The use and toxicity of steroids in the management of patients with brain metastases

Sturdza, Alina; Millar, Barbara‐Ann; Bana, Neelufer; Laperrière, Normand; Pond, Gregory R.; Wong, Rebecca; Bezjak, Andrea

doi:10.1007/s00520-007-0395-8

Cited by 83 publications

(75 citation statements)

References 15 publications

(52 reference statements)

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“…The literature addressing the use of dexamethasone for adult patients with brain tumours is limited and conflicting, and primarily describes patients with brain metastases. In a review describing the prescribing practices of oncologists and palliative care specialists for their patients with brain metastases, Sturdza and colleagues 8 reported that 45% of surveyed physicians routinely prescribe dexamethasone at a fixed dose of 16 mg daily for Of studies with specific details on dexamethasone dosing (n = 4), 2 used 16 mg daily; 1 used 2 mg 4 times daily; and 1 used 10 mg/m 2 daily. 5 Studies reported tapering the dose as tolerated after wbrt.…”

Section: Question 2: Dosingmentioning

confidence: 99%

Section: Question 2: Dosingmentioning

confidence: 99%

“…The presence or absence of symptoms, the types of symptoms, the types of neurologic deficits, and the degree of edema on imaging were all factors cited by the physicians who chose to prescribe a dose other than 16 mg daily 8 . In an accompanying chart review of 88 patients with brain metastases, the authors reported that, of patients treated with dexamethasone, 91% of those receiving 16 mg or more daily and 65% of those receiving less than 16 mg daily experienced at least one side effect ( p=0.006) 8 . In a systematic review of twenty-one randomized controlled trials of whole-brain radiotherapy for patients with multiple brain metastases, Millar and colleagues 7 reported that, of the eighteen studies documenting steroid use, only five provided details on the type and dose of steroid.…”

Section: Question 2: Dosingmentioning

confidence: 99%

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Use of Dexamethasone in Patients with High-Grade Glioma: A Clinical Practice Guideline

et al. 2014

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phd, || and the Alberta Provincial CNS Tumour Team• Patients who have high-grade tumours, are symptomatic, or have poor life expectancy, can be maintained on a 0.5-1.0 mg dose of dexamethasone daily.• Side effects with dexamethasone are common, and they increase in frequency and severity with increased dose and duration of therapy. Patients should be carefully monitored for endocrine, muscular, skeletal, gastrointestinal, psychiatric, and hematologic complications, and for infections and other general side effects.

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Section: Question 2: Dosingmentioning

confidence: 99%

Section: Question 2: Dosingmentioning

confidence: 99%

Section: Question 2: Dosingmentioning

confidence: 99%

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Use of Dexamethasone in Patients with High-Grade Glioma: A Clinical Practice Guideline

et al. 2014

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“…26,27 Sturdza et al 27 surveyed 38 oncologists at a single large cancer center who managed patients with brain metastases to document the use of steroids and the frequency of their side effects. Ninety percent of physicians responded to the survey.…”

Section: Steroidsmentioning

confidence: 99%

ACR Appropriateness Criteria^® Pre-Irradiation Evaluation and Management of Brain Metastases

Gore

Bradley

et al. 2014

Journal of Palliative Medicine

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Pretreatment evaluation is performed to determine the number, location, and size of the brain metastases and magnetic resonance imaging (MRI) is the recommended imaging technique, particularly in patients being considered for surgery or stereotactic radiosurgery. A contiguous thin-cut volumetric MRI with gadolinium with newer gadolinium-based agents can improve detection of small brain metastases. A systemic workup and medical evaluation are important, given that subsequent treatment for the brain metastases will also depend on the extent of the extracranial disease and on the age and performance status of the patient. Patients with hydrocephalus or impending brain herniation should be started on high doses of corticosteroids and evaluated for possible neurosurgical intervention. Patients with moderate symptoms should receive approximately 4-8 mg/d of dexamethasone in divided doses. The routine use of corticosteroids in patients without neurologic symptoms is not necessary. There is no proven benefit of anticonvulsants in patient without seizures. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

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“…Side-effects include myopathy, weight gain, osteoporosis, hyperglycemia, and mood or personality changes. [9][10][11] Dexamethasone doses above 24 mg in malignant spinal cord compression are associated with serious acute gastrointestinal toxicity. 1 12 Proximal myopathy has been reported in 10-60% of brain metastases patients on corticosteroids for more than 3 weeks for cerebral edema, and high doses were related to cushingoid features and steroid-induced hyperglycemia.…”

Section: Introductionmentioning

confidence: 99%

Validating self-report and proxy reports of the Dexamethasone Symptom Questionnaire -Chronic for the evaluation of longer-term corticosteroid toxicity

Agar

Koh

Gibbs

et al. 2015

Support Care Cancer

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PurposeIn brain tumours, brain metastases, or advanced cancer treatment with corticosteroids, side effects can add to symptoms. These are best assessed by patients, complementing clinical assessment. We assessed the feasibility and validity of Dexamethasone Symptom Questionnaire-Chronic (DSQ-Chronic), patient and caregiver versions. MethodsA longitudinal cohort study was conducted, collecting clinician-rated toxicity, performance status, dexamethasone dose and DSQ-Chronic (patient and caregiver versions) at baseline, then 2, 4, and 8 weeks later. Patients had a primary malignant brain tumour, brain metastases, or advanced cancer, Karnofsky Performance Status ≥40, and predicted survival ≥8 weeks. Analysis included completion rates, frequency and severity of dexamethasone-attributable side-effects, agreement between patient and caregiver ratings, comparison with clinician-rated toxicity, and correlation with performance status. ResultsSixty-six patients were recruited (mean age 60 years), with their caregivers. Completion of questionnaires was over 90% for the dyad at baseline but dropped over time, with caregivers completion rates higher at all timepoints. Agreement between patients and proxies was fair to moderate, and while proxies systematically overestimated symptom severity on DSQ-chronic total scores, the bias was less than 10 points. Patient and clinician agreement was higher for more objective symptoms. SEED study 4 ConclusionThe DSQ-Chronic is feasible when the patient is relatively well. As capacity to complete the DSQ-Chronic diminishes, caregivers can be proxy-raters. Clinicians capture corticosteroid toxicities, which may not be obvious to the patient. The DSQ-Chronic, patient and caregiver versions, are useful tools to be used with clinician assessment. Trial registration: ACTRN12611000378921SEED study 5

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The use and toxicity of steroids in the management of patients with brain metastases

Cited by 83 publications

References 15 publications

Use of Dexamethasone in Patients with High-Grade Glioma: A Clinical Practice Guideline

Use of Dexamethasone in Patients with High-Grade Glioma: A Clinical Practice Guideline

ACR Appropriateness Criteria^® Pre-Irradiation Evaluation and Management of Brain Metastases

Validating self-report and proxy reports of the Dexamethasone Symptom Questionnaire -Chronic for the evaluation of longer-term corticosteroid toxicity

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The use and toxicity of steroids in the management of patients with brain metastases

Cited by 83 publications

References 15 publications

Use of Dexamethasone in Patients with High-Grade Glioma: A Clinical Practice Guideline

Use of Dexamethasone in Patients with High-Grade Glioma: A Clinical Practice Guideline

ACR Appropriateness Criteria® Pre-Irradiation Evaluation and Management of Brain Metastases

Validating self-report and proxy reports of the Dexamethasone Symptom Questionnaire -Chronic for the evaluation of longer-term corticosteroid toxicity

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ACR Appropriateness Criteria^® Pre-Irradiation Evaluation and Management of Brain Metastases