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Erschienen in: Supportive Care in Cancer 9/2008

01.09.2008 | Original Article

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

verfasst von: Alina Sturdza, Barbara-Ann Millar, Neelufer Bana, Normand Laperriere, Gregory Pond, Rebecca K. S. Wong, Andrea Bezjak

Erschienen in: Supportive Care in Cancer | Ausgabe 9/2008

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Abstract

Goals of work

To document the use of steroids and frequency of their side effects in patients with brain metastases.

Patients and methods

A survey of oncologists who manage patients with brain metastases was conducted to document steroid prescribing practice in our institution. In addition, a retrospective chart review of 88 patients treated with whole brain radiotherapy (WBRT), identified through the Palliative Radiation Oncology Program database, was conducted for a 6-month period to documents steroid doses prescribed, tapering schedules, and steroid side effects.

Results

Ninety percent of physicians responded to the survey. Forty-five percent routinely used dexamethasone 4 mg qid (16 mg/day). The others determined the dose of steroid according to the presence or absence of neurological symptoms. Sixty percent tapered the patient’s steroids over the 4 weeks following completion of WBRT. The most common side effects noted by physicians were: increased appetite or weight gain (46%), insomnia (24%), gastro-intestinal symptoms (20%). In the retrospective study, dexamethasone 4 mg qid was prescribed to 52% patients prior and during WBRT. Sixty-six percent of patients were instructed to taper dexamethasone after WBRT, but details were not provided. The most frequently documented steroid-related side effects were: increased appetite (32%), proximal muscle weakness (28%), and insomnia (21%).

Conclusions

There is considerable variation in the prescribing practices even within a single institution, with many patients receiving high dose of steroids for considerable periods of time and developing related side effects. Strategies to reduce the amount and length of steroids may result in improved therapeutic ratio; we are currently accruing onto such a trial.
Literatur
1.
Zurück zum Zitat Bascuas M, Amares SG, Machuca Munoz MT, Bascuas Asta L (1985) Effect of dexamethasone at the level of cerebral metastases: evaluation by CT and nuclear medicine. Rev Esp Oncol 32:539–542 Bascuas M, Amares SG, Machuca Munoz MT, Bascuas Asta L (1985) Effect of dexamethasone at the level of cerebral metastases: evaluation by CT and nuclear medicine. Rev Esp Oncol 32:539–542
2.
Zurück zum Zitat Bezjak A et al (2001) Radiotherapy for brain metastases: defining palliative response. Radiother Oncol 61:71–76PubMedCrossRef Bezjak A et al (2001) Radiotherapy for brain metastases: defining palliative response. Radiother Oncol 61:71–76PubMedCrossRef
3.
Zurück zum Zitat Bezjak A et al (2002) Symptom response after palliative radiotherapy for patients with brain metastases. Eur J Cancer 38:487–496PubMedCrossRef Bezjak A et al (2002) Symptom response after palliative radiotherapy for patients with brain metastases. Eur J Cancer 38:487–496PubMedCrossRef
4.
Zurück zum Zitat Cairncross JG, Kim JH, Posner JB (1980) Radiation therapy for brain metastases. Ann Neurol 7:529–41PubMedCrossRef Cairncross JG, Kim JH, Posner JB (1980) Radiation therapy for brain metastases. Ann Neurol 7:529–41PubMedCrossRef
5.
Zurück zum Zitat Cairncross JG, Posner JB (1983) The management of brain metastases. In: Walker MD (ed) Oncology of the nervous system. vol. 12. Springer, Verlag, pp 342–377 Cairncross JG, Posner JB (1983) The management of brain metastases. In: Walker MD (ed) Oncology of the nervous system. vol. 12. Springer, Verlag, pp 342–377
6.
Zurück zum Zitat Galicich JH, French LA, Melby JC (1961) Use of dexamethasone in the treatment of cerebral edema associated with brain Tumors. Lancet 81:46 Galicich JH, French LA, Melby JC (1961) Use of dexamethasone in the treatment of cerebral edema associated with brain Tumors. Lancet 81:46
7.
Zurück zum Zitat Hempen C, Weiss E, Hess CF (2002) Dexamethasone treatment in patients with brain metastases and primary brain tumors: do the benefits outweigh the side effects. Support Care Cancer 10:322–328PubMedCrossRef Hempen C, Weiss E, Hess CF (2002) Dexamethasone treatment in patients with brain metastases and primary brain tumors: do the benefits outweigh the side effects. Support Care Cancer 10:322–328PubMedCrossRef
8.
Zurück zum Zitat Hoskin PJ, Crow J, Ford HT (1990) The influence of extent and local management on the outcome of radiotherapy for brain metastases. Int J Radiat Oncol Biol Phys 19:111–115PubMed Hoskin PJ, Crow J, Ford HT (1990) The influence of extent and local management on the outcome of radiotherapy for brain metastases. Int J Radiat Oncol Biol Phys 19:111–115PubMed
9.
Zurück zum Zitat Lagerwaard FJ et al (1991) Identification of prognostic factors in patients with brain metastases: a review of 1292 patients. Int J Radiat Oncol Biol Phys 43:795–803 Lagerwaard FJ et al (1991) Identification of prognostic factors in patients with brain metastases: a review of 1292 patients. Int J Radiat Oncol Biol Phys 43:795–803
10.
Zurück zum Zitat Mackworth N (1992) Quality of life self-reports from 200 brain tumor patients: comparison with Karnofsky performance scores. J Neuro–Oncol 14:243–253 Mackworth N (1992) Quality of life self-reports from 200 brain tumor patients: comparison with Karnofsky performance scores. J Neuro–Oncol 14:243–253
11.
Zurück zum Zitat Messer J, Reitman D, Sacks HS, Smith H Jr, Chalmers TC (1983) Association of adrenocorticosteroid therapy and peptic-ulcer disease. N Engl J Med 309:21–24PubMedCrossRef Messer J, Reitman D, Sacks HS, Smith H Jr, Chalmers TC (1983) Association of adrenocorticosteroid therapy and peptic-ulcer disease. N Engl J Med 309:21–24PubMedCrossRef
12.
Zurück zum Zitat Millar BM, Bezjak A, Tsao M, Sturdza A, Laperriere N (2004) Defining the impact and contribution of steroids in patients receiving whole brain irradiation for cerebral metastases. Clin Oncol 16:339–344CrossRef Millar BM, Bezjak A, Tsao M, Sturdza A, Laperriere N (2004) Defining the impact and contribution of steroids in patients receiving whole brain irradiation for cerebral metastases. Clin Oncol 16:339–344CrossRef
13.
Zurück zum Zitat Ito U et al (1988) Formation and propagation of brain oedema fluid around human brain metastases: a CT study. Acta Neurochir 90:35–41CrossRef Ito U et al (1988) Formation and propagation of brain oedema fluid around human brain metastases: a CT study. Acta Neurochir 90:35–41CrossRef
14.
Zurück zum Zitat Routh AK, Khansur T, Hickman BT, Bass D (1994) Management of brain metastases: past, present and future. South Med J 87:1218–1226PubMed Routh AK, Khansur T, Hickman BT, Bass D (1994) Management of brain metastases: past, present and future. South Med J 87:1218–1226PubMed
15.
Zurück zum Zitat Sawaya R (2001) Consideration in the diagnosis and management of brain metastases. Oncol 15:1144–1154 Sawaya R (2001) Consideration in the diagnosis and management of brain metastases. Oncol 15:1144–1154
16.
Zurück zum Zitat Schiff D (2001) Single brain metastases: current treatment options. Neurol 3:89–99 Schiff D (2001) Single brain metastases: current treatment options. Neurol 3:89–99
18.
Zurück zum Zitat Tikhtman AJ, Patchell RA (1994) Brain metastases. In: Morantz RA, Walsh JW (eds) Brain tumors. A comprehensive text. Marcel Dekker, New York, pp 553–566 Tikhtman AJ, Patchell RA (1994) Brain metastases. In: Morantz RA, Walsh JW (eds) Brain tumors. A comprehensive text. Marcel Dekker, New York, pp 553–566
19.
Zurück zum Zitat Vecht Ch J, Hovestadt A (1994) Dose-effect relationship of dexamethasone on Karnofsky performance in metastatic brain tumors. Neurol 44:675–680 Vecht Ch J, Hovestadt A (1994) Dose-effect relationship of dexamethasone on Karnofsky performance in metastatic brain tumors. Neurol 44:675–680
20.
Zurück zum Zitat Weissman DE, Janjan N (1991) Twice-daily tapering dexamethasone treatment during cranial radiation for newly diagnosed brain metastases. J Neuro–Oncol 11:235–239CrossRef Weissman DE, Janjan N (1991) Twice-daily tapering dexamethasone treatment during cranial radiation for newly diagnosed brain metastases. J Neuro–Oncol 11:235–239CrossRef
21.
Zurück zum Zitat Wolfson A (1994) The role of steroids in the management of metastatic carcinoma to the brain. Am J Clin Oncol 17:234–238PubMedCrossRef Wolfson A (1994) The role of steroids in the management of metastatic carcinoma to the brain. Am J Clin Oncol 17:234–238PubMedCrossRef
Metadaten
Titel
The use and toxicity of steroids in the management of patients with brain metastases
verfasst von
Alina Sturdza
Barbara-Ann Millar
Neelufer Bana
Normand Laperriere
Gregory Pond
Rebecca K. S. Wong
Andrea Bezjak
Publikationsdatum
01.09.2008
Verlag
Springer-Verlag
Erschienen in
Supportive Care in Cancer / Ausgabe 9/2008
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-007-0395-8

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