***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: The incidence of brain metastases secondary to small cell lung cancer ( SCLC ) is about 35 % and the treatment strategy of brain irradiation with respect to dose and fractionation is controversial . In order to evaluate treatment outcome of brain irradiation in SCLC patients with brain relapse , we retrospectively evaluated all patients treated with brain irradiation in the eastern part of Denmark from 1988 to 1992 ( PCI patients excluded ) . During this 5-year period , 101 evaluable patients were included ( 44 females , 57 males ) ( median age 61 years ; range , 39 - 75 years ) . Forty-four patients , of whom 43 were in extracerebral complete remission ( CR ) , received  extended course ( EC ) brain irradiation  ( > 45 Gy , treatment schedule > 4 weeks ) . Fifty-seven patients received short course ( SC ) brain irradiation ( < 30 Gy , treatment schedule < 1 week ) . Among the SC treated patients , 14 were in CR , 20 had partial remission or stable disease and 23 had progressive extracerebral disease . The median survival ( from diagnosis of brain metastases ) in the group receiving irradiation with EC ( 44 patients ) was 160 days ( range , 74 - 2021 days ) , while the 57 patients treated with SC had a median survival of 88 days ( range , 20 - 948 days ) ( P = 0.00001 , Log-Rank analysis ) . In a subgroup of 14 patients in extracerebral CR , receiving SC irradiation , the median survival was 83 days ( range , 15 - 948 days ) . When the latter patients were compared to the 43 patients in CR in the group treated with EC , a statistically significant difference was shown ( P = 0.034 , Log-Rank analysis ) . Using Cox-hazard regression analysis with backward elimination , liver metastases and poor performance status were adverse prognostic signs , although the only significant parameters of survival were gender ( female vs. male , relative risk of dying 1 and 1.52 , P = 0.05 ) and schedule of brain irradiation ( extended course vs. short course , relative risk of dying , 0.36 and 1 , P < 0.001 ) . Extended course irradiation of brain relapse secondary to SCLC seems in general to be of limited value , although a significant prolonged survival at approximately 7 weeks , was obtained . The prolongation of survival does not seem worthwhile considering the length of treatment time ( 5 - 6 weeks ) compared to SC treatment ( 1 week ) . However , the data do not permit evaluation of the quality of life of the patients . This retrospective evaluation suggests the need for r and omized trials with carefully planned quality -of-life assessment BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . 
    Output:
    
Abstract Should whole brain radiation therapy ( WBRT ) be used as the sole therapy in patients with newly-diagnosed , surgically accessible , single brain metastases , compared with WBRT plus surgical resection , and in what clinical setting s?Target population This recommendation applies to adults with newly diagnosed single brain metastases amenable to surgical resection ; however , the recommendation does not apply to relatively radiosensitive tumors histologies ( i.e. , small cell lung cancer , leukemia , lymphoma , germ cell tumors and multiple myeloma ) .
RecommendationS urgical resection plus WBRT versus WBRT aloneLevel 1 Class I evidence supports the use of surgical resection plus post-operative WBRT , as compared to WBRT alone , in patients with good performance status ( functionally independent and spending less than 50 % of time in bed ) and limited extra-cranial disease .
There is insufficient evidence to make a recommendation for patients with poor performance scores , advanced systemic disease , or multiple brain metastases .
Recommendation Level 1 Class I evidence suggests that altered dose/fractionation schedules of WBRT do not result in significant differences in median survival , local control or neurocognitive outcomes when compared with “ st and ard ” WBRT dose/fractionation . (
If WBRT is used , what impact does tumor histopathology have on treatment outcomes ?
Recommendation Given the extremely limited data available , there is insufficient evidence to support the choice of any particular dose/fractionation regimen based on histopathology .
RecommendationS urgical resection plus WBRT versus surgical resection aloneLevel 1 Surgical resection followed by WBRT represents a superior treatment modality , in terms of improving tumor control at the original site of the metastasis and in the brain overall , when compared to surgical resection alone