***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 compare the results of short-course vs. long-course radiotherapy ( RT ) for metastatic spinal cord compression . METHODS AND MATERIAL S A total of 231 patients who underwent RT between January 2006 and August 2007 were included in this two-arm prospect i ve nonr and omized study . Patients received short-course ( n = 114 ) or long-course ( n = 117 ) RT . The primary endpoint was progression-free survival ( PFS ) . The secondary endpoints were local control ( LC ) , functional outcome , and overall survival ( OS ) . An additional 10 potential prognostic factors were investigated for outcomes . PFS and LC were judged according to motor function , not pain control . RESULTS The PFS rate at 12 months was 72 % after long-course and 55 % after short-course RT ( p = 0.034 ) . These results were confirmed in a multivariate analysis ( relative risk , 1.33 ; 95 % confidence interval , 1.01 - 1.79 ; p = 0.046 ) . The 12-month LC rate was 77 % and 61 % after long-course and short-course RT , respectively ( p = 0.032 ) . These results were also confirmed in a multivariate analysis ( relative risk , 1.49 ; 95 % confidence interval , 1.03 - 2.24 ; p = 0.035 ) . The corresponding 12-month OS rates were 32 % and 25 % ( p = 0.37 ) . Improvement in motor function was observed in 30 % and 28 % of patients undergoing long-course vs. short-course RT , respectively ( p = 0.61 ) . In addition to radiation schedule , PFS was associated with the interval to developing motor deficits before RT ( relative risk , 1.99 ; 95 % confidence interval , 1.10 - 3.55 ; p = 0.024 ) . LC was associated only with the radiation schedule . Post-RT motor function was associated with performance status ( p = 0.031 ) , tumor type ( p = 0.013 ) , interval to developing motor deficits ( p = 0.001 ) , and bisphosphonate administration ( p = 0.006 ) . OS was associated with performance status ( p < 0.001 ) , number of involved vertebrae ( p = 0.007 ) , visceral metastases ( p < 0.001 ) , ambulatory status ( p < 0.001 ) , and bisphosphonate administration ( p < 0.001 ) . CONCLUSION Short-course and long-course RT result ed in similar functional outcome and OS . Long-course RT was significant for improved PFS and improved LC This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence AIM To test the viability of a full-scale r and omised comparison of two steroid doses given with radiotherapy for malignant spinal-cord compression ( MSCC ) , to test Internet r and omisation and to compare different functional outcome measures . MATERIAL S AND METHODS A log of screened patients at eight recruiting centres was maintained . Patients were r and omised via the Superdex website to either 96 mg or 16 mg daily of dexamethasone . Radiotherapy treatment was 30 Gy in 10 fractions . Outcomes assessed used ambulation , Barthel Index ambulation , Functional Independence Measure ( FIM ) ambulation and Functional Improvement Score ( FIS ) at 1 month . RESULTS One hundred and thirty-one patients were screened . Ninety-three ( 71 % ) were ineligible , 65 % of these were because duration of prior steroid use was greater than 12 h , failure to meet strict definition of magnetic resonance imaging , defined MSCC , multi-level disease or previous spinal-cord compression treatment . Twenty of the 38 eligible patients were r and omised , including seven outside st and ard office hours . There was a high rate of serious adverse events ( n = 9 ) , but only one was considered likely to be related to study medication . At baseline , 75 % were ambulant , 70 % had FIM ambulation scores greater than 5 and 50 % had Barthel Index ambulation scores greater than 2 . At day 28 , including all r and omised patients ( by scoring four dead patients as non-ambulant ) , ambulation scores by the various definitions were 60 % , 45 % and 40 % , respectively . For the 16 patients evaluable at day 28 , the mean FIS was -1.4 . Median survival was 69 days and 1-year survival 13 % . CONCLUSION Web r and omisation was successful ; however , the high in eligibility rate precludes a full-scale dexamethasone dose trial in Australia . Choice of measure of ambulation has potentially significant effects on outcomes and implication s for the design of any future MSCC trials . Referral delays are of concern A controlled clinical trial evaluated the usefulness of three different therapeutic approaches in the treatment of spinal cord compression ( SCC ) as primary manifestation of malignant lymphoma with the following end-points : neurological function , event free survival ( EFS ) and overall survival ( OS ) .  Forty-eight patients with SCC as unique manifestation ( IE ) of malignant lymphoma , were r and omly assigned to receive either : radiotherapy ( 16 patients ) , chemotherapy ( 11 patients ) or combined therapy ( radiotherapy followed by chemotherapy , 21 patients ) . Although neurological recovery was similar in both groups , EFS and OS were better in the combined therapy arm . Actuarial curves at 10 years showed that EFS was 50 % for patients treated with radiotherapy , 46 % in the chemotherapy arm and 76 % in the combined therapy group . Overall survival was 58 , 38 and 76 % , respectively , however because of the small number of patients , no statistical differences were observed . Although malignant lymphoma with SCC as primary manifestation could be considered as a localized disease , more patients could have microscopic disseminated disease . The use of combined therapy improves the outcome in this group of patients , and so it should be considered the treatment of choice The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . To encourage dissemination of the CONSORT 2010 Statement , this article is freely accessible on bmj.com and will also be published in the Lancet , Obstetrics and Gynecology , PLoS Medicine , Annals of Internal Medicine , Open Medicine , Journal of Clinical Epidemiology , BMC Medicine , and Trials When interim analyses of r and omised trials suggest large beneficial treatment effects , investigators sometimes terminate trials earlier than planned . Gordon H Guyatt and colleagues show how this practice can have far reaching and harmful 
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Gastrointestinal adverse effects were infrequent with the three RT regimens ( moderate quality evidence ) , and serious adverse events or post-radiotherapy myelopathy were not noted .
We did not find trials comparing radiotherapy schedules in people with MESCC and a good prognosis .
Based on current evidence , ambulant adults with MESCC with stable spines and predicted survival of less than six months will probably benefit as much from one dose of radiation ( 8 Gy ) as from two doses ( 16 Gy ) or eight doses ( 30 Gy ) .
We are unsure if a single dose is as effective as two or more doses in preventing local tumour recurrence .
Laminectomy preceding radiotherapy may offer no benefits over radiotherapy alone .
Decompressive surgery followed by radiotherapy may benefit ambulant and non-ambulant adults younger than 65 years of age , with poor prognostic factors for radiotherapy , a single area of compression , paraplegia for less than 48 hours , and a predicted survival of more than six months .
We are uncertain whether high doses of corticosteroids offer any benefits over moderate doses or indeed no corticosteroids ; but high-dose steroids probably significantly increases the risk of serious adverse effects .