The evaluation of the effects of steroid treatment on the tumor and peritumoral edema by DWI and MR spectroscopy in brain tumors

Kural, Cahit; Ataç, Gökçe Kaan; Tehli, Özkan; Solmaz, İlker; Temız, Cüneyt; Hodaj, İrgen; İzci, Yusuf

doi:10.1016/j.pjnns.2018.03.002

Cited by 17 publications

(27 citation statements)

References 16 publications

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“…Our results indicate that—after adjustment for volume and the number of individual BM—treatment with GC leads to decreasing VE volumes in large and higher numbers of BM. In contrast, we found 3 former studies propagating no effect of GC administration on VE size (8, 10, 11). This might be due to measurement errors for small BM (according to the formula for volume of a sphere, little changes of diameter lead to significant volume changes) or GC may be ineffective until the VE exceeds a certain volume threshold what we consider less likely.…”

Section: Discussioncontrasting

confidence: 77%

“…Prior reports on the radiographic effect of GC in BM patients showed ambiguous results: whereas two studies demonstrated reduced VE size after GC administration in 3 and 13 BM patients, three other studies were not able to detect significant differences in VE volume in 4, 7, and 4 BM patients (7–11). Most patients presenting with clinical symptoms due to mass effect of BM receive GC immediately in the emergency room or even before referral to our academic medical center.…”

Section: Introductionmentioning

confidence: 88%

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Efficiency of Dexamethasone for Treatment of Vasogenic Edema in Brain Metastasis Patients: A Radiographic Approach

et al. 2019

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Background and Purpose: To date, imaging studies quantifying the amount of vasogenic edema reduction (VE) in patients with brain metastases (BM) treated with glucocorticoids (GC) have included a very limited number of patients and showed ambiguous results. Here, we aim to determine the radiological effect of GC on VE in BM patients in a large cohort with multiple primary tumor entities in a cross-sectional approach. Materials and Methods: This monocentric retrospective study includes 299 patients first-ever diagnosed with 2,759 intra-axial BM on the respective MRI. 126/299 patients received GC prior to MRI due to mass effect of edema on cranial CT scan and clinical symptoms (GC-pos) and 173 patients did not (GC-neg). GC dose was documented in 85/126 patients. All BM and their respective VE were semi-automatically segmented on post-contrast T1-weighted images. Results: VE volumes were higher in GC-pos compared to GC-neg ( p = 0.009) and did not correlate with GC dose. Multivariate linear regression analysis with interaction terms on the assumption that BM volume and BM number influence the probability of GC administration shows that large and higher numbers of BM under GC treatment generate less VE than without ( p < 0.001 and p = 0.038, respectively). The primary tumor type and total BM volume did not influence VE volume. Conclusion: Use of GC is especially effective for treatment of VE formation in patients with larger and multiple BM regardless of primary tumor type and dosage. However, based on the present data a direct causative relationship between GC and VE cannot be proven.

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Section: Discussioncontrasting

confidence: 77%

Section: Introductionmentioning

confidence: 88%

Efficiency of Dexamethasone for Treatment of Vasogenic Edema in Brain Metastasis Patients: A Radiographic Approach

et al. 2019

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“…A number of studies have demonstrated DEX effectiveness in management of patients with brain peri-tumor oedema by ameliorating the symptoms associated with vasogenic oedema and intracranial high pressure within 48 h of treatment (Galicich et al, 1961; Hossmann et al, 1983; Ostergaard et al, 1999; Sinha et al, 2004; Dietrich et al, 2011; Kostaras et al, 2014). An excellent technique for monitoring tumor-related oedema in patients is magnetic resonance imaging (MRI) that allows the evaluation of various water diffusion parameters (Yamasaki et al, 2012; Bode et al, 2006; Kural et al, 2018). Using diffusion tensor imaging, Sinha et al (2004) examined individuals with intracranial tumors and observed a significant reduction in the mean diffusivity of brain oedema after 48–72 h post-DEX treatment.…”

Section: Dex Therapy In Gbmmentioning

confidence: 99%

“…Using diffusion tensor imaging, Sinha et al (2004) examined individuals with intracranial tumors and observed a significant reduction in the mean diffusivity of brain oedema after 48–72 h post-DEX treatment. However, a recent study conducted in 28 patients with different degrees of glioma, brain metastases and neurological deficits, reported that DEX had no significant effect on the volume of peritumoral oedema in 19 patients, while some improvements were observed in the remaining (Kural et al, 2018). Given the very frequent use of DEX in GBM therapy and the controversies concerning its effects there is now a renewed interest to evaluate the correlation between the use of this drug and the overall survival (OS) rate of treated patients.…”

Section: Dex Therapy In Gbmmentioning

confidence: 99%

Dexamethasone in Glioblastoma Multiforme Therapy: Mechanisms and Controversies

Cenciarini

Valentino

Belia

et al. 2019

Front. Mol. Neurosci.

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Glioblastoma multiforme (GBM) is the most common and malignant of the glial tumors. The world-wide estimates of new cases and deaths annually are remarkable, making GBM a crucial public health issue. Despite the combination of radical surgery, radio and chemotherapy prognosis is extremely poor (median survival is approximately 1 year). Thus, current therapeutic interventions are highly unsatisfactory. For many years, GBM-induced brain oedema and inflammation have been widely treated with dexamethasone (DEX), a synthetic glucocorticoid (GC). A number of studies have reported that DEX also inhibits GBM cell proliferation and migration. Nevertheless, recent controversial results provided by different laboratories have challenged the widely accepted dogma concerning DEX therapy for GBM. Here, we have reviewed the main clinical features and genetic and epigenetic abnormalities underlying GBM. Finally, we analyzed current notions and concerns related to DEX effects on cerebral oedema, cancer cell proliferation and migration and clinical outcome.

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“…In the context of malignant brain tumors, it is used to control peritumoral edema and alleviate symptoms due to high intracranial pressure (ICP) or focal neurologic symptoms [2]. While symptomatic improvement is usually seen within 24 to 72 h [3, 4], the use of DXM is associated with a variety of adverse events including muscular weakness, hyperglycemia, cushingoid symptoms, mental disorders, and gastrointestinal ulceration [3].…”

Section: Introductionmentioning

confidence: 99%

Evidence-based dexamethasone dosing in malignant brain tumors: what do we really know?

et al. 2019

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Purpose The present study aims to conduct a systematic review of literature reporting on the dose and dosing schedule of dexamethasone (DXM) in relation to clinical outcomes in malignant brain tumor patients, with particular attention to evidence-based practice. Methods A systematic search was performed in PubMed, Embase, Web of Science, Cochrane, Academic Search Premier, and PsycINFO to identify studies that reported edema volume reduction, symptomatic relief, adverse events and survival in relation to dexamethasone dose in glioma or brain metastasis (BM) patients. Results After screening 1812 studies, fifteen articles were included for qualitative review. Most studies reported a dose of 16 mg, mostly in a schedule of 4 mg four times a day. Due to heterogeneity of studies, it was not possible to perform quantitative meta-analysis. For BMs, best available evidence suggests that higher doses of DXM may give more adverse events, but may not necessarily result in better clinical condition. Some studies suggest that higher DXM doses are associated with shorter survival in the palliative setting. For glioma, DXM may lead to symptomatic improvement, yet no studies directly compare different doses. Results regarding edema reduction and survival in glioma patients are conflicting. Conclusions Evidence on the safety and efficacy of different DXM doses in malignant brain tumor patients is scarce and conflicting. Best available evidence suggests that low DXM doses may be noninferior to higher doses in certain circumstances, but more comparative research in this area is direly needed, especially in light of the increasing importance of immunotherapy for brain tumors. Electronic supplementary material The online version of this article (10.1007/s11060-019-03238-4) contains supplementary material, which is available to authorized users.

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The evaluation of the effects of steroid treatment on the tumor and peritumoral edema by DWI and MR spectroscopy in brain tumors

Cited by 17 publications

References 16 publications

Efficiency of Dexamethasone for Treatment of Vasogenic Edema in Brain Metastasis Patients: A Radiographic Approach

Efficiency of Dexamethasone for Treatment of Vasogenic Edema in Brain Metastasis Patients: A Radiographic Approach

Dexamethasone in Glioblastoma Multiforme Therapy: Mechanisms and Controversies

Evidence-based dexamethasone dosing in malignant brain tumors: what do we really know?

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