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 To determine whether the addition of cisplatin-based chemotherapy ( CT ) to pelvic radiation therapy ( RT ) will improve the survival of early-stage , high-risk patients with cervical carcinoma . PATIENTS AND METHODS Patients with clinical stage IA(2 ) , IB , and IIA carcinoma of the cervix , initially treated with radical hysterectomy and pelvic lymphadenectomy , and who had positive pelvic lymph nodes and /or positive margins and /or microscopic involvement of the parametrium were eligible for this study . Patients were r and omized to receive RT or RT + CT . Patients in each group received 49.3 GY RT in 29 fractions to a st and ard pelvic field . Chemotherapy consisted of bolus cisplatin 70 mg/m(2 ) and a 96-hour infusion of fluorouracil 1,000 mg/m(2)/d every 3 weeks for four cycles , with the first and second cycles given concurrent to RT . RESULTS Between 1991 and 1996 , 268 patients were entered onto the study . Two hundred forty-three patients were assessable ( 127 RT + CT patients and 116 RT patients ) .  Progression-free and overall survival are significantly improved in the patients receiving CT . The hazard ratios for progression-free survival and overall survival in the RT only arm versus the RT + CT arm are 2.01 ( P = .003 ) and 1.96 ( P = . 007 ) , respectively . The projected progression-free survivals at 4 years is 63 % with RT and 80 % with RT + CT . The projected overall survival rate at 4 years is 71 % with RT and 81 % with RT + CT . Grade s 3 and 4 hematologic and gastrointestinal toxicity were more frequent in the RT + CT group . CONCLUSION The addition of concurrent cisplatin-based CT to RT significantly improves progression-free and overall survival for high-risk , early-stage patients who undergo radical hysterectomy and pelvic lymphadenectomy for carcinoma of the cervix BACKGROUND Stage Ib and IIa cervical carcinoma can be cured by radical surgery or radiotherapy . These two procedures are equally effective , but differ in associated morbidity and type of complications . In this prospect i ve r and omised trial of radiotherapy versus surgery , our aim was to assess the 5-year survival and the rate and pattern of complications and recurrences associated with each treatment . METHODS Between September , 1986 , and December , 1991 , 469 women with newly diagnosed stage Ib and IIa cervical carcinoma were referred to our institute . 343 eligible patients were r and omised : 172 to surgery and 171 to radical radiotherapy . Adjuvant radiotherapy was delivered after surgery for women with surgical stage pT2b or greater , less than 3 mm of safe cervical stroma , cut-through , or positive nodes . The primary outcome measures were 5-year survival and the rate of complications . The analysis of survival and recurrence was by intention to treat and analysis of complications was by treatment delivered . FINDINGS 170 patients in the surgery group and 167 in the radiotherapy group were included in the intention-to-treat analysis ; scheduled treatment was delivered to 169 and 158 women , respectively , 62 of 114 women with cervical diameters of 4 cm or smaller and 46 of 55 with diameters larger than 4 cm received adjuvant therapy . After a median follow-up of 87 ( range 57 - 120 ) months , 5-year overall and disease-free survival were identical in the surgery and radiotherapy groups ( 83 % and 74 % , respectively , for both groups ) , 86 women developed recurrent disease : 42 ( 25 % ) in the surgery group and 44 ( 26 % ) in the radiotherapy group . Significant factors for survival in univariate and multivariate analyses were : cervical diameter , positive lymphangiography , and adeno-carcinomatous histotype . 48 ( 28 % ) surgery-group patients had severe morbidity compared with 19 ( 12 % ) radiotherapy-group patients ( p = 0.0004 ) . INTERPRETATION There is no treatment of choice for early-stage cervical carcinoma in terms of overall or disease-free survival . The combination of surgery and radiotherapy has the worst morbidity , especially urological complications . The optimum therapy for each patient should take account of clinical factors such as menopausal status , age , medical illness , histological type , and cervical diameter to yield the best cure with minimum complications A prospect i ve study of the treatment of 119 patients with Stage I carcinoma of the cervix by radical hysterectomy alone ( 58 patients ) or radiotherapy alone ( 61 patients ) was undertaken between Jan. 1 , 1956 , and May 31 , 1966 . Eighty-one per cent of the patients treated by radical hysterectomy  survived 5 years as compared with 74 per cent of those treated by radiotherapy . The 10 year survival rates were 75 and 65 per cent , respectively . These differences were not statistically significant . Complications of treatment were relatively few except for a greater incidence of urinary tract problems after surgical treatment ; most of these were resolved with restoration of normal function . When recurrence occurred in the surgical series further treatment by radiotherapy offered a reasonable prospect of survival . Failure of radiotherapy  left relatively little opportunity for later treatment by operation BACKGROUND AND METHODS On behalf of the Gynecologic Oncology Group , we performed a r and omized trial of radiotherapy in combination with three concurrent chemotherapy regimens -- cisplatin alone ; cisplatin , fluorouracil , and hydroxyurea ; and hydroxyurea alone -- in patients with locally advanced cervical cancer . Women with primary untreated invasive squamous-cell carcinoma , adenosquamous carcinoma , or adenocarcinoma of the cervix of stage IIB , III , or IVA , without involvement of the para-aortic lymph nodes , were enrolled . The patients had to have a leukocyte count of at least 3000 per cubic millimeter , a platelet count of at least 100,000 per cubic millimeter , a serum creatinine level no higher than 2 mg per deciliter ( 177 micromol per liter ) , and adequate hepatic function . All patients received external-beam radiotherapy according to a strict protocol . Patients were r and omly assigned to receive one of three chemotherapy regimens : 40 mg of cisplatin per square meter of body-surface area per week for six weeks ( group 1 ) ; 50 mg of cisplatin per square meter on days 1 and 29 , followed by 4 g of fluorouracil per square meter given as a 96-hour infusion on days 1 and 29 , and 2 g of oral hydroxyurea per square meter twice weekly for six weeks ( group 2 ) ; or 3 g of oral hydroxyurea per square meter twice weekly for six weeks ( group 3 ) . RESULTS The analysis included 526 women . The median duration of follow-up was 35 months . Both groups that received cisplatin had a higher rate of progression-free survival than the group that received hydroxyurea alone ( P<0.001 for both comparisons ) . The relative risks of progression of disease or death were 0.57 ( 95 percent confidence interval , 0.42 to 0.78 ) in group 1 and 0.55 ( 95 percent confidence interval , 0.40 to 0.75 ) in group 2 , as compared with group 3 . The overall survival rate was significantly higher in groups 1 and 2 than in group 3 , with relative risks of death of 0.61 ( 95 percent confidence interval , 0.44 to 0.85 ) and 0.58 ( 95 percent confidence interval , 0.41 to 0.81 ) , respectively . CONCLUSIONS Regimens of radiotherapy and chemotherapy that contain cisplatin improve the rates of survival and progression-free survival among women with locally advanced cervical cancer Ninety-two consecutive patients with stages IB and IIA carcinoma of the cervix were treated by one of two regimens : pre-operative intracavitary caesium-137 followed by a Wertheim hysterectomy ( group 1 ) or staging laparotomy with biopsy of suspicious lymph nodes ( group 2 ) ( if there was no evidence of tumour on examination of a frozen section of the lymph nodes a Wertheim hysterectomy was performed , but if a tumour was present the abdomen was closed and a course of radical irradiation given ) . When there was evidence of extracervical spread on examination of the specimen after the Wertheim hysterectomy , postoperative irradiation was given . It was found that clinical staging had been incorrect in 38,5 % of patients thought to have stage IB disease and in 71,4 % of those thought to have stage IIA disease . The actuarial survival curves showed no significant statistical difference between group 1 and group 2 . When examination of the operative specimen showed tumour invasion of the parametrium only , the disease was well controlled by postoperative irradiation ( all 7 such patients survived ) . On the other h and , when there was evidence of tumour invasion of pelvic lymph nodes the 4-year survival rate fell to 31 % ( 4 out of 13 patients ) , despite the use of postoperative irradiation BACKGROUND Bulky stage IB cervical cancers have a poorer prognosis than smaller stage I cervical cancers . For the Gynecologic Oncology Group , we conducted a trial to determine whether weekly infusions of cisplatin during radiotherapy improve progression-free and overall survival among patients with bulky stage IB cervical cancer . METHODS Women with bulky stage IB cervical cancers ( tumor , > or = 4 cm in diameter ) were r and omly assigned to receive radiotherapy alone or in combination with cisplatin ( 40 mg per square meter of body-surface area once a week for up to six doses ; maximal weekly dose , 70 mg ) , followed in all patients by adjuvant hysterectomy .  Women with evidence of lymphadenopathy on computed tomographic scanning or lymphangiography were ineligible unless histologic analysis showed that there was no lymph-node involvement . The cumulative dose of external pelvic and intracavitary radiation was 75 Gy to point A ( cervical parametrium ) and 55 Gy to point B ( pelvic wall ) . Cisplatin was given during external radiotherapy , and adjuvant hysterectomy was performed three to six weeks later . RESULTS The relative risks of progression of disease and death among the 183 women assigned to receive radiotherapy and chemotherapy with cisplatin  , as compared with the 186 women assigned to receive radiotherapy alone , were 0.51 ( 95 percent confidence interval , 0.34 to 0.75 ) and 0.54 ( 95 percent confidence interval , 0.34 to 0.86 ) , respectively . The rates of both progression-free survival ( P<0.001 ) and overall survival ( P=0.008 ) were significantly higher in the combined-therapy group at four years . In the combined-therapy group there were higher frequencies of transient grade 3 ( moderate ) and grade 4 ( severe ) adverse hematologic effects ( 21 percent , vs. 2 percent in the radiotherapy group ) and adverse gastrointestinal effects ( 14 percent vs. 5 percent ) . CONCLUSIONS Adding weekly infusions of cisplatin to pelvic radiotherapy followed by hysterectomy significantly reduced the risk of disease recurrence and death in women with bulky stage IB cervical cancers To investigate whether surgery or radiotherapy should be preferred in the early stages of carcinoma of the cervix a r and omized study was performed in which operable patients with small FIGO stage 2 squamous cell carcinoma were included . Of these patients , 122 were in stage 2A and 20 in stage 2B . The patients were treated with intracavitary radium , followed by either radical surgery with pelvic lymphadenectomy ( Group A , 72 patients ) or high-voltage external irradiation 40 Gy to a pelvic field ( Group B , 70 patients ) . Postoperative irradiation 40 to 50 Gy was given in Group A if lymph node metastases were found at operation . Fourteen patients in Group A and 23 in Group B died of recurrent disease . The 5- , 10- , and 20-year survival in Group A was 87 , 84 and 81 % respectively compared with 72 , 69 , and 68 % in Group B , p < 0.05 . Twenty-three ( 34 % ) of 67 radically operated patients had metastases to pelvic lymph nodes . A high rate of pelvic and para-aortic recurrences accounts for the difference between Groups A and B. Young patients ( < 40 years ) with large tumours had a high risk of recurrent disease . Severe urinary and gastrointestinal complications were more common in Group A , especially among patients given postoperative radiotherapy .  Lymphoedema was seen almost exclusively in Group A. Two patients in Group A and one in Group B died of complications to treatment . The corrected 10-year survival of 69.5 % as achieved in the radiotherapy arm of this series is comparable to other reported studies . 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: PURPOSE To determine whether the addition of cisplatin-based chemotherapy ( CT ) to pelvic radiation therapy ( RT ) will improve the survival of early-stage , high-risk patients with cervical carcinoma . PATIENTS AND METHODS Patients with clinical stage IA(2 ) , IB , and IIA carcinoma of the cervix , initially treated with radical hysterectomy and pelvic lymphadenectomy , and who had positive pelvic lymph nodes and /or positive margins and /or microscopic involvement of the parametrium were eligible for this study . Patients were r and omized to receive RT or RT + CT . Patients in each group received 49.3 GY RT in 29 fractions to a st and ard pelvic field . Chemotherapy consisted of bolus cisplatin 70 mg/m(2 ) and a 96-hour infusion of fluorouracil 1,000 mg/m(2)/d every 3 weeks for four cycles , with the first and second cycles given concurrent to RT . RESULTS Between 1991 and 1996 , 268 patients were entered onto the study . Two hundred forty-three patients were assessable ( 127 RT + CT patients and 116 RT patients ) .  Progression-free and overall survival are significantly improved in the patients receiving CT . The hazard ratios for progression-free survival and overall survival in the RT only arm versus the RT + CT arm are 2.01 ( P = .003 ) and 1.96 ( P = . 007 ) , respectively . The projected progression-free survivals at 4 years is 63 % with RT and 80 % with RT + CT . The projected overall survival rate at 4 years is 71 % with RT and 81 % with RT + CT . Grade s 3 and 4 hematologic and gastrointestinal toxicity were more frequent in the RT + CT group . CONCLUSION The addition of concurrent cisplatin-based CT to RT significantly improves progression-free and overall survival for high-risk , early-stage patients who undergo radical hysterectomy and pelvic lymphadenectomy for carcinoma of the cervix BACKGROUND Stage Ib and IIa cervical carcinoma can be cured by radical surgery or radiotherapy . These two procedures are equally effective , but differ in associated morbidity and type of complications . In this prospect i ve r and omised trial of radiotherapy versus surgery , our aim was to assess the 5-year survival and the rate and pattern of complications and recurrences associated with each treatment . METHODS Between September , 1986 , and December , 1991 , 469 women with newly diagnosed stage Ib and IIa cervical carcinoma were referred to our institute . 343 eligible patients were r and omised : 172 to surgery and 171 to radical radiotherapy . Adjuvant radiotherapy was delivered after surgery for women with surgical stage pT2b or greater , less than 3 mm of safe cervical stroma , cut-through , or positive nodes . The primary outcome measures were 5-year survival and the rate of complications . The analysis of survival and recurrence was by intention to treat and analysis of complications was by treatment delivered . FINDINGS 170 patients in the surgery group and 167 in the radiotherapy group were included in the intention-to-treat analysis ; scheduled treatment was delivered to 169 and 158 women , respectively , 62 of 114 women with cervical diameters of 4 cm or smaller and 46 of 55 with diameters larger than 4 cm received adjuvant therapy . After a median follow-up of 87 ( range 57 - 120 ) months , 5-year overall and disease-free survival were identical in the surgery and radiotherapy groups ( 83 % and 74 % , respectively , for both groups ) , 86 women developed recurrent disease : 42 ( 25 % ) in the surgery group and 44 ( 26 % ) in the radiotherapy group . Significant factors for survival in univariate and multivariate analyses were : cervical diameter , positive lymphangiography , and adeno-carcinomatous histotype . 48 ( 28 % ) surgery-group patients had severe morbidity compared with 19 ( 12 % ) radiotherapy-group patients ( p = 0.0004 ) . INTERPRETATION There is no treatment of choice for early-stage cervical carcinoma in terms of overall or disease-free survival . The combination of surgery and radiotherapy has the worst morbidity , especially urological complications . The optimum therapy for each patient should take account of clinical factors such as menopausal status , age , medical illness , histological type , and cervical diameter to yield the best cure with minimum complications A prospect i ve study of the treatment of 119 patients with Stage I carcinoma of the cervix by radical hysterectomy alone ( 58 patients ) or radiotherapy alone ( 61 patients ) was undertaken between Jan. 1 , 1956 , and May 31 , 1966 . Eighty-one per cent of the patients treated by radical hysterectomy  survived 5 years as compared with 74 per cent of those treated by radiotherapy . The 10 year survival rates were 75 and 65 per cent , respectively . These differences were not statistically significant . Complications of treatment were relatively few except for a greater incidence of urinary tract problems after surgical treatment ; most of these were resolved with restoration of normal function . When recurrence occurred in the surgical series further treatment by radiotherapy offered a reasonable prospect of survival . Failure of radiotherapy  left relatively little opportunity for later treatment by operation BACKGROUND AND METHODS On behalf of the Gynecologic Oncology Group , we performed a r and omized trial of radiotherapy in combination with three concurrent chemotherapy regimens -- cisplatin alone ; cisplatin , fluorouracil , and hydroxyurea ; and hydroxyurea alone -- in patients with locally advanced cervical cancer . Women with primary untreated invasive squamous-cell carcinoma , adenosquamous carcinoma , or adenocarcinoma of the cervix of stage IIB , III , or IVA , without involvement of the para-aortic lymph nodes , were enrolled . The patients had to have a leukocyte count of at least 3000 per cubic millimeter , a platelet count of at least 100,000 per cubic millimeter , a serum creatinine level no higher than 2 mg per deciliter ( 177 micromol per liter ) , and adequate hepatic function . All patients received external-beam radiotherapy according to a strict protocol . Patients were r and omly assigned to receive one of three chemotherapy regimens : 40 mg of cisplatin per square meter of body-surface area per week for six weeks ( group 1 ) ; 50 mg of cisplatin per square meter on days 1 and 29 , followed by 4 g of fluorouracil per square meter given as a 96-hour infusion on days 1 and 29 , and 2 g of oral hydroxyurea per square meter twice weekly for six weeks ( group 2 ) ; or 3 g of oral hydroxyurea per square meter twice weekly for six weeks ( group 3 ) . RESULTS The analysis included 526 women . The median duration of follow-up was 35 months . Both groups that received cisplatin had a higher rate of progression-free survival than the group that received hydroxyurea alone ( P<0.001 for both comparisons ) . The relative risks of progression of disease or death were 0.57 ( 95 percent confidence interval , 0.42 to 0.78 ) in group 1 and 0.55 ( 95 percent confidence interval , 0.40 to 0.75 ) in group 2 , as compared with group 3 . The overall survival rate was significantly higher in groups 1 and 2 than in group 3 , with relative risks of death of 0.61 ( 95 percent confidence interval , 0.44 to 0.85 ) and 0.58 ( 95 percent confidence interval , 0.41 to 0.81 ) , respectively . CONCLUSIONS Regimens of radiotherapy and chemotherapy that contain cisplatin improve the rates of survival and progression-free survival among women with locally advanced cervical cancer Ninety-two consecutive patients with stages IB and IIA carcinoma of the cervix were treated by one of two regimens : pre-operative intracavitary caesium-137 followed by a Wertheim hysterectomy ( group 1 ) or staging laparotomy with biopsy of suspicious lymph nodes ( group 2 ) ( if there was no evidence of tumour on examination of a frozen section of the lymph nodes a Wertheim hysterectomy was performed , but if a tumour was present the abdomen was closed and a course of radical irradiation given ) . When there was evidence of extracervical spread on examination of the specimen after the Wertheim hysterectomy , postoperative irradiation was given . It was found that clinical staging had been incorrect in 38,5 % of patients thought to have stage IB disease and in 71,4 % of those thought to have stage IIA disease . The actuarial survival curves showed no significant statistical difference between group 1 and group 2 . When examination of the operative specimen showed tumour invasion of the parametrium only , the disease was well controlled by postoperative irradiation ( all 7 such patients survived ) . On the other h and , when there was evidence of tumour invasion of pelvic lymph nodes the 4-year survival rate fell to 31 % ( 4 out of 13 patients ) , despite the use of postoperative irradiation BACKGROUND Bulky stage IB cervical cancers have a poorer prognosis than smaller stage I cervical cancers . For the Gynecologic Oncology Group , we conducted a trial to determine whether weekly infusions of cisplatin during radiotherapy improve progression-free and overall survival among patients with bulky stage IB cervical cancer . METHODS Women with bulky stage IB cervical cancers ( tumor , > or = 4 cm in diameter ) were r and omly assigned to receive radiotherapy alone or in combination with cisplatin ( 40 mg per square meter of body-surface area once a week for up to six doses ; maximal weekly dose , 70 mg ) , followed in all patients by adjuvant hysterectomy .  Women with evidence of lymphadenopathy on computed tomographic scanning or lymphangiography were ineligible unless histologic analysis showed that there was no lymph-node involvement . The cumulative dose of external pelvic and intracavitary radiation was 75 Gy to point A ( cervical parametrium ) and 55 Gy to point B ( pelvic wall ) . Cisplatin was given during external radiotherapy , and adjuvant hysterectomy was performed three to six weeks later . RESULTS The relative risks of progression of disease and death among the 183 women assigned to receive radiotherapy and chemotherapy with cisplatin  , as compared with the 186 women assigned to receive radiotherapy alone , were 0.51 ( 95 percent confidence interval , 0.34 to 0.75 ) and 0.54 ( 95 percent confidence interval , 0.34 to 0.86 ) , respectively . The rates of both progression-free survival ( P<0.001 ) and overall survival ( P=0.008 ) were significantly higher in the combined-therapy group at four years . In the combined-therapy group there were higher frequencies of transient grade 3 ( moderate ) and grade 4 ( severe ) adverse hematologic effects ( 21 percent , vs. 2 percent in the radiotherapy group ) and adverse gastrointestinal effects ( 14 percent vs. 5 percent ) . CONCLUSIONS Adding weekly infusions of cisplatin to pelvic radiotherapy followed by hysterectomy significantly reduced the risk of disease recurrence and death in women with bulky stage IB cervical cancers To investigate whether surgery or radiotherapy should be preferred in the early stages of carcinoma of the cervix a r and omized study was performed in which operable patients with small FIGO stage 2 squamous cell carcinoma were included . Of these patients , 122 were in stage 2A and 20 in stage 2B . The patients were treated with intracavitary radium , followed by either radical surgery with pelvic lymphadenectomy ( Group A , 72 patients ) or high-voltage external irradiation 40 Gy to a pelvic field ( Group B , 70 patients ) . Postoperative irradiation 40 to 50 Gy was given in Group A if lymph node metastases were found at operation . Fourteen patients in Group A and 23 in Group B died of recurrent disease . The 5- , 10- , and 20-year survival in Group A was 87 , 84 and 81 % respectively compared with 72 , 69 , and 68 % in Group B , p < 0.05 . Twenty-three ( 34 % ) of 67 radically operated patients had metastases to pelvic lymph nodes . A high rate of pelvic and para-aortic recurrences accounts for the difference between Groups A and B. Young patients ( < 40 years ) with large tumours had a high risk of recurrent disease . Severe urinary and gastrointestinal complications were more common in Group A , especially among patients given postoperative radiotherapy .  Lymphoedema was seen almost exclusively in Group A. Two patients in Group A and one in Group B died of complications to treatment . The corrected 10-year survival of 69.5 % as achieved in the radiotherapy arm of this series is comparable to other reported studies . The 
    Output:
    