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 We examined the rate of acute skin toxicity within a prospect ively managed data base of patients treated for early-stage non-small-cell lung cancer ( NSCLC ) and investigated factors that might predict skin toxicity . METHODS From May 2006 through January 2008 , 50 patients with Stage I NSCLC were treated at Memorial Sloan-Kettering Cancer Center with 60 Gy in three fractions or 44 - 48 Gy in four fractions .  Patients were treated with multiple coplanar beams ( 3 - 7 , median 4 ) with a 6 MV linac using intensity-modulated radiotherapy ( IMRT ) and dynamic multileaf collimation .  Toxicity grading was performed and based on the National Cancer Institute Common Terminology Criteria for Adverse Effects . Factors associated with Grade 2 or higher acute skin reactions were calculated by Fisher 's exact test . RESULTS After a minimum 3 months of follow-up , 19 patients ( 38 % ) developed Grade 1 , 4 patients ( 8 % ) Grade 2 , 2 patients ( 4 % ) Grade 3 , and 1 patient Grade 4 acute skin toxicity . Factors associated with Grade 2 or higher acute skin toxicity included using only 3 beams ( p = 0.0007 ) , distance from the tumor to the posterior chest wall skin of less than 5 cm ( p = 0.006 ) , and a maximum skin dose of 50 % or higher of the prescribed dose ( p = 0.02 ) . CONCLUSIONS SBRT can be associated with significant skin toxicity . One must consider the skin dose when evaluating the treatment plan and consider the bolus effect of immobilization devices PURPOSE To present the results of stereotactic body radiotherapy ( SBRT ) for medically inoperable patients with Stage I non-small-cell lung cancer ( NSCLC ) and contrast outcomes in patients with and without a pathologic diagnosis . METHODS AND MATERIAL S Between December 2004 and October 2008 , 108 patients ( 114 tumors ) underwent treatment according to the prospect i ve research ethics board-approved SBRT protocol s at our cancer center . Of the 108 patients , 88 ( 81.5 % ) had undergone pretreatment whole-body [18F]-fluorodeoxyglucose positron emission tomography/computed tomography .  A pathologic diagnosis was unavailable for 33 ( 28.9 % ) of the 114 lesions . The SBRT schedules included 48 Gy in 4 fractions or 54 - 60 Gy in 3 fractions for peripheral lesions and 50 - 60 Gy in 8 - 10 fractions for central lesions . Toxicity and radiologic response were assessed at the 3 - 6-month follow-up visits using conventional criteria . RESULTS The mean tumor diameter was 2.4-cm ( range , 0.9 - 5.7 ) . The median follow-up was 19.1 months ( range , 1 - 55.7 ) . The estimated local control rate at 1 and 4 years was 92 % ( 95 % confidence interval [ CI ] , 86 - 97 % ) and 89 % ( 95 % CI , 81 - 96 % ) . The cause-specific survival rate at 1 and 4 years was 92 % ( 95 % CI , 87 - 98 % ) and 77 % ( 95 % CI , 64 - 89 % ) , respectively . No statistically significant difference was found in the local , regional , and distant control between patients with and without pathologically confirmed NSCLC . The most common acute toxicity was Grade 1 or 2 fatigue ( 53 of 108 patients ) . No toxicities of Grade 4 or greater were identified . CONCLUSIONS Lung SBRT for early-stage NSCLC result ed in excellent local control and cause-specific survival with minimal toxicity . The disease-specific outcomes were comparable for patients with and without a pathologic diagnosis . SBRT can be considered an option for selected patients with proven or presumed early-stage NSCLC Abstract Introduction . Stereotactic body radiation therapy ( SBRT ) for early stage non-small cell lung cancer ( NSCLC ) is now an accepted and patient friendly treatment , but still controversy exists about its comparability to conventional radiation therapy ( RT ) . The purpose of this single-institutional report is to describe survival outcome for medically inoperable patients with early stage NSCLC treated with SBRT compared with high dose conventional RT . Material and methods . From August 2005 to June 2012 , 100 medically inoperable patients were treated with SBRT at Odense University Hospital . The thoracic RT consisted of 3 fractions ( F ) of 15–22 Gy delivered in nine days . For comparison a group of 32 medically inoperable patients treated with conventional RT with 80 Gy/35–40  F ( 5 F/week ) in the period of July 1998 to August 2011 were analyzed . All tumors had histological or cytological proven NSCLC T1 - 2N0M0 . Results . The median overall survival was 36.1 months versus 24.4 months for SBRT and conventional RT , respectively ( p = 0.015 ) . Local failure-free survival rates at one year were in SBRT group 93 % versus 89 % in the conventional RT group and at five years 69 % versus 66 % , SBRT and conventional RT respectively ( p = 0.99 ) . On multivariate analysis , female gender and performance status of 0–1 and SBRT predicted improved prognosis . Conclusion . In a cohort of patients with NSCLC there was a significant difference in overall survival  favoring SBRT . Performance status of 0–1 , female gender and SBRT predicted improved prognosis . However , staging procedure , confirmation procedure of recurrence and technical improvements of radiation treatment is likely to influence outcomes . However , SBRT seems to be as efficient as conventional RT and is a more convenient treatment for the patients PURPOSE To compare the efficacy of three lung stereotactic body radiotherapy ( SBRT ) regimens in a large institutional cohort . METHODS Between 2004 and 2009 , 130 patients underwent definitive lung cancer SBRT to a single lesion at the Mallinckrodt Institute of Radiology . We delivered 18 Gy × 3 fractions for peripheral tumors ( n = 111 ) and either 9 Gy × 5 fractions ( n = 8) or 10 Gy × 5 fractions ( n = 11 ) for tumors that were central or near critical structures . Univariate and multivariate analysis of prognostic factors was performed using the Cox proportional hazard model . RESULTS Median follow-up was 11 , 16 , and 13 months for the 9 Gy × 5 , 10 Gy × 5 , and 18 Gy × 3 groups , respectively . Local control statistics for Years 1 and 2 were , respectively , 75 % and 50 % for 9 Gy × 5 , 100 % and 100 % for 10 Gy × 5 , and 99 % and 91 % for 18 Gy × 3 . Median overall survival was 14 months , not reached , and 34 months for the 9 Gy × 5 , 10 Gy × 5 , and 18 Gy × 3 treatments , respectively . No difference in local control or overall survival was found between the 10 Gy × 5 and 18 Gy × 3 groups on log-rank test , but both groups had improved local control and overall survival compared with 9 Gy × 5 . Treatment with 9 Gy × 5 was the only independent prognostic factor for reduced local control on multivariate analysis , and increasing age , increasing tumor volume , and poor performance status predicted independently for reduced overall survival . CONCLUSION Treatment regimens of 10 Gy × 5 and 18 Gy × 3 seem to be efficacious for lung cancer SBRT and provide superior local control and overall survival compared with 9 Gy × 5 Background Stereotactic ablative radiotherapy ( SABR ) can achieve excellent local control rates in early-stage non-small cell lung cancer ( NSCLC ) and has emerged as a st and ard treatment option for patients who can not undergo surgery or those with isolated recurrences . However , factors that may predict toxicity or survival are largely unknown . We sought here to identify predictors of survival and pneumonitis after SABR for NSCLC in a relatively large single-institution series . Methods Subjects were 130 patients with stage I NSCLC treated with four-dimensional computed tomography ( 4D CT ) –planned , on-board volumetric image – guided SABR to 50 Gy in 4 fractions . Disease was staged by positron emission tomography/computed tomography ( PET/CT ) and scans were obtained again at the second follow-up after SABR . Results At a median follow-up time of 26 months , the 2-year local control rate was 98.5 % . The median overall survival ( OS ) time was 60 months , and OS rates were 93.0 % at 1 year , 78.2 % at 2 years , and 65.3 % at 3 years . No patient experienced grade 4–5 toxicity ; 15 had radiation pneumonitis ( 12 [ 9.3 % ] grade 2 and 3 [ 2.3 % ] grade 3 ) . Performance status , st and ardized uptake value (SUV)max on staging PET/CT , tumor histology , and disease operability were associated with OS on univariate analysis , but only staging SUVmax was independently predictive on multivariate analysis ( P = 0.034 ) . Dosimetric factors were associated with radiation pneumonitis on univariate analysis , but only mean ipsilateral lung dose ≥9.14 Gy was significant on multivariate analysis ( P = 0.005 ) . Conclusions OS and radiation pneumonitis after SABR for stage I NSCLC can be predicted by staging PET SUVmax and ipsilateral mean lung dose , respectively BACKGROUND Stereotactic body radiotherapy ( SBRT ) has been introduced for small lung tumors due to excellent local control and few side effects , even though there are no comparative studies . SPACE ( Stereotactic Precision And Conventional radiotherapy Evaluation ) is the first r and omized phase II trial comparing SBRT and conventional fractionated radiotherapy ( 3DCRT ) . METHODS Patients with stage I medically inoperable NSCLC were r and omized to receive SBRT to 66Gy in 3 fractions ( one week ) or 3DCRT to 70Gy ( 7weeks ) . Patients were followed to assess efficacy , toxicity and HRQL . FINDINGS Between 2007 and 2011 , 102 patients were r and omized . Mean age 74 ( 57 - 86 ) , 60 % women , the vast majority ( 92 % ) had COPD or cardiovascular comorbidity . The SBRT arm included more patients with T2-tumors ( p=0.02 ) and male gender ( p=0.35 ) . The median follow-up was 37months with a 1- , 2- and 3-year PFS of : SBRT : 76 % , 53 % , 42 % and 3DCRT : 87 % , 54 % 42 % , HR=0.85 ( 95 % CI 0.52 - 1.36 ) with no difference between the groups and no difference in OS ( HR=0.75 , 95 % CI 0.43 - 1.30 ) . At the end of the study 70 % of SBRT patients had not progressed compared to 59 % ( 3DCRT , p=0.26 ) . Toxicity was low with no grade 5 events . Pneumonitis of any grade was observed in 19 % ( SBRT ) and 34 % ( 3DCRT , p=0.26 ) , and esophagitis in 8 % and 30 % respectively ( p=0.006 ) . HRQL was evaluated with the EORTC QLQ 30 and LC14 module and patients treated with 3DCRT experienced worse dyspnea ( p=0.01 ) , chest pain ( p=0.02 ) and cough ( > 10 points difference ) . INTERPRETATION There was no difference in PFS and OS between SBRT and conventionally treated patients despite an imbalance of prognostic factors . We observed a tendency of an improved disease control rate in the SBRT group and they experienced better HRQL and less toxicity .  SBRT is convenient for patients and should be considered st and ard treatment for patients with inoperable stage I NSCLC PURPOSE Stereotactic body radiation therapy for medically inoperable early-stage non-small cell lung cancer ( NSCLC ) offers excellent control rates . Most published series deal mainly with small ( usually < 4 cm ) , peripheral , solitary tumors . Larger tumors are associated with poorer outcomes ( ie , lower control rates , higher toxicity ) when treated with conventional RT . It is unclear whether SBRT is sufficiently potent to control these larger tumors . We therefore evaluated and examined the influence of tumor size on treatment outcomes after SBRT . METHODS AND MATERIAL S Between October 2004 and October 2010 , 185 medically inoperable patients with early ( T1-T2N0M0 ) NSCLC were treated on a prospect i ve research ethics board-approved single-institution protocol . Prescription doses were risk-adapted based on tumor size and location . Follow-up included prospect i ve assessment of toxicity ( as per Common Terminology Criteria for Adverse Events , version 3.0 ) and serial computed tomography scans . Patterns 
    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 We examined the rate of acute skin toxicity within a prospect ively managed data base of patients treated for early-stage non-small-cell lung cancer ( NSCLC ) and investigated factors that might predict skin toxicity . METHODS From May 2006 through January 2008 , 50 patients with Stage I NSCLC were treated at Memorial Sloan-Kettering Cancer Center with 60 Gy in three fractions or 44 - 48 Gy in four fractions .  Patients were treated with multiple coplanar beams ( 3 - 7 , median 4 ) with a 6 MV linac using intensity-modulated radiotherapy ( IMRT ) and dynamic multileaf collimation .  Toxicity grading was performed and based on the National Cancer Institute Common Terminology Criteria for Adverse Effects . Factors associated with Grade 2 or higher acute skin reactions were calculated by Fisher 's exact test . RESULTS After a minimum 3 months of follow-up , 19 patients ( 38 % ) developed Grade 1 , 4 patients ( 8 % ) Grade 2 , 2 patients ( 4 % ) Grade 3 , and 1 patient Grade 4 acute skin toxicity . Factors associated with Grade 2 or higher acute skin toxicity included using only 3 beams ( p = 0.0007 ) , distance from the tumor to the posterior chest wall skin of less than 5 cm ( p = 0.006 ) , and a maximum skin dose of 50 % or higher of the prescribed dose ( p = 0.02 ) . CONCLUSIONS SBRT can be associated with significant skin toxicity . One must consider the skin dose when evaluating the treatment plan and consider the bolus effect of immobilization devices PURPOSE To present the results of stereotactic body radiotherapy ( SBRT ) for medically inoperable patients with Stage I non-small-cell lung cancer ( NSCLC ) and contrast outcomes in patients with and without a pathologic diagnosis . METHODS AND MATERIAL S Between December 2004 and October 2008 , 108 patients ( 114 tumors ) underwent treatment according to the prospect i ve research ethics board-approved SBRT protocol s at our cancer center . Of the 108 patients , 88 ( 81.5 % ) had undergone pretreatment whole-body [18F]-fluorodeoxyglucose positron emission tomography/computed tomography .  A pathologic diagnosis was unavailable for 33 ( 28.9 % ) of the 114 lesions . The SBRT schedules included 48 Gy in 4 fractions or 54 - 60 Gy in 3 fractions for peripheral lesions and 50 - 60 Gy in 8 - 10 fractions for central lesions . Toxicity and radiologic response were assessed at the 3 - 6-month follow-up visits using conventional criteria . RESULTS The mean tumor diameter was 2.4-cm ( range , 0.9 - 5.7 ) . The median follow-up was 19.1 months ( range , 1 - 55.7 ) . The estimated local control rate at 1 and 4 years was 92 % ( 95 % confidence interval [ CI ] , 86 - 97 % ) and 89 % ( 95 % CI , 81 - 96 % ) . The cause-specific survival rate at 1 and 4 years was 92 % ( 95 % CI , 87 - 98 % ) and 77 % ( 95 % CI , 64 - 89 % ) , respectively . No statistically significant difference was found in the local , regional , and distant control between patients with and without pathologically confirmed NSCLC . The most common acute toxicity was Grade 1 or 2 fatigue ( 53 of 108 patients ) . No toxicities of Grade 4 or greater were identified . CONCLUSIONS Lung SBRT for early-stage NSCLC result ed in excellent local control and cause-specific survival with minimal toxicity . The disease-specific outcomes were comparable for patients with and without a pathologic diagnosis . SBRT can be considered an option for selected patients with proven or presumed early-stage NSCLC Abstract Introduction . Stereotactic body radiation therapy ( SBRT ) for early stage non-small cell lung cancer ( NSCLC ) is now an accepted and patient friendly treatment , but still controversy exists about its comparability to conventional radiation therapy ( RT ) . The purpose of this single-institutional report is to describe survival outcome for medically inoperable patients with early stage NSCLC treated with SBRT compared with high dose conventional RT . Material and methods . From August 2005 to June 2012 , 100 medically inoperable patients were treated with SBRT at Odense University Hospital . The thoracic RT consisted of 3 fractions ( F ) of 15–22 Gy delivered in nine days . For comparison a group of 32 medically inoperable patients treated with conventional RT with 80 Gy/35–40  F ( 5 F/week ) in the period of July 1998 to August 2011 were analyzed . All tumors had histological or cytological proven NSCLC T1 - 2N0M0 . Results . The median overall survival was 36.1 months versus 24.4 months for SBRT and conventional RT , respectively ( p = 0.015 ) . Local failure-free survival rates at one year were in SBRT group 93 % versus 89 % in the conventional RT group and at five years 69 % versus 66 % , SBRT and conventional RT respectively ( p = 0.99 ) . On multivariate analysis , female gender and performance status of 0–1 and SBRT predicted improved prognosis . Conclusion . In a cohort of patients with NSCLC there was a significant difference in overall survival  favoring SBRT . Performance status of 0–1 , female gender and SBRT predicted improved prognosis . However , staging procedure , confirmation procedure of recurrence and technical improvements of radiation treatment is likely to influence outcomes . However , SBRT seems to be as efficient as conventional RT and is a more convenient treatment for the patients PURPOSE To compare the efficacy of three lung stereotactic body radiotherapy ( SBRT ) regimens in a large institutional cohort . METHODS Between 2004 and 2009 , 130 patients underwent definitive lung cancer SBRT to a single lesion at the Mallinckrodt Institute of Radiology . We delivered 18 Gy × 3 fractions for peripheral tumors ( n = 111 ) and either 9 Gy × 5 fractions ( n = 8) or 10 Gy × 5 fractions ( n = 11 ) for tumors that were central or near critical structures . Univariate and multivariate analysis of prognostic factors was performed using the Cox proportional hazard model . RESULTS Median follow-up was 11 , 16 , and 13 months for the 9 Gy × 5 , 10 Gy × 5 , and 18 Gy × 3 groups , respectively . Local control statistics for Years 1 and 2 were , respectively , 75 % and 50 % for 9 Gy × 5 , 100 % and 100 % for 10 Gy × 5 , and 99 % and 91 % for 18 Gy × 3 . Median overall survival was 14 months , not reached , and 34 months for the 9 Gy × 5 , 10 Gy × 5 , and 18 Gy × 3 treatments , respectively . No difference in local control or overall survival was found between the 10 Gy × 5 and 18 Gy × 3 groups on log-rank test , but both groups had improved local control and overall survival compared with 9 Gy × 5 . Treatment with 9 Gy × 5 was the only independent prognostic factor for reduced local control on multivariate analysis , and increasing age , increasing tumor volume , and poor performance status predicted independently for reduced overall survival . CONCLUSION Treatment regimens of 10 Gy × 5 and 18 Gy × 3 seem to be efficacious for lung cancer SBRT and provide superior local control and overall survival compared with 9 Gy × 5 Background Stereotactic ablative radiotherapy ( SABR ) can achieve excellent local control rates in early-stage non-small cell lung cancer ( NSCLC ) and has emerged as a st and ard treatment option for patients who can not undergo surgery or those with isolated recurrences . However , factors that may predict toxicity or survival are largely unknown . We sought here to identify predictors of survival and pneumonitis after SABR for NSCLC in a relatively large single-institution series . Methods Subjects were 130 patients with stage I NSCLC treated with four-dimensional computed tomography ( 4D CT ) –planned , on-board volumetric image – guided SABR to 50 Gy in 4 fractions . Disease was staged by positron emission tomography/computed tomography ( PET/CT ) and scans were obtained again at the second follow-up after SABR . Results At a median follow-up time of 26 months , the 2-year local control rate was 98.5 % . The median overall survival ( OS ) time was 60 months , and OS rates were 93.0 % at 1 year , 78.2 % at 2 years , and 65.3 % at 3 years . No patient experienced grade 4–5 toxicity ; 15 had radiation pneumonitis ( 12 [ 9.3 % ] grade 2 and 3 [ 2.3 % ] grade 3 ) . Performance status , st and ardized uptake value (SUV)max on staging PET/CT , tumor histology , and disease operability were associated with OS on univariate analysis , but only staging SUVmax was independently predictive on multivariate analysis ( P = 0.034 ) . Dosimetric factors were associated with radiation pneumonitis on univariate analysis , but only mean ipsilateral lung dose ≥9.14 Gy was significant on multivariate analysis ( P = 0.005 ) . Conclusions OS and radiation pneumonitis after SABR for stage I NSCLC can be predicted by staging PET SUVmax and ipsilateral mean lung dose , respectively BACKGROUND Stereotactic body radiotherapy ( SBRT ) has been introduced for small lung tumors due to excellent local control and few side effects , even though there are no comparative studies . SPACE ( Stereotactic Precision And Conventional radiotherapy Evaluation ) is the first r and omized phase II trial comparing SBRT and conventional fractionated radiotherapy ( 3DCRT ) . METHODS Patients with stage I medically inoperable NSCLC were r and omized to receive SBRT to 66Gy in 3 fractions ( one week ) or 3DCRT to 70Gy ( 7weeks ) . Patients were followed to assess efficacy , toxicity and HRQL . FINDINGS Between 2007 and 2011 , 102 patients were r and omized . Mean age 74 ( 57 - 86 ) , 60 % women , the vast majority ( 92 % ) had COPD or cardiovascular comorbidity . The SBRT arm included more patients with T2-tumors ( p=0.02 ) and male gender ( p=0.35 ) . The median follow-up was 37months with a 1- , 2- and 3-year PFS of : SBRT : 76 % , 53 % , 42 % and 3DCRT : 87 % , 54 % 42 % , HR=0.85 ( 95 % CI 0.52 - 1.36 ) with no difference between the groups and no difference in OS ( HR=0.75 , 95 % CI 0.43 - 1.30 ) . At the end of the study 70 % of SBRT patients had not progressed compared to 59 % ( 3DCRT , p=0.26 ) . Toxicity was low with no grade 5 events . Pneumonitis of any grade was observed in 19 % ( SBRT ) and 34 % ( 3DCRT , p=0.26 ) , and esophagitis in 8 % and 30 % respectively ( p=0.006 ) . HRQL was evaluated with the EORTC QLQ 30 and LC14 module and patients treated with 3DCRT experienced worse dyspnea ( p=0.01 ) , chest pain ( p=0.02 ) and cough ( > 10 points difference ) . INTERPRETATION There was no difference in PFS and OS between SBRT and conventionally treated patients despite an imbalance of prognostic factors . We observed a tendency of an improved disease control rate in the SBRT group and they experienced better HRQL and less toxicity .  SBRT is convenient for patients and should be considered st and ard treatment for patients with inoperable stage I NSCLC PURPOSE Stereotactic body radiation therapy for medically inoperable early-stage non-small cell lung cancer ( NSCLC ) offers excellent control rates . Most published series deal mainly with small ( usually < 4 cm ) , peripheral , solitary tumors . Larger tumors are associated with poorer outcomes ( ie , lower control rates , higher toxicity ) when treated with conventional RT . It is unclear whether SBRT is sufficiently potent to control these larger tumors . We therefore evaluated and examined the influence of tumor size on treatment outcomes after SBRT . METHODS AND MATERIAL S Between October 2004 and October 2010 , 185 medically inoperable patients with early ( T1-T2N0M0 ) NSCLC were treated on a prospect i ve research ethics board-approved single-institution protocol . Prescription doses were risk-adapted based on tumor size and location . Follow-up included prospect i ve assessment of toxicity ( as per Common Terminology Criteria for Adverse Events , version 3.0 ) and serial computed tomography scans . Patterns 
    Output:
    