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: HYPOTHESIS The most common cause of palliative resection and recurrence in gastric cancer is peritoneal seeding . This study evaluates the efficacy of intraperitoneal chemohyperthermia after cytoreductive surgery in patients with peritoneal carcinomatosis arising from gastric cancer . DESIGN Prospect i ve clinical trial . SETTING Surgical department at a university academic hospital . PATIENTS Forty-nine consecutive patients with peritoneal carcinomatosis treated between January 1 , 1989 , and February 29 , 2000 . INTERVENTIONS All patients underwent intraperitoneal chemohyperthermia with mitomycin C ( 40 - 60 mg ) ; 21 patients had previously undergone extensive cytoreductive surgery . MAIN OUTCOME MEASURES Clinicopathologic factors that affect overall survival rates . RESULTS With median follow-up of 99 months , overall median survival was 10.3 months . Two factors were significant independent predictors of survival by multivariate analysis : preoperative ascites ( P = .04 ) and completeness of cancer resection ( CCR ) by cytoreductive surgery ( P<.001 ) . Median survival was 21.3 months for patients with CCR-0 ( macroscopic complete resection ) or CCR-1 ( diameter of residual nodules < 5 mm ) and 6.1 months for patients with CCR-2 ( diameter of residual nodules > 5 mm ) ( P<.001 ) . Four patients survived longer than 5 years . CONCLUSIONS An aggressive management strategy combining intraperitoneal chemohyperthermia with cytoreductive surgery is effective for patients with peritoneal carcinomatosis arising from gastric cancer . In highly selected patients ( good general status , resectable primary tumor , resectable peritoneal carcinomatosis ) , this therapy may result in long-term survival Objective A treatment plan to be used in patients with peritoneal carcinomatosis was devised and tested as a Phase II study . Background Background carcinomatosis from appendical or colorectal cancer has been regarded as a fatal clinical entity . Treatment protocol s have not been reported previously . Methods The authors used cytoreductive surgery and intraperitoneal chemotherapy to treat 181 consecutive patients with peritoneal carcinomatosis . There were 51 patients with colorectal cancer and 130 patients with appendiceal cancer . Mean follow-up is 24 months , with a range of 0 to 149 months . Results Results features that showed prognostic significance included appendiceal versus colorectal primary tumors ( p = 0.0001 ) , grade 1 versus grade s 2 and 3 histopathology ( p = 0.0003 ) , complete versus incomplete cytoreductions ( p = 0.0001 ) , lymph node-negative versus lymph node-positive primary tumors ( p = 0.0001 ) , and volume of peritoneal carcinomatosis present preoperatively for colon cancer ( p = 0.0006 ) . Features with no statistical prognostic significance included preoperative tumor volume for appendiceal cancer , age , sex , number of cycles of chemotherapy , operative time , complications , blood loss , and institution providing treatment . From these prognostic features , four prognostic groups were identified , and 3-year survival was estimated by the product-limit survival method . Group I patients ( n = 76 ) were those with grade 1 histology , no lymph node metastases , and complete cytoreductions ( survival at 3 years = 99 % ) . Group II patients ( n = 23 ) were those with grade 2 or 3 histology , no lymph node metastases , and complete cytoreductions ( 65 % ) . Group III patients ( n = 24 ) had any histology , lymph node metastases , and complete cytoreductions ( 66 % ) . Group IV patients ( n = 58 ) had incomplete cytoreductions ( 20 % ) . Conclusions Conclusions cacinomatosis is a treatable condition in selected patients with the possibility for longterm , disease-free survival Intraperitoneal chemotherapy ( IC ) is emerging as a valuable adjuvant therapeutic modality in patients with gastric cancer . The purpose of this study was to assess morbidity and mortality of early postoperative IC ( EPIC ) in gastric cancer patients . Two hundred forty-eight gastric cancer patients thought to have resectable cancer were r and omized intraoperatively to receive EPIC with mitomycin C on postoperative day 1 and 5-fluorouracil on postoperative days 2 to 5 versus surgery only .  Sixty-four patients who were stage IV at histopathologic examination remain in the analysis . Morbidity and mortality were compared using Fisher 's exact test . All patients completed the therapy . In the study group , overall morbidity was higher than in the control group ( 28.8 % versus 20.3 % , respectively ) , although the difference was not significant ( P = 0.121 ) . Intra-abdominal sepsis without anastomotic leak ( P = 0.008 ) and bleeding ( P = 0.002 ) occurred significantly more often in the study group . Also , 37.6 per cent of patients who received EPIC experienced a variety of minor complications attributable to EPIC .  Postoperative mortality was higher in the study group ( 5.6 % ) than in controls ( 0.8 % ) , but not significantly ( P = 0.299 ) . Patients treated with EPIC  stayed in the hospital an average of 4 days longer ( P = 0.002 ) ; in patients with morbidity , however , there was no difference with the control group . A period analysis of the morbidity demonstrated that it followed the pattern of a learning curve . Surgery with EPIC tended to increase the postoperative morbidity and mortality . The therapy-associated risk must be justified by a significant improvement in survival of treated patients with stage III disease . Selective application of perioperative IC may be indicated OBJECTIVE Surgeons have postulated on numerous occasions that cancer resection may participate in the dissemination of a malignancy . This r and omized trial sought to determine whether a large volume of chemotherapy solution used perioperatively to flood the peritoneal cavity could eliminate microscopic residual disease and thereby improve survival of patients with gastric cancer . SUMMARY BACKGROUND DATA Surgical treatment failures in patients with gastric cancer are confined to the abdomen in most patients . Resection site and peritoneal surface spread , along with liver metastases , are the most common areas of recurrence . Survival and quality of life of patients with gastric cancer would be improved if disease progression at these anatomic sites was reduced . METHODS In a prospect i ve r and omized trial of 248 patients , intraperitoneal mitomycin C on day 1 and intraperitoneal 5-fluorouracil on days 2 through 5 were administered after gastric cancer resection .  Patients who were thought to have stage II or stage III disease were r and omized after resection to surgery alone versus surgery plus early postoperative intraperitoneal chemotherapy . After final pathologic examinations , there were 39 patients with stage I , 50 with stage II 95 with stage III , and 64 with resected stage IV cancer . RESULTS The 5-year survival of the surgery-only group was 29.3 % , and the surgery-plus-intraperitoneal chemotherapy group was 38.7 % ( p = 0.219 ) . In a subset analysis , the patients with stage I , stage II , and stage IV disease showed no statistically significant difference in survival . The 5-year survival rate of patients with stage III disease who underwent surgery only was 18.4 % versus a survival rate of 49.1 % for patients who underwent surgery plus intraperitoneal chemotherapy ( p = 0.011 ) . CONCLUSIONS In a subset analysis , patients with stage III gastric cancer have shown a statistically significant improvement in survival when treated with perioperative intraperitoneal chemotherapy . Further studies in patients with gastric cancer with surgically directed chemotherapy are suggested OBJECTIVE To evaluate the effects of continuous hyperthermic peritoneal perfusion ( CHPP ) together with st and ard chemotherapy on the prognosis of patients with gastric cancer invading the serosa . DESIGN Retrospective study . SETTING University hospital , Japan . SUBJECTS 174 patients who had undergone curative resection for gastric cancer invading the serosa ( T3 ) between 1980 and 1989 , 78 of whom had been r and omised to be treated with CHPP after operation and 96 who received st and ard chemotherapy .  INTERVENTIONS CHPP was done immediately after operation ; 8 - 10 l fluid containing 80 - 100 mg/m2 mitomycin C was perfused at a rate of 100 - 200 ml/minute , and inflow and out flow temperatures were maintained at 44 - 45 degrees C and 40 - 42 degrees C , respectively . This was followed by a st and ard regimen of mitomycin C and 1-(2-tetrahydrofuryl)-5-fluorouracil/uracil ( 1:4 ) ( UFT ) . The control group received the st and ard regimen only . MAIN OUTCOME MEASURES Five year survival and patterns of recurrence in three groups : no lymph node metastases , 1 - 9 , and 10 or more . RESULTS Only in the group with 1 - 9 lymph node metastases was there an appreciable but not significant difference in 5 year survival : 66 % compared with 44 % ( p = 0.084 ) . The mean disease free survival for patients with peritoneal metastases was 30 months in the CHPP group compared with 23 months among the controls . CONCLUSION CHPP improved prognosis in patients with T3 gastric cancer who had only 1 - 9 metastatic lymph nodes Summary The currently accepted therapies for ovarian cancer have produced only limited numbers of extended complete remissions in advanced-stage disease . Studies of high-volume intraperitoneal chemotherapy have been initiated to define the toxicology , pharmacokinetics , and the therapeutic effectiveness of this treatment modality . This technique has been virtually ignored until recently , because little success has been achieved with it except in one study ( Rutledge , 1966 ) , in which large intraperitoneal fluid volumes were used . The general lack of success probably reflects inadequate attention to physiologic and pharmacologic principles of drug distribution and absorption in a space as large as the peritoneal cavity . Biomedical engineers , pharmacologists , and clinicians at the NCI have cooperated in the development of a rational chemotherapy for ovarian cancer . Following mathematical pharmacokinetic modeling and toxicologic studies in rat , a Phase I clinical trial of intraperitoneal methotrexate administered in large volumes of dialysis fluid was initiated . Results in three patients confirm the practicality of this approach , and further investigation is warranted BACKGROUND Promising findings obtained using a weekly regimen of 5-fluorouracil ( 5-FU ) , epidoxorubicin , leucovorin ( LV ) , and cisplatin ( PELFw ) to treat locally advanced and metastatic gastric cancer prompted the Italian Group for the Study of Digestive Tract Cancer ( GISCAD ) to investigate the efficacy of this regimen as adjuvant treatment for high-risk radically resected gastric cancer patients . METHODS From January 1998 to January 2003 , 400 gastric cancer patients at high risk for recurrence including patients with serosal invasion ( stage pT3 N0 ) and /or lymph node metastasis ( stage pT2 or pT3 N1 , N2 , or N3 ) , were enrolled in a trial of adjuvant chemotherapies ; 201 patients were r and omly assigned to receive the  PELFw regimen , consisting of eight weekly administrations of cisplatin ( 40 mg/m2 ) , LV ( 250 mg/m2 ) , epidoxorubicin ( 35 mg/m2 ) , 5-FU ( 500 mg/m2 ) , and glutathione ( 1.5 g/m2 ) with the support of filgrastim , and 196 patients were assigned to a regimen consisting of six monthly administrations of a 5-day course of 5-FU ( 375 mg/m2 daily ) and LV ( 20 mg/m2 daily , 5-FU/LV ) . Disease-free and overall survival were estimated and compared between arms using hazard ratios ( HRs ) and Kaplan-Meier estimates . All statistical tests were two-sided . RESULTS The 5-year survival rates were 52 % in the PELFw arm and 50 % in the 5-FU/LV arm . Compared with the 5-FU/LV regimen , the PELFw regimen did not reduce the risk of death ( HR = 0.95 , 95 % confidence interval [ CI ] = 0.70 to 1.29 ) or relapse ( HR = 0.98 , 95 % CI = 0.75 to 1.29 ) . Less than 10 % of patients in either arm experienced a grade 3 or 4 toxic episode . Neutropenia ( occurring more often in the PELFw arm ) and diarrhea and mucositis 
    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: HYPOTHESIS The most common cause of palliative resection and recurrence in gastric cancer is peritoneal seeding . This study evaluates the efficacy of intraperitoneal chemohyperthermia after cytoreductive surgery in patients with peritoneal carcinomatosis arising from gastric cancer . DESIGN Prospect i ve clinical trial . SETTING Surgical department at a university academic hospital . PATIENTS Forty-nine consecutive patients with peritoneal carcinomatosis treated between January 1 , 1989 , and February 29 , 2000 . INTERVENTIONS All patients underwent intraperitoneal chemohyperthermia with mitomycin C ( 40 - 60 mg ) ; 21 patients had previously undergone extensive cytoreductive surgery . MAIN OUTCOME MEASURES Clinicopathologic factors that affect overall survival rates . RESULTS With median follow-up of 99 months , overall median survival was 10.3 months . Two factors were significant independent predictors of survival by multivariate analysis : preoperative ascites ( P = .04 ) and completeness of cancer resection ( CCR ) by cytoreductive surgery ( P<.001 ) . Median survival was 21.3 months for patients with CCR-0 ( macroscopic complete resection ) or CCR-1 ( diameter of residual nodules < 5 mm ) and 6.1 months for patients with CCR-2 ( diameter of residual nodules > 5 mm ) ( P<.001 ) . Four patients survived longer than 5 years . CONCLUSIONS An aggressive management strategy combining intraperitoneal chemohyperthermia with cytoreductive surgery is effective for patients with peritoneal carcinomatosis arising from gastric cancer . In highly selected patients ( good general status , resectable primary tumor , resectable peritoneal carcinomatosis ) , this therapy may result in long-term survival Objective A treatment plan to be used in patients with peritoneal carcinomatosis was devised and tested as a Phase II study . Background Background carcinomatosis from appendical or colorectal cancer has been regarded as a fatal clinical entity . Treatment protocol s have not been reported previously . Methods The authors used cytoreductive surgery and intraperitoneal chemotherapy to treat 181 consecutive patients with peritoneal carcinomatosis . There were 51 patients with colorectal cancer and 130 patients with appendiceal cancer . Mean follow-up is 24 months , with a range of 0 to 149 months . Results Results features that showed prognostic significance included appendiceal versus colorectal primary tumors ( p = 0.0001 ) , grade 1 versus grade s 2 and 3 histopathology ( p = 0.0003 ) , complete versus incomplete cytoreductions ( p = 0.0001 ) , lymph node-negative versus lymph node-positive primary tumors ( p = 0.0001 ) , and volume of peritoneal carcinomatosis present preoperatively for colon cancer ( p = 0.0006 ) . Features with no statistical prognostic significance included preoperative tumor volume for appendiceal cancer , age , sex , number of cycles of chemotherapy , operative time , complications , blood loss , and institution providing treatment . From these prognostic features , four prognostic groups were identified , and 3-year survival was estimated by the product-limit survival method . Group I patients ( n = 76 ) were those with grade 1 histology , no lymph node metastases , and complete cytoreductions ( survival at 3 years = 99 % ) . Group II patients ( n = 23 ) were those with grade 2 or 3 histology , no lymph node metastases , and complete cytoreductions ( 65 % ) . Group III patients ( n = 24 ) had any histology , lymph node metastases , and complete cytoreductions ( 66 % ) . Group IV patients ( n = 58 ) had incomplete cytoreductions ( 20 % ) . Conclusions Conclusions cacinomatosis is a treatable condition in selected patients with the possibility for longterm , disease-free survival Intraperitoneal chemotherapy ( IC ) is emerging as a valuable adjuvant therapeutic modality in patients with gastric cancer . The purpose of this study was to assess morbidity and mortality of early postoperative IC ( EPIC ) in gastric cancer patients . Two hundred forty-eight gastric cancer patients thought to have resectable cancer were r and omized intraoperatively to receive EPIC with mitomycin C on postoperative day 1 and 5-fluorouracil on postoperative days 2 to 5 versus surgery only .  Sixty-four patients who were stage IV at histopathologic examination remain in the analysis . Morbidity and mortality were compared using Fisher 's exact test . All patients completed the therapy . In the study group , overall morbidity was higher than in the control group ( 28.8 % versus 20.3 % , respectively ) , although the difference was not significant ( P = 0.121 ) . Intra-abdominal sepsis without anastomotic leak ( P = 0.008 ) and bleeding ( P = 0.002 ) occurred significantly more often in the study group . Also , 37.6 per cent of patients who received EPIC experienced a variety of minor complications attributable to EPIC .  Postoperative mortality was higher in the study group ( 5.6 % ) than in controls ( 0.8 % ) , but not significantly ( P = 0.299 ) . Patients treated with EPIC  stayed in the hospital an average of 4 days longer ( P = 0.002 ) ; in patients with morbidity , however , there was no difference with the control group . A period analysis of the morbidity demonstrated that it followed the pattern of a learning curve . Surgery with EPIC tended to increase the postoperative morbidity and mortality . The therapy-associated risk must be justified by a significant improvement in survival of treated patients with stage III disease . Selective application of perioperative IC may be indicated OBJECTIVE Surgeons have postulated on numerous occasions that cancer resection may participate in the dissemination of a malignancy . This r and omized trial sought to determine whether a large volume of chemotherapy solution used perioperatively to flood the peritoneal cavity could eliminate microscopic residual disease and thereby improve survival of patients with gastric cancer . SUMMARY BACKGROUND DATA Surgical treatment failures in patients with gastric cancer are confined to the abdomen in most patients . Resection site and peritoneal surface spread , along with liver metastases , are the most common areas of recurrence . Survival and quality of life of patients with gastric cancer would be improved if disease progression at these anatomic sites was reduced . METHODS In a prospect i ve r and omized trial of 248 patients , intraperitoneal mitomycin C on day 1 and intraperitoneal 5-fluorouracil on days 2 through 5 were administered after gastric cancer resection .  Patients who were thought to have stage II or stage III disease were r and omized after resection to surgery alone versus surgery plus early postoperative intraperitoneal chemotherapy . After final pathologic examinations , there were 39 patients with stage I , 50 with stage II 95 with stage III , and 64 with resected stage IV cancer . RESULTS The 5-year survival of the surgery-only group was 29.3 % , and the surgery-plus-intraperitoneal chemotherapy group was 38.7 % ( p = 0.219 ) . In a subset analysis , the patients with stage I , stage II , and stage IV disease showed no statistically significant difference in survival . The 5-year survival rate of patients with stage III disease who underwent surgery only was 18.4 % versus a survival rate of 49.1 % for patients who underwent surgery plus intraperitoneal chemotherapy ( p = 0.011 ) . CONCLUSIONS In a subset analysis , patients with stage III gastric cancer have shown a statistically significant improvement in survival when treated with perioperative intraperitoneal chemotherapy . Further studies in patients with gastric cancer with surgically directed chemotherapy are suggested OBJECTIVE To evaluate the effects of continuous hyperthermic peritoneal perfusion ( CHPP ) together with st and ard chemotherapy on the prognosis of patients with gastric cancer invading the serosa . DESIGN Retrospective study . SETTING University hospital , Japan . SUBJECTS 174 patients who had undergone curative resection for gastric cancer invading the serosa ( T3 ) between 1980 and 1989 , 78 of whom had been r and omised to be treated with CHPP after operation and 96 who received st and ard chemotherapy .  INTERVENTIONS CHPP was done immediately after operation ; 8 - 10 l fluid containing 80 - 100 mg/m2 mitomycin C was perfused at a rate of 100 - 200 ml/minute , and inflow and out flow temperatures were maintained at 44 - 45 degrees C and 40 - 42 degrees C , respectively . This was followed by a st and ard regimen of mitomycin C and 1-(2-tetrahydrofuryl)-5-fluorouracil/uracil ( 1:4 ) ( UFT ) . The control group received the st and ard regimen only . MAIN OUTCOME MEASURES Five year survival and patterns of recurrence in three groups : no lymph node metastases , 1 - 9 , and 10 or more . RESULTS Only in the group with 1 - 9 lymph node metastases was there an appreciable but not significant difference in 5 year survival : 66 % compared with 44 % ( p = 0.084 ) . The mean disease free survival for patients with peritoneal metastases was 30 months in the CHPP group compared with 23 months among the controls . CONCLUSION CHPP improved prognosis in patients with T3 gastric cancer who had only 1 - 9 metastatic lymph nodes Summary The currently accepted therapies for ovarian cancer have produced only limited numbers of extended complete remissions in advanced-stage disease . Studies of high-volume intraperitoneal chemotherapy have been initiated to define the toxicology , pharmacokinetics , and the therapeutic effectiveness of this treatment modality . This technique has been virtually ignored until recently , because little success has been achieved with it except in one study ( Rutledge , 1966 ) , in which large intraperitoneal fluid volumes were used . The general lack of success probably reflects inadequate attention to physiologic and pharmacologic principles of drug distribution and absorption in a space as large as the peritoneal cavity . Biomedical engineers , pharmacologists , and clinicians at the NCI have cooperated in the development of a rational chemotherapy for ovarian cancer . Following mathematical pharmacokinetic modeling and toxicologic studies in rat , a Phase I clinical trial of intraperitoneal methotrexate administered in large volumes of dialysis fluid was initiated . Results in three patients confirm the practicality of this approach , and further investigation is warranted BACKGROUND Promising findings obtained using a weekly regimen of 5-fluorouracil ( 5-FU ) , epidoxorubicin , leucovorin ( LV ) , and cisplatin ( PELFw ) to treat locally advanced and metastatic gastric cancer prompted the Italian Group for the Study of Digestive Tract Cancer ( GISCAD ) to investigate the efficacy of this regimen as adjuvant treatment for high-risk radically resected gastric cancer patients . METHODS From January 1998 to January 2003 , 400 gastric cancer patients at high risk for recurrence including patients with serosal invasion ( stage pT3 N0 ) and /or lymph node metastasis ( stage pT2 or pT3 N1 , N2 , or N3 ) , were enrolled in a trial of adjuvant chemotherapies ; 201 patients were r and omly assigned to receive the  PELFw regimen , consisting of eight weekly administrations of cisplatin ( 40 mg/m2 ) , LV ( 250 mg/m2 ) , epidoxorubicin ( 35 mg/m2 ) , 5-FU ( 500 mg/m2 ) , and glutathione ( 1.5 g/m2 ) with the support of filgrastim , and 196 patients were assigned to a regimen consisting of six monthly administrations of a 5-day course of 5-FU ( 375 mg/m2 daily ) and LV ( 20 mg/m2 daily , 5-FU/LV ) . Disease-free and overall survival were estimated and compared between arms using hazard ratios ( HRs ) and Kaplan-Meier estimates . All statistical tests were two-sided . RESULTS The 5-year survival rates were 52 % in the PELFw arm and 50 % in the 5-FU/LV arm . Compared with the 5-FU/LV regimen , the PELFw regimen did not reduce the risk of death ( HR = 0.95 , 95 % confidence interval [ CI ] = 0.70 to 1.29 ) or relapse ( HR = 0.98 , 95 % CI = 0.75 to 1.29 ) . Less than 10 % of patients in either arm experienced a grade 3 or 4 toxic episode . Neutropenia ( occurring more often in the PELFw arm ) and diarrhea and mucositis 
    Output:
    