In the past, radiotherapy was used more widely for low-grade tumors than is currently the case. The EORTC controlled trial of adjuvant radiotherapy  showed no difference in survival between patients treated with surgery and patients treated with both surgery and postoperative radiotherapy. Whereas there is general agreement that radiotherapy should be used in patients whose tumor has undergone malignant change, its use in patients with low-grade tumors remains controversial. The long-term morbidity of radiotherapy remains a major concern in these patients, especially in view of the fact that so many of them, unlike patients with high-grade tumors, live for many years after treatment, and the known fact that the adverse effects of radiation increase over time. Cognitive impairment can be quite easily missed if not specifically looked for, or mistakenly attributed to the effects of the tumor itself. On the basis of what has been published to date, it is impossible to quantify the nature or degree of these possible long-term adverse effects. In the short term, radiotherapy is well tolerated. Suffice it to say that, given the absence of any good evidence that radiotherapy improves survival in these cases, the author and his neuro-oncological colleagues do not routinely use radiotherapy in asymptomatic patients with low-grade gliomas.
Chemotherapy remains of uncertain value for low-grade astrocytomas that have not undergone anaplastic change. There is no clear evidence of efficacy in the literature and it is not widely used. With oligodendrogliomas [11,12], especially those with anaplastic change, there is an increasing body of evidence that chemotherapy has a role to play. At the present time, opinions vary as to whether it should be considered as first-line or second-line treatment for such tumors.
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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.