Document Detail

The use and toxicity of steroids in the management of patients with brain metastases.
MedLine Citation:
PMID:  18256860     Owner:  NLM     Status:  MEDLINE    
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.
Alina Sturdza; Barbara-Ann Millar; Neelufer Bana; Normand Laperriere; Gregory Pond; Rebecca K S Wong; Andrea Bezjak
Publication Detail:
Type:  Journal Article     Date:  2008-02-07
Journal Detail:
Title:  Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer     Volume:  16     ISSN:  0941-4355     ISO Abbreviation:  Support Care Cancer     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-08-07     Completed Date:  2008-10-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9302957     Medline TA:  Support Care Cancer     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1041-8     Citation Subset:  IM    
Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, Ontario, Canada.
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MeSH Terms
Adrenal Cortex Hormones / adverse effects,  therapeutic use*
Antineoplastic Agents, Hormonal / adverse effects,  therapeutic use*
Brain Neoplasms / drug therapy*,  secondary*
Databases as Topic
Dexamethasone / adverse effects,  therapeutic use*
Middle Aged
Physician's Practice Patterns / statistics & numerical data
Retrospective Studies
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Antineoplastic Agents, Hormonal; 50-02-2/Dexamethasone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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