The selection of a treatment plan for an individual patient must consider multiple factors. These include the number, location and size of the metastases, the histology, extent and prior treatment of the systemic disease, and the patient's neurologic status, medical condition and personal preference. In general, radio-surgery is the treatment of choice for most patients with one to three brain metastases. Surgical resection is indicated for one or two accessible lesions larger than 2-3 cm in diameter and for those threatening cerebral hernia-tion; adjuvant radiosurgery to any residual tumor or the resection bed is likely warranted. WBRT is indicated when there are more than a few metastases, when the histology predicts disseminated metastasis or radiosensitivity or when the patient has a particularly poor prognosis. Table 16.4 summarizes general recommendations for the treatment of metastases, taking these factors into consideration. The
Was this article helpful?
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.