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 Early response criteria and surgical outcome were evaluated in patients with advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy . Patients with FIGO stage IIIC or IV ovarian cancer and an ascites volume of > or=500 ml were r and omly assigned to receive preoperatively 3 ( A1 ) or 2 ( A2 ) of 6 cycles of carboplatin and docetaxel intravenously . Response was monitored by measuring target lesions , ascites volumes and serum CA 125 levels . The primary outcome measure was the preoperative reduction of ascites volume . Secondary outcome measures were the evaluation of residual tumor and perioperative morbidity and mortality .  Eighty-three patients underwent cytoreductive surgery , 40 after 3 cycles and 43 patients after 2 cycles of neoadjuvant chemotherapy .  ' Optimal debulking ' ( < or=1 cm ) was achieved in 30 ( A1 ) and 32 patients ( A2 ) . Eight ( A1 ) and 6 patients ( A2 ) had a persistent ascites volume > or=500 ml . A decrease of the CA 125 level from baseline of less than 50 % was observed in 7 ( A1 ) and 9 patients ( A2 ) . Computed tomography scan results showed progressive disease in 6 patients ( 3 A1 ; 3 A2 ) . Any amount of residual disease after cytoreductive surgery , persistent ascites , and a less pronounced decrease of CA 125 were associated with poor progression-free survival rates . In conclusion , ascites volume reduction and CA 125 decline appear to be appropriate response criteria . A treatment schedule with two preoperative cycles is a reasonable option for neoadjuvant chemotherapy in advanced ovarian cancer . High surgical st and ards are m and atory , even after neoadjuvant chemotherapy OBJECTIVE Intraperitoneal ( IP ) chemotherapy prolongs survival in optimally reduced ovarian cancer patients . For patients in whom optimal debulking can not be achieved , one could incorporate IP therapy post-operatively if the cancer was optimally debulked following neoadjuvant chemotherapy . We sought to evaluate overall survival ( OS ) , progression-free survival ( PFS ) , percent of patients optimally debulked and toxicity in patients treated with this strategy . METHODS Women with adenocarcinoma by biopsy or cytology with stage III/IV ( pleural effusions only ) epithelial ovarian , fallopian tube or primary peritoneal carcinoma that presented with bulky disease were treated with neoadjuvant intravenous ( IV ) paclitaxel 175 mg/m2 and carboplatin AUC 6 q 21 daysx3 cycles followed by surgery ( if > /=50 % decrease in CA125 ) . If optimally debulked they received IV paclitaxel 175 mg/m2 and IP carboplatin AUC 5 ( day 1 ) and IP paclitaxel 60 mg/m2 ( day 8) q 28 daysx6 cycles . RESULTS Sixty-two patients were registered . Four were ineligible . Fifty-six were evaluated for neoadjuvant chemotherapy toxicities . One patient died of pneumonia . Five patients had grade 4 toxicity , including neutropenia ( 3 ) , anemia , leukopenia , anorexia , fatigue , muscle weakness , respiratory infection , and cardiac ischemia . Thirty-six patients had debulking surgery . Two had grade 4 hemorrhage . Twenty-six patients received post-cytoreduction chemotherapy . Four had grade 4 neutropenia . At a median follow-up of 21 months , median PFS is 21 months and median OS is 32 months for all 58 patients . PFS and OS for the 26 patients who received IV/IP chemotherapy is 29 and 34 months respectively . CONCLUSIONS These results compare favorably with other studies of sub-optimally debulked patients 5010 Background : To compare the operative morbidity of  primary ( PDS ) and interval debulking surgery ( IDS )  for advanced stage ovarian cancer . METHODS A large multi-institutional cooperative group study ( GOG 152 ) was conducted to evaluate the impact of IDS on progression-free and overall survival . Operative records were review ed to determine operative data and morbidity . The first three quartiles ( 1st q , median and 3rd q ) of the distribution is reported . A sign test is used to compare the characteristics and morbidities between PDS and IDS . RESULTS Two hundred and one patients underwent IDS  following r and omization to this procedure and three cycles of chemotherapy . All but nine cases had PDS and all but one had IDS performed by a board certified GYN surgeon . The surgeon estimated a similar percentage of the initial tumor volume was debulked during PDS and IDS . However , significantly less ascites , blood loss and duration of hospitalization were reported with IDS . [ Figure : see text ] Conclusion : There is less operative morbidity with IDS than with primary debulking surgery . This is consistent with previous retrospective studies . A r and omized trial evaluating the efficacy and morbidity of primary surgery vs neoadjuvant chemotherapy followed by IDS ( EORTC 55971 ) is ongoing . No significant financial relationships to disclose 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 OBJECTIVES The primary objective was to determine the completion rate of 6 cycles of paclitaxel and carboplatin chemotherapy with no dose reductions in patients > or = 70 years of age . METHODS Phase II study of intravenous ( IV ) carboplatin Area Under the Curve ( AUC ) of 5 and paclitaxel 175 mg/m(2 ) given to patients > or = 70 years of age , had any stage Müllerian cancer , and an ECOG performance status ( PS ) of 0 - 2 . RESULTS Twelve patients were enrolled ( median age of 82 years , range 75 to 86 years ) . Six of 12 completed 6 cycles of chemotherapy with no dose reductions . Three patients died on study precipitating study closure ; one with refractory cancer following cycle 1 , one of aspiration pneumonia after cycle 1 , and one with sudden death on day 5 of cycle 6 . Patients undergoing upfront debulking surgery tolerated chemotherapy better compared to patients receiving neoadjuvant chemotherapy .  Grade 3 or higher hematologic toxicities included 2 patients with febile neutropenia ( 17 % ) . > or = Grade 3 non-hematologic toxicities included fatigue ( 8 % ) , nausea ( 8 % ) , constipation ( 8 % ) , obstipation ( 8 % ) , vomiting ( 8 % ) , and hypoxia ( 8 % ) . CONCLUSIONS In this prospect i ve trial of st and ard carboplatin and paclitaxel chemotherapy in a heterogeneous population of elderly patients , chemotherapy was well tolerated by patients who underwent upfront debulking surgery , had a PS of 0 - 1 , and had few comorbidities . Patients not undergoing upfront debulking surgery because of either advanced cancer or poor surgical risk had excess morbidity/mortality . Prospect i ve studies to identify risk factors for toxicity prediction are needed 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 om 
    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 Early response criteria and surgical outcome were evaluated in patients with advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy . Patients with FIGO stage IIIC or IV ovarian cancer and an ascites volume of > or=500 ml were r and omly assigned to receive preoperatively 3 ( A1 ) or 2 ( A2 ) of 6 cycles of carboplatin and docetaxel intravenously . Response was monitored by measuring target lesions , ascites volumes and serum CA 125 levels . The primary outcome measure was the preoperative reduction of ascites volume . Secondary outcome measures were the evaluation of residual tumor and perioperative morbidity and mortality .  Eighty-three patients underwent cytoreductive surgery , 40 after 3 cycles and 43 patients after 2 cycles of neoadjuvant chemotherapy .  ' Optimal debulking ' ( < or=1 cm ) was achieved in 30 ( A1 ) and 32 patients ( A2 ) . Eight ( A1 ) and 6 patients ( A2 ) had a persistent ascites volume > or=500 ml . A decrease of the CA 125 level from baseline of less than 50 % was observed in 7 ( A1 ) and 9 patients ( A2 ) . Computed tomography scan results showed progressive disease in 6 patients ( 3 A1 ; 3 A2 ) . Any amount of residual disease after cytoreductive surgery , persistent ascites , and a less pronounced decrease of CA 125 were associated with poor progression-free survival rates . In conclusion , ascites volume reduction and CA 125 decline appear to be appropriate response criteria . A treatment schedule with two preoperative cycles is a reasonable option for neoadjuvant chemotherapy in advanced ovarian cancer . High surgical st and ards are m and atory , even after neoadjuvant chemotherapy OBJECTIVE Intraperitoneal ( IP ) chemotherapy prolongs survival in optimally reduced ovarian cancer patients . For patients in whom optimal debulking can not be achieved , one could incorporate IP therapy post-operatively if the cancer was optimally debulked following neoadjuvant chemotherapy . We sought to evaluate overall survival ( OS ) , progression-free survival ( PFS ) , percent of patients optimally debulked and toxicity in patients treated with this strategy . METHODS Women with adenocarcinoma by biopsy or cytology with stage III/IV ( pleural effusions only ) epithelial ovarian , fallopian tube or primary peritoneal carcinoma that presented with bulky disease were treated with neoadjuvant intravenous ( IV ) paclitaxel 175 mg/m2 and carboplatin AUC 6 q 21 daysx3 cycles followed by surgery ( if > /=50 % decrease in CA125 ) . If optimally debulked they received IV paclitaxel 175 mg/m2 and IP carboplatin AUC 5 ( day 1 ) and IP paclitaxel 60 mg/m2 ( day 8) q 28 daysx6 cycles . RESULTS Sixty-two patients were registered . Four were ineligible . Fifty-six were evaluated for neoadjuvant chemotherapy toxicities . One patient died of pneumonia . Five patients had grade 4 toxicity , including neutropenia ( 3 ) , anemia , leukopenia , anorexia , fatigue , muscle weakness , respiratory infection , and cardiac ischemia . Thirty-six patients had debulking surgery . Two had grade 4 hemorrhage . Twenty-six patients received post-cytoreduction chemotherapy . Four had grade 4 neutropenia . At a median follow-up of 21 months , median PFS is 21 months and median OS is 32 months for all 58 patients . PFS and OS for the 26 patients who received IV/IP chemotherapy is 29 and 34 months respectively . CONCLUSIONS These results compare favorably with other studies of sub-optimally debulked patients 5010 Background : To compare the operative morbidity of  primary ( PDS ) and interval debulking surgery ( IDS )  for advanced stage ovarian cancer . METHODS A large multi-institutional cooperative group study ( GOG 152 ) was conducted to evaluate the impact of IDS on progression-free and overall survival . Operative records were review ed to determine operative data and morbidity . The first three quartiles ( 1st q , median and 3rd q ) of the distribution is reported . A sign test is used to compare the characteristics and morbidities between PDS and IDS . RESULTS Two hundred and one patients underwent IDS  following r and omization to this procedure and three cycles of chemotherapy . All but nine cases had PDS and all but one had IDS performed by a board certified GYN surgeon . The surgeon estimated a similar percentage of the initial tumor volume was debulked during PDS and IDS . However , significantly less ascites , blood loss and duration of hospitalization were reported with IDS . [ Figure : see text ] Conclusion : There is less operative morbidity with IDS than with primary debulking surgery . This is consistent with previous retrospective studies . A r and omized trial evaluating the efficacy and morbidity of primary surgery vs neoadjuvant chemotherapy followed by IDS ( EORTC 55971 ) is ongoing . No significant financial relationships to disclose 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 OBJECTIVES The primary objective was to determine the completion rate of 6 cycles of paclitaxel and carboplatin chemotherapy with no dose reductions in patients > or = 70 years of age . METHODS Phase II study of intravenous ( IV ) carboplatin Area Under the Curve ( AUC ) of 5 and paclitaxel 175 mg/m(2 ) given to patients > or = 70 years of age , had any stage Müllerian cancer , and an ECOG performance status ( PS ) of 0 - 2 . RESULTS Twelve patients were enrolled ( median age of 82 years , range 75 to 86 years ) . Six of 12 completed 6 cycles of chemotherapy with no dose reductions . Three patients died on study precipitating study closure ; one with refractory cancer following cycle 1 , one of aspiration pneumonia after cycle 1 , and one with sudden death on day 5 of cycle 6 . Patients undergoing upfront debulking surgery tolerated chemotherapy better compared to patients receiving neoadjuvant chemotherapy .  Grade 3 or higher hematologic toxicities included 2 patients with febile neutropenia ( 17 % ) . > or = Grade 3 non-hematologic toxicities included fatigue ( 8 % ) , nausea ( 8 % ) , constipation ( 8 % ) , obstipation ( 8 % ) , vomiting ( 8 % ) , and hypoxia ( 8 % ) . CONCLUSIONS In this prospect i ve trial of st and ard carboplatin and paclitaxel chemotherapy in a heterogeneous population of elderly patients , chemotherapy was well tolerated by patients who underwent upfront debulking surgery , had a PS of 0 - 1 , and had few comorbidities . Patients not undergoing upfront debulking surgery because of either advanced cancer or poor surgical risk had excess morbidity/mortality . Prospect i ve studies to identify risk factors for toxicity prediction are needed 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 om 
    Output:
    