The evaluation of treatment of NM is complicated by the lack of standard treatments, the difficulty of
determining the response to treatment given the suboptimal sensitivity of the diagnostic procedures and that most patients will die of systemic disease, and the fact that most of the studies are small, nonrandomized, and retrospective . However, it is clear that the treatment of NM can provide effective palliation and in some cases result in prolonged survival. The treatment requires the combination of surgery, radiation, and chemotherapy in most cases. Figure 22.1 outlines a treatment algorithm for NM.
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