***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: High- quality cancer registry data are essential for assessing trends in incidence rates . This study evaluated the consistency of  brain tumor surveillance data using a r and om sample of cases from the Connecticut Tumor Registry . Three neuropathologists independently and blindly review ed tumor slides from 204 cases and a nosologist blindly review ed and assigned International Classification of Diseases for Oncology ( ICD-O ) codes to 326 cases . For the pathology review , absolute concordance was as high as 81 % for all primary brain tumors . Absolute concordance rates were high for nerve sheath ( 89 % ) , meningioma ( 95 % ) , and pituitary ( 95 % ) tumors . Rates were much lower for malignant tumors . ICD-O coding of malignant brain tumors is of relatively high quality with the exception of mixed gliomas and unspecified tumors . A high level of consistency for nonmalignant brain tumor diagnoses suggests that rates for these tumors , when actively reported to a surveillance system , can be of high quality A controlled , prospect i ve , r and omized study evaluated the use of 1,3-bis(2-chloroethyl)-1-nitrosourea ( BCNU ) and /or radiotherapy in the treatment of patients who were operated on and had histological confirmation of anaplastic glioma . A total of 303 patients were r and omized into this study , of whom 222 ( 73 % ) were within the Valid Study Group ( VSG ) , having met the protocol criteria of neuropathology , corticosteroid control , and therapeutic approach . Patients were divided into four r and om groups , and received BCNU ( 80 mg/sq m/day on 3 successive days every 6 to 8 weeks ) , and /or radiotherapy ( 5000 to 6000 rads to the whole brain through bilateral opposing ports ) , or best conventional care but no chemotherapy or radiotherapy . Analysis was performed on all patients who received any amount of therapy ( VSG ) and on the Adequately Treated Group ( ATG ) , who had received 5000 or more rads radiotherapy , two or more courses of chemotherapy , and had a minimum survival of 8 or more weeks ( the interval that would have been required to have received either the radiotherapy or chemotherapy ) . Median survival of patients in the VSG was , best conventional care : 14 weeks ( ATG : 17.0 weeks ) ; BCNU : 18.5 weeks ( ATG : 25.0 weeks ) ; radiotherapy : 35 weeks ( ATG : 37.5 weeks ) ; and BCNU plus radiotherapy : 34.5 weeks ( ATG : 40.5 weeks ) . All therapeutic modalities showed some statistical superiority compared to best conventional care . There was no significant difference between the four groups in relation to age distribution , sex , location of tumor , diagnosis , tumor characteristics , signs or symptoms , or the amount of corticosteroid used . An analysis of prognostic factors indicates that the initial performance status ( Karnofsky rating ) , age , the use of only a surgical biopsy , parietal location , the presence of seizures , or the involvement of cranial nerves II , III , IV , and VI are all of significance . Toxicity included acceptable , reversible thrombocytopenia and leukopenia Abstract Objective : Recently a r and omized placebo-controlled phase III trial of biodegradable polymers containing carmustine has demonstrated a significant survival benefit for patients treated with local chemotherapy .  A local chemotherapy applied directly to the resection cavity may act directly on residual tumor cells in adjacent brain possibly leading to a local control of the tumor and increased survival . Methods : We have analyzed the pattern of recurrence using serial MRI studies of 24 patients treated with GLIADEL ® Wafers or placebo wafers following resection of glioblastomas . Results : Of 24 patients 11 received carmustine wafers and 13 placebo .  The age distribution and Karnowsky performance scores of the two population s were not different . However , the median survival ( 14.7 versus 9.5 months ; P = 0.007 ) and the time to neurological deterioration ( 12.9 ± 4.85 vs. 9.4 ± 2.73 months ; P = 0.035 ) was significantly longer in the treatment group versus the placebo treated control . Preoperative and follow up MRI studies were evaluated in a blinded fashion . Out of 24 patients that entered the analysis 11 showed clearance of all contrast enhancement following resection of glioblastomas . Seventeen tumors progressed locally and 7 showed different patterns of distant failure . Within the carmustine treated group 8 patients showed a local treatment failure with recurrent tumors immediately adjacent to the resection cavity or progression form a residual tumor . Three patients showed a multifocal distant and local pattern of failure after complete or subtotal removal . In no case the local chemotherapy result ed in a distant recurrence only . However , the time to radiographic progression was 165.1 ± 80.75 days for the GLIADEL ® Wafer group and 101.9 ± 43.06 days for the placebo group ( P = 0.023 ) . Conclusion : In this subgroup analysis of a phase III trial population both the clinical progression and radiological progression were significantly delayed in patients treated with local chemotherapy , result ing in an increased survival time  . Local chemotherapy with carmustine containing wafer implants did not result in an altered pattern of recurrence and did not promote multifocal patterns of recurrence A previous placebo-controlled trial has shown that biodegradable 1,3-bis (2-chloroethyl)-1-nitrosourea ( BCNU ) wafers ( Gliadel wafers ) prolong survival in patients with recurrent glioblastoma multiforme . A previously completed phase 3 trial , also placebo controlled , in 32 patients with newly diagnosed malignant glioma also demonstrated a survival benefit in those patients treated with BCNU wafers . Because of the small number of patients in that trial , a larger phase 3 trial was performed to confirm these results . Two hundred forty patients were r and omized to receive either BCNU or placebo wafers at the time of primary surgical resection ; both groups were treated with external beam radiation postoperatively . The two groups were similar for age , sex , Karnofsky performance status ( KPS ) , and tumor histology . Median survival in the intent-to-treat group was 13.9 months for the BCNU wafer-treated group and 11.6 months for the placebo-treated group ( log-rank P -value stratified by country = 0.03 ) , with a 29 % reduction in the risk of death in the treatment group . When adjusted for factors affecting survival , the treatment effect remained positive with a risk reduction of 28 % ( P = 0.03 ) . Time to decline in KPS and in 10/11 neuroperformance measures was statistically significantly prolonged in the BCNU wafer-treated group ( P < /= 0.05 ) . Adverse events were comparable for the 2 groups , except for CSF leak ( 5 % in the BCNU wafer-treated group vs. 0.8 % in the placebo-treated group ) and intracranial hypertension ( 9.1 % in the BCNU wafer-treated group vs. 1.7 % in the placebo group ) . This study confirms that local chemotherapy with BCNU wafers is well tolerated and offers a survival benefit to patients with newly diagnosed malignant glioma The results of a multi-institutional phase I trial evaluating the safety of surgically implanted biodegradable 1,3-bis(chloro-ethyl)-1-nitrosourea ( BCNU ) impregnated polymer as theinitial therapy for malignant brain tumors are reported . This is the first study of locally delivered BCNU and st and ard external beam radiation therapy ( XRT ) given concurrently . Twenty-two patients were treated at three hospitals . The entry criteria were : single unilateral tumor focus larger than 1 cm3 ; age over 18 years ; Karnofsky Performance Score ( KPS ) of at least 60 h ; and an intra-operative diagnosis of malignant glioma . Twenty-one of twenty-two patients had glioblastoma multiforme . After surgery , seven or eight BCNU-loaded polyanhydride polymer discs ( 7.7 mg BCNU each ) were placed in the resection cavity . Postoperatively , all patients received st and ard radiation therapy ; none received additional chemotherapy in the first 6 months . Neurotoxicity , systemic toxicity , and survival were assessed . No perioperative mortality was seen . Neurotoxicity was equivalent to that occurring in other series of patients undergoing craniotomy and XRT without local chemotherapy . Systematic ally , no significant bone marrow suppression occurred , and there were no wound infections . Median survival in this group of older patients ( mean age=60 ) was 42 weeks , 8 patients survived 1 year , and 4 patients survived more than 18 months . Interstitial chemotherapy with BCNU-polymer with subsequent radiation therapy appears to be safe as an initial therapy . Several long-term survivors in this group of older patients with predominantly glioblastoma suggests efficacy in some patients . Dose escalation and efficacy trials are planned to further evaluate interstitial chemotherapy for the initial treatment of malignant gliomas This clinical study was design ed to evaluate the safety and efficacy of the sustained release form of dibutryl adenosine-3′,5′-cyclic monophosphate ( dB-cAMP , bucladesine ) placed in the tumor resection cavity at the time of recurrence of the de novo glioblastoma multiforme ( GBM ) patients .In a r and omized prospect i ve manner , 40 patients who were diagnosed as GBM in their first operations were included in this study . Four different therapy protocol s were used : First group of 10 patients had tumor resection only . Second group assessed had only systemic chemotherapy as six i.v . infusions of fotémustine after tumor resection . Third group had implantation of bucladesine-loaded biodegradable polymeric sustained release ( bcl-SR ) pellets while the last group received six i.v . infusions of systemic fotémustine as in the second group in addition to local implantation of bcl-SR pellets . A biodegradable polymer , poly-dl-lactide-co-glycolide with molecular weight of 80 000 , was used as carrier matrix for the drug with an approximately 4–5 months of release time . Maximal doses of 20 mg of bucladesine with a mean dose of 15.5 mg were implanted . No bone marrow suppression occurred and there were no wound infections as far as the local bucladesine-loaded polymer therapy is concerned . In this r and omized prospect i ve trial of local interstitial chemotherapy with long acting bcl-SR did show a statistically significant delay of recurrence on the treatment of GBM patients . Best treatment results obtained from the local bcl-SR + systemic fotémustine treated group in which survival rate estimated by the Kaplan – Meier method was 70 % in de novo GBM at 12 months OBJECTIVE To find out the effect of carmustine ( bischloroethyl-nitrosourea ) combined with a biodegradable polymer in the treatment of malignant ( Grade s III and IV ) gliomas , applied locally , at the time of the primary operation . METHODS Prospect i ve , r and omized double-blind study of an active treatment group versus a placebo group . Conducted at the Departments of Neurosurgery of the University Hospitals of Helsinki , Tampere , and Turku in Finl and and Trondheim in Norway . The study consisted of 32 patients ( 16 in each treatment group ) enrolled between March 23 , 1992 , and March 19 , 1993 . The study was planned to include 100 patients but had to be terminated prematurely , because the drug that was being used had become unobtainable . The main outcome measures included the survival times of patients after the operations and the application of an active drug  or  placebo .  RESULTS The median time from surgery to death was 58.1 weeks for the active treatment group versus 39.9 weeks for the placebo group ( P = 0.012 ) . For 27 patients with Grade IV tumors , the corresponding times were 39.9 weeks for the placebo group and 53.3 weeks for the active treatment group ( P = 0.008 ) . At the end of the study , six patients were still alive , five of whom belonged to the active treatment group . CONCLUSION Carmustine applied locally in a biodegradable polymer at the time of primary operation , seems to have a favorable effect on the life span of patients with high- grade gliomas Abstract Glioblastoma multiforme ( GBM ) makes up as many as 30 % of all primary brain tumors . Despite the employment of multimodal antitumor treatment , the overall survival is less than one year . Between 06/01/1998 and 06/01/2000 17 patients ( Group A ) with GBM ( 11 males , 6 females ; median age 54.3 years ) were administered local chemotherapy with cisplatin incorporated into biodegradable 6-carboxylcellulose polymer ( cisplatin-depot ( CDDP-D ) ) . After the subtotal removal of GBM , twenty 1.5 × 1.5 cm polymer plates with a total area of 45 cm2 ( the density of cisplatin immobilization on 6-carboxylcellulose being 1 mg/cm2 , a total cisplatin dose of 45 mg ) were implanted into the tumor bed . Group B ( 21 patients with GBM ; 11 males , 10 females ; median age 53.2 years ) was control : the subtotal tumor ablation without CD 
    Output:
    
Gliadel(R ) results in a prolongation of survival without an increased incidence of adverse events when used as primary therapy .
There is no evidence of enhanced progression free survival ( PFS ) or QOL .
In recurrent disease , Gliadel(R ) does not appear to confer any added benefit .