debulking surgery or three cycles of additional chemotherapy with the same regimen according to the resectability and response . Interval debulking surgery followed by second-line chemotherapy was applied to patients with no response to NAC . During the same period , patients who did not agree to the protocol were treated by the conventional method of tumor debulking surgery followed by adjuvant chemotherapy , and served as the control group . A comparison of both groups of patients was carried out . RESULTS A total of 40 patients were involved in the study . All patients were evaluable . Eighteen patients underwent NAC and 22 patients were treated by conventional therapy .  Optimal debulking was possible in 14 patients ( 77.8 % ) in the NAC group and in 10 patients ( 45.5 % ) in the conventional therapy group ( P = 0.04 ) . The mean estimated blood loss was 620 cc ( range : 300 - 1500 cc ) in the NAC group and 1061 cc ( range : 300 - 3500 cc ) in the conventional therapy group ( P = 0.04 ) . However , no significant differences were found in the disease-free and overall survival rates between the two groups ( P = 0.48 and P = 0.61 , respectively ) . CONCLUSION NAC provided a higher rate of optimum cytoreduction and equivalent survival with less invasive surgery and reduced morbidity compared with conventional therapy in patients with advanced epithelial ovarian cancer inadequate for primary optimum surgery . Therefore , NAC may be a valuable alternative treatment for these patients Background Ovarian cancer is one of the most frequently fatal gynecological cancers because most cases are diagnosed at an advanced stage . Loss of growth control and a marked resistance to apoptosis are considered major mechanisms driving tumor progression . Little is known about the effect of various treatment regimens on the distribution of molecular markers of apoptosis in epithelial ovarian cancer . The objective of this study was to compare the expression levels of both proapoptotic and antiapoptotic proteins p53 , p73 , Bcl-2 , Bcl-XL and survivin in the ascitic cells and tumor sample s of patients undergoing treatment with two different regimens . Methods A total of 24 patients with untreated epithelial ovarian cancer were r and omized into two groups of 12 each . Group 1 patients received three cycles of chemotherapy prior to surgery and three cycles after surgery and group 2 patients received six cycles of chemotherapy prior to surgery . The expression of apoptosis-related proteins was analyzed in ascitic fluid and tumor sample s by Western blotting and immunohistochemistry . The apoptotic index was also determined in these sample s by the TUNEL assay . Results Significant decreases in antiapoptotic bcl-2 and survivin were seen , accompanied by increases in apoptotic index in tumors that had undergone chemotherapy as compared to the baseline ascites sample s. No significant change in bcl-XL was observed . A significant decrease in proapoptotic p53 was also seen . No expression of p73 was observed in tumors or ascites . The findings were similar in groups 1 and 2 patients and were not statistically significantly different , perhaps due to the small sample size ( n=12 ) of each group . Conclusions The above findings indicate that chemotherapy in ovarian carcinoma leads to an increase in apoptosis by a p53-independent pathway , which involves the downregulation of antiapoptotic Bcl-2 and survivin but not Bcl-XL . Furthermore , administering neoadjuvant chemotherapy ( six cycles ) as an alternative form of therapy for advanced epithelial ovarian cancer is more effective in inducing apoptosis than three cycles . However , the findings of this study need to be corroborated using a larger sample OBJECTIVE This study was aim ed at comparison of neoadjuvant chemotherapy with primary debulking surgery in advanced ovarian carcinoma . METHODS Retrospective analysis of 285 patients with advanced ovarian carcinoma treated between 1980 and 1997 was performed . RESULTS In the period 1980 - 1988 all patients underwent primary debulking surgery and 82 % were cytoreduced to less than 0.5 cm largest residual tumor mass ( n = 112 ) . Analysis of this group of patients showed that some subgroups of patients ( e.g. , Stage IV disease or a total metastatic tumor load of more than 1000 g prior to debulking surgery ) had a poor survival despite cytoreduction to no or less than 1 g of total residual tumor load . The complication rate was high especially in the group with unfavorable prognosis ( postoperative mortality , 6 % ) . In the period 1989 - 1997 ( n = 173 ) the patients were surgically evaluated to receive primary chemotherapy ( 43 % ) or primary debulking surgery ( 57 % ) . Prognostic variables were similar for both treatment periods . The actuarial crude survival was higher in the second time period ( 3-year crude survival of 26 % + /- 4 . 3 and 42 % + /- 4.6 for the first and second time periods , respectively ; P = 0.0001 ) . The postoperative mortality was 0 % during the second time period . From 1993 on , the decision to give neoadjuvant chemotherapy or to perform primary debulking surgery in patients with clinical ly obvious metastatic disease was made with the help of an open laparoscopy ( n = 77 ) . Median duration of the laparoscopy , blood loss , and hospital stay due to this procedure were 25 min , 10 ml , and 2 days . Primary and interval debulking surgery was performed in 36 and 63 % of this subgroup of patients , respectively . CONCLUSION In this retrospective analysis over two different time periods , crude survival was higher when treating about half of the patients with advanced ovarian carcinoma with primary chemotherapy instead of primary debulking surgery . The role of neoadjuvant chemotherapy should be evaluated in a prospect i ve r and omized study PURPOSE To compare self-reported quality of life ( QOL ) in patients who did versus did not undergo interval secondary cytoreduction after initial surgery and combination chemotherapy for advanced ovarian cancer and to assess the association between baseline QOL scores and survival . PATIENTS AND METHODS Consenting patients participating in a Gynecologic Oncology Group ( GOG ) phase III treatment trial ( GOG 152 ) completed the Functional Assessment of Cancer Therapy-Ovarian ( FACT-O ) question naire and treatment-specific supplemental questions at the third and sixth chemotherapy cycles and at 6 and 12 months after starting treatment . RESULTS For all patients , QOL decreased approximately 1 unit from the first to second assessment . Significant improvement observed at 6 months ( P < .001 ) was sustained at 12 months , with no appreciable between-group difference . The baseline FACT-O score was associated with overall survival ( P = .048 ) but not progression-free survival . Less neurotoxicity was reported among patients who did ( 38.4 % ) versus did not ( 54.0 % ) undergo interval secondary cytoreduction at the third assessment ( P = .005 ) , and older patients experienced more long-term effects . CONCLUSION This is the first multicenter r and omized trial in ovarian cancer to longitudinally examine self-reported QOL and establish a predictive value of baseline QOL on survival , attributed primarily to the lowest-scoring quartile . Although interval secondary cytoreduction result ed in no notable long-term difference , a clinical ly significant improvement was seen in both arms at 6 and 12 months after starting therapy . Interestingly , there were fewer complaints of neurotoxicity at 6 months among patients who did versus did not undergo interval secondary cytoreduction Single-agent gemcitabine demonstrated response rates of 11–60 % in platinum/paclitaxel-resistant ovarian cancer . Twenty-four patients with epithelial ovarian cancer were treated with gemcitabine 800 mg/m2 on days 1 and 8 , carboplatin area under the curve 5 on day 1 , and paclitaxel 175 mg/m2 over 3 h on day 1 every 3 weeks for six cycles . Median age was 54 years , and FIGO stage distribution was IIC , 1 patient , III , 18 , and IV , 5 . A total of 22 ( 92 % ) patients completed all the six planned courses of chemotherapy . Doses were reduced in 8 out of 24 ( 33 % ) patients . Of 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: 15025 Background : In the past years the concept of neoadjuvant chemotherapy and interval laparotomy has emerged for patients with advanced ovarian cancer and unfavorable prognosis ( e.g. diffuse peritoneal carcinosis ) . In a recent study on neoadjuvant chemotherapy higher tumor resection rates and longer median survival were demonstrated in patients with advanced ovarian carcinoma and ascites > 500ml . Most studies use three cycles of preoperative chemotherapy . However , chemoresistant tumorclones may be induced by increasing number of preoperative chemotherapy cycles . The purpose of this study is to evaluate the optimal number of cycles prior to interval laparotomy . METHODS 67/73 patients with advanced serous ovarian carcinoma ( FIGO IIIc n = 48 , FIGO IV n = 19 ) and ascites > 500ml were r and omized into two arms , receiving either 2 ( n = 33 ) or 3 ( n = 34 ) cycles of Carboplatin ( AUC5 ) and Docetaxel ( 75mg/m2 ) before interval laparotomy . Postoperatively , they received either 4 or 3 additional cycles . Response rate and postoperative residual tumor were evaluated . RESULTS Surgical response was assessed during interval laparotomy . At present 32 patients underwent tumordebulking . Partial remission was observed in 28/32 patients irrespective of the number of preoperative chemotherapy cycles . Two patients in each arm showed stable disease . Optimal cytoreduction was achieved in 25/32 patients . No severe adverse events were reported . Six of 73 patients were not eligible . Two patients were excluded due to therapy-unrelated events . In 4 patients ovarian cancer was excluded by laparoscopy prior to neoadjuvant chemotherapy . CONCLUSIONS Neoadjuvant chemotherapy followed by interval laparotomy was safe and well tolerated . Diagnostic laparoscopy prior to neoadjuvant chemotherapy allowed differentiation of primary ovarian cancers from tumors of other origin . In these cases laparotomy could be circumvented . Optimal tumor reduction was achieved in a significant number of patients . Response rate and postoperative residual tumor were essentially the same in both arms . Our data indicate that two cycles of preoperative chemotherapy may be the preferential choice of therapy for future studies . No significant financial relationships to disclose The results of the treatment of 75 patients with ovarian carcinoma of epithelial origin are reported . The authors give a r and omised clinical comparison of the efficacy of two schemes of complex treatment of 54 patients with ascitic ovarian carcinoma and 21 patients with non-ascitic ovarian carcinoma . The first scheme included cytoxan chemotherapy plus surgery plus polychemotherapy ( 25 patients ) ; the second -- surgery plus polychemotherapy ( 29 patients ) . Patients with non-ascitic carcinoma ( 21 ) received the second type of treatment . Polychemotherapy consisted of two alternating schedules : 5 fluorouracil plus cyclophosphamide and hexamethylamine plus cyclophosphamide after a two week interval . Better results were obtained in the group of patients treated surgically at the initial stage of treatment Background To achieve anti-ovarian tumor responses similar to those obtained with high-dose chemotherapy but with milder side effects , we developed a treatment protocol in which semi-high dose multi-cycle neoadjuvant chemotherapy was supported by autologous peripheral blood stem-cell transplantation ( auto-PBSCT ) . Methods Seventeen patients with advanced ovarian cancer were enrolled in this study . Two cycles of semi-high dose neoadjuvant chemotherapy , using carboplatin ( AUC , 8.75 ; average dose , 621 mg/m2 ) and etoposide ( average dose , 960 mg/m2 ) were supported by auto-PBSCT and followed by cytoreductive surgery and further chemotherapy . Each patient was followed for at least 5 years . Results This treatment schedule achieved an overall response rate of 70.6 % in 17 patients with stage III or stage IV ovarian cancer .  The 5-year disease-free survival rate was 52.9 % ( 95 % confidence interval , 29.2%–76.6 % ) and the median survival time was 63 months ( 95 % confidence interval , 16–79 months ) . Thus , we obtained superior treatment outcomes in these 17 patients in comparison with published conventional protocol s. Conclusion Cyclic semi-high dose neoadjuvant chemotherapy supported by auto-PBSCT may be tolerable and favorable for patients with advanced ovarian cancer AIM This study was performed to evaluate the efficacy of neoadjuvant chemotherapy ( NAC ) with paclitaxel and cisplatin in patients with advanced epithelial ovarian cancer who were inadequate for primary optimal surgery . METHODS Patients with histologically confirmed epithelial ovarian cancer at International Federation of Gynecology and Obstetrics stages IIIc/IV that was unresectable according to computed tomography findings were eligible for this study . Three cycles of paclitaxel plus cisplatin NAC were administered and the response was evaluated . Patients were then selected for interval debulking surgery or three cycles of additional chemotherapy with the same regimen according to the resectability and response . Interval debulking surgery followed by second-line chemotherapy was applied to patients with no response to NAC . During the same period , patients who did not agree to the protocol were treated by the conventional method of tumor debulking surgery followed by adjuvant chemotherapy , and served as the control group . A comparison of both groups of patients was carried out . RESULTS A total of 40 patients were involved in the study . All patients were evaluable . Eighteen patients underwent NAC and 22 patients were treated by conventional therapy .  Optimal debulking was possible in 14 patients ( 77.8 % ) in the NAC group and in 10 patients ( 45.5 % ) in the conventional therapy group ( P = 0.04 ) . The mean estimated blood loss was 620 cc ( range : 300 - 1500 cc ) in the NAC group and 1061 cc ( range : 300 - 3500 cc ) in the conventional therapy group ( P = 0.04 ) . However , no significant differences were found in the disease-free and overall survival rates between the two groups ( P = 0.48 and P = 0.61 , respectively ) . CONCLUSION NAC provided a higher rate of optimum cytoreduction and equivalent survival with less invasive surgery and reduced morbidity compared with conventional therapy in patients with advanced epithelial ovarian cancer inadequate for primary optimum surgery . Therefore , NAC may be a valuable alternative treatment for these patients Background Ovarian cancer is one of the most frequently fatal gynecological cancers because most cases are diagnosed at an advanced stage . Loss of growth control and a marked resistance to apoptosis are considered major mechanisms driving tumor progression . Little is known about the effect of various treatment regimens on the distribution of molecular markers of apoptosis in epithelial ovarian cancer . The objective of this study was to compare the expression levels of both proapoptotic and antiapoptotic proteins p53 , p73 , Bcl-2 , Bcl-XL and survivin in the ascitic cells and tumor sample s of patients undergoing treatment with two different regimens . Methods A total of 24 patients with untreated epithelial ovarian cancer were r and omized into two groups of 12 each . Group 1 patients received three cycles of chemotherapy prior to surgery and three cycles after surgery and group 2 patients received six cycles of chemotherapy prior to surgery . The expression of apoptosis-related proteins was analyzed in ascitic fluid and tumor sample s by Western blotting and immunohistochemistry . The apoptotic index was also determined in these sample s by the TUNEL assay . Results Significant decreases in antiapoptotic bcl-2 and survivin were seen , accompanied by increases in apoptotic index in tumors that had undergone chemotherapy as compared to the baseline ascites sample s. No significant change in bcl-XL was observed . A significant decrease in proapoptotic p53 was also seen . No expression of p73 was observed in tumors or ascites . The findings were similar in groups 1 and 2 patients and were not statistically significantly different , perhaps due to the small sample size ( n=12 ) of each group . Conclusions The above findings indicate that chemotherapy in ovarian carcinoma leads to an increase in apoptosis by a p53-independent pathway , which involves the downregulation of antiapoptotic Bcl-2 and survivin but not Bcl-XL . Furthermore , administering neoadjuvant chemotherapy ( six cycles ) as an alternative form of therapy for advanced epithelial ovarian cancer is more effective in inducing apoptosis than three cycles . However , the findings of this study need to be corroborated using a larger sample OBJECTIVE This study was aim ed at comparison of neoadjuvant chemotherapy with primary debulking surgery in advanced ovarian carcinoma . METHODS Retrospective analysis of 285 patients with advanced ovarian carcinoma treated between 1980 and 1997 was performed . RESULTS In the period 1980 - 1988 all patients underwent primary debulking surgery and 82 % were cytoreduced to less than 0.5 cm largest residual tumor mass ( n = 112 ) . Analysis of this group of patients showed that some subgroups of patients ( e.g. , Stage IV disease or a total metastatic tumor load of more than 1000 g prior to debulking surgery ) had a poor survival despite cytoreduction to no or less than 1 g of total residual tumor load . The complication rate was high especially in the group with unfavorable prognosis ( postoperative mortality , 6 % ) . In the period 1989 - 1997 ( n = 173 ) the patients were surgically evaluated to receive primary chemotherapy ( 43 % ) or primary debulking surgery ( 57 % ) . Prognostic variables were similar for both treatment periods . The actuarial crude survival was higher in the second time period ( 3-year crude survival of 26 % + /- 4 . 3 and 42 % + /- 4.6 for the first and second time periods , respectively ; P = 0.0001 ) . The postoperative mortality was 0 % during the second time period . From 1993 on , the decision to give neoadjuvant chemotherapy or to perform primary debulking surgery in patients with clinical ly obvious metastatic disease was made with the help of an open laparoscopy ( n = 77 ) . Median duration of the laparoscopy , blood loss , and hospital stay due to this procedure were 25 min , 10 ml , and 2 days . Primary and interval debulking surgery was performed in 36 and 63 % of this subgroup of patients , respectively . CONCLUSION In this retrospective analysis over two different time periods , crude survival was higher when treating about half of the patients with advanced ovarian carcinoma with primary chemotherapy instead of primary debulking surgery . The role of neoadjuvant chemotherapy should be evaluated in a prospect i ve r and omized study PURPOSE To compare self-reported quality of life ( QOL ) in patients who did versus did not undergo interval secondary cytoreduction after initial surgery and combination chemotherapy for advanced ovarian cancer and to assess the association between baseline QOL scores and survival . PATIENTS AND METHODS Consenting patients participating in a Gynecologic Oncology Group ( GOG ) phase III treatment trial ( GOG 152 ) completed the Functional Assessment of Cancer Therapy-Ovarian ( FACT-O ) question naire and treatment-specific supplemental questions at the third and sixth chemotherapy cycles and at 6 and 12 months after starting treatment . RESULTS For all patients , QOL decreased approximately 1 unit from the first to second assessment . Significant improvement observed at 6 months ( P < .001 ) was sustained at 12 months , with no appreciable between-group difference . The baseline FACT-O score was associated with overall survival ( P = .048 ) but not progression-free survival . Less neurotoxicity was reported among patients who did ( 38.4 % ) versus did not ( 54.0 % ) undergo interval secondary cytoreduction at the third assessment ( P = .005 ) , and older patients experienced more long-term effects . CONCLUSION This is the first multicenter r and omized trial in ovarian cancer to longitudinally examine self-reported QOL and establish a predictive value of baseline QOL on survival , attributed primarily to the lowest-scoring quartile . Although interval secondary cytoreduction result ed in no notable long-term difference , a clinical ly significant improvement was seen in both arms at 6 and 12 months after starting therapy . Interestingly , there were fewer complaints of neurotoxicity at 6 months among patients who did versus did not undergo interval secondary cytoreduction Single-agent gemcitabine demonstrated response rates of 11–60 % in platinum/paclitaxel-resistant ovarian cancer . Twenty-four patients with epithelial ovarian cancer were treated with gemcitabine 800 mg/m2 on days 1 and 8 , carboplatin area under the curve 5 on day 1 , and paclitaxel 175 mg/m2 over 3 h on day 1 every 3 weeks for six cycles . Median age was 54 years , and FIGO stage distribution was IIC , 1 patient , III , 18 , and IV , 5 . A total of 22 ( 92 % ) patients completed all the six planned courses of chemotherapy . Doses were reduced in 8 out of 24 ( 33 % ) patients . Of the 
    Output:
    