Many of the principles of treating brain metastases at their original presentation apply to treatment of recurrent disease, with the proviso that the effects of the previous therapy must be considered. Local recurrence of a previously treated tumor has different implications from the appearance of distant failure. Surgery, stereotactic radiosurgery, focal radiotherapy, interstitial radiosurgery and brachytherapy are options for local recurrences, depending on the size and location of the lesion. In one study, among patients with a single recurrent tumor and well controlled systemic disease, two-thirds improved neurologically after tumor resection and the median duration of survival was 9 months .
Diffuse distant metastases probably warrant WBRT if it has not been given. For tumors recurrent after WBRT, an additional 20 Gy of fractionated radiation may improve the neurologic function of selected patients but does not significantly lengthen survival . In one study, among patients with well controlled systemic disease and a good response to their initial radiation, fewer than half had neurologic improvement after additional radiotherapy and the median duration of survival was 5 months .
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.