Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Steroids in the Treatment of Adults with Metastatic Brain Tumors

Timothy C. Ryken, John Kuo, Roshan S. Prabhu, Jonathan H. Sherman, Steven N. Kalkanis, Jeffrey J. Olson

Research output: Contribution to journalReview article

23 Citations (Scopus)

Abstract

QUESTION: Do steroids improve neurological symptoms and/or quality of life in patients with metastatic brain tumors compared to supportive care only or other treatment options? If steroids are given, what dose should be used? TARGET POPULATION: These recommendations apply to adults diagnosed with brain metastases. RECOMMENDATIONS: STEROID THERAPY VERSUS NO STEROID THERAPY Asymptomatic brain metastases patients withoutmass effect Insufficient evidence exists to make a treatment recommendation for this clinical scenario. Brain metastases patients with mild symptoms related tomass effect Level 3: Corticosteroids are recommended to provide temporary symptomatic relief of symptoms related to increased intracranial pressure and edema secondary to brainmetastases. It is recommended for patients who are symptomatic from metastatic disease to the brain that a starting dose of 4 to 8 mg/d of dexamethasone be considered. Brain metastases patients with moderate to severe symptoms related tomass effect Level 3: Corticosteroids are recommended to provide temporary symptomatic relief of symptoms related to increased intracranial pressure and edema secondary to brainmetastases. If patients exhibit severe symptoms consistent with increased intracranial pressure, it is recommended that higher doses such as 16 mg/d or more be considered. CHOICE OF STEROID: Level 3: If corticosteroids are given, dexamethasone is the best drug choice given the available evidence. Duration of Corticosteroid Administration Level 3: Corticosteroids, if given, should be tapered as rapidly as possible but no faster than clinically tolerated, based upon an individualized treatment regimen and a full understanding of the long-term sequelae of corticosteroid therapy. Given the very limited number of studies (2) which met the eligibility criteria for the systematic review, these are the only recommendations that can be offered based on this methodology. The full guideline can be found at https://www.cns.org/guidelines/guidelines-treatment -adults-metastatic-brain-tumors/chapter-7.

Original languageEnglish (US)
Pages (from-to)E189-E191
JournalClinical Neurosurgery
Volume84
Issue number3
DOIs
StatePublished - Mar 1 2019

Fingerprint

Brain Neoplasms
Steroids
Guidelines
Adrenal Cortex Hormones
Intracranial Pressure
Neoplasm Metastasis
Brain Edema
Brain
Dexamethasone
Therapeutics
Brain Diseases
Quality of Life
Pharmaceutical Preparations

Keywords

  • Brainmetastases
  • Cerebral metastases
  • Corticosteroids
  • Neurological symptoms
  • Practice guideline
  • Steroid dosage
  • Systematic review

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Steroids in the Treatment of Adults with Metastatic Brain Tumors. / Ryken, Timothy C.; Kuo, John; Prabhu, Roshan S.; Sherman, Jonathan H.; Kalkanis, Steven N.; Olson, Jeffrey J.

In: Clinical Neurosurgery, Vol. 84, No. 3, 01.03.2019, p. E189-E191.

Research output: Contribution to journalReview article

Ryken, Timothy C. ; Kuo, John ; Prabhu, Roshan S. ; Sherman, Jonathan H. ; Kalkanis, Steven N. ; Olson, Jeffrey J. / Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Steroids in the Treatment of Adults with Metastatic Brain Tumors. In: Clinical Neurosurgery. 2019 ; Vol. 84, No. 3. pp. E189-E191.
@article{dd7d25fadb8c44beab093982e72269bd,
title = "Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Steroids in the Treatment of Adults with Metastatic Brain Tumors",
abstract = "QUESTION: Do steroids improve neurological symptoms and/or quality of life in patients with metastatic brain tumors compared to supportive care only or other treatment options? If steroids are given, what dose should be used? TARGET POPULATION: These recommendations apply to adults diagnosed with brain metastases. RECOMMENDATIONS: STEROID THERAPY VERSUS NO STEROID THERAPY Asymptomatic brain metastases patients withoutmass effect Insufficient evidence exists to make a treatment recommendation for this clinical scenario. Brain metastases patients with mild symptoms related tomass effect Level 3: Corticosteroids are recommended to provide temporary symptomatic relief of symptoms related to increased intracranial pressure and edema secondary to brainmetastases. It is recommended for patients who are symptomatic from metastatic disease to the brain that a starting dose of 4 to 8 mg/d of dexamethasone be considered. Brain metastases patients with moderate to severe symptoms related tomass effect Level 3: Corticosteroids are recommended to provide temporary symptomatic relief of symptoms related to increased intracranial pressure and edema secondary to brainmetastases. If patients exhibit severe symptoms consistent with increased intracranial pressure, it is recommended that higher doses such as 16 mg/d or more be considered. CHOICE OF STEROID: Level 3: If corticosteroids are given, dexamethasone is the best drug choice given the available evidence. Duration of Corticosteroid Administration Level 3: Corticosteroids, if given, should be tapered as rapidly as possible but no faster than clinically tolerated, based upon an individualized treatment regimen and a full understanding of the long-term sequelae of corticosteroid therapy. Given the very limited number of studies (2) which met the eligibility criteria for the systematic review, these are the only recommendations that can be offered based on this methodology. The full guideline can be found at https://www.cns.org/guidelines/guidelines-treatment -adults-metastatic-brain-tumors/chapter-7.",
keywords = "Brainmetastases, Cerebral metastases, Corticosteroids, Neurological symptoms, Practice guideline, Steroid dosage, Systematic review",
author = "Ryken, {Timothy C.} and John Kuo and Prabhu, {Roshan S.} and Sherman, {Jonathan H.} and Kalkanis, {Steven N.} and Olson, {Jeffrey J.}",
year = "2019",
month = "3",
day = "1",
doi = "10.1093/neuros/nyy546",
language = "English (US)",
volume = "84",
pages = "E189--E191",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Steroids in the Treatment of Adults with Metastatic Brain Tumors

AU - Ryken, Timothy C.

AU - Kuo, John

AU - Prabhu, Roshan S.

AU - Sherman, Jonathan H.

AU - Kalkanis, Steven N.

AU - Olson, Jeffrey J.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - QUESTION: Do steroids improve neurological symptoms and/or quality of life in patients with metastatic brain tumors compared to supportive care only or other treatment options? If steroids are given, what dose should be used? TARGET POPULATION: These recommendations apply to adults diagnosed with brain metastases. RECOMMENDATIONS: STEROID THERAPY VERSUS NO STEROID THERAPY Asymptomatic brain metastases patients withoutmass effect Insufficient evidence exists to make a treatment recommendation for this clinical scenario. Brain metastases patients with mild symptoms related tomass effect Level 3: Corticosteroids are recommended to provide temporary symptomatic relief of symptoms related to increased intracranial pressure and edema secondary to brainmetastases. It is recommended for patients who are symptomatic from metastatic disease to the brain that a starting dose of 4 to 8 mg/d of dexamethasone be considered. Brain metastases patients with moderate to severe symptoms related tomass effect Level 3: Corticosteroids are recommended to provide temporary symptomatic relief of symptoms related to increased intracranial pressure and edema secondary to brainmetastases. If patients exhibit severe symptoms consistent with increased intracranial pressure, it is recommended that higher doses such as 16 mg/d or more be considered. CHOICE OF STEROID: Level 3: If corticosteroids are given, dexamethasone is the best drug choice given the available evidence. Duration of Corticosteroid Administration Level 3: Corticosteroids, if given, should be tapered as rapidly as possible but no faster than clinically tolerated, based upon an individualized treatment regimen and a full understanding of the long-term sequelae of corticosteroid therapy. Given the very limited number of studies (2) which met the eligibility criteria for the systematic review, these are the only recommendations that can be offered based on this methodology. The full guideline can be found at https://www.cns.org/guidelines/guidelines-treatment -adults-metastatic-brain-tumors/chapter-7.

AB - QUESTION: Do steroids improve neurological symptoms and/or quality of life in patients with metastatic brain tumors compared to supportive care only or other treatment options? If steroids are given, what dose should be used? TARGET POPULATION: These recommendations apply to adults diagnosed with brain metastases. RECOMMENDATIONS: STEROID THERAPY VERSUS NO STEROID THERAPY Asymptomatic brain metastases patients withoutmass effect Insufficient evidence exists to make a treatment recommendation for this clinical scenario. Brain metastases patients with mild symptoms related tomass effect Level 3: Corticosteroids are recommended to provide temporary symptomatic relief of symptoms related to increased intracranial pressure and edema secondary to brainmetastases. It is recommended for patients who are symptomatic from metastatic disease to the brain that a starting dose of 4 to 8 mg/d of dexamethasone be considered. Brain metastases patients with moderate to severe symptoms related tomass effect Level 3: Corticosteroids are recommended to provide temporary symptomatic relief of symptoms related to increased intracranial pressure and edema secondary to brainmetastases. If patients exhibit severe symptoms consistent with increased intracranial pressure, it is recommended that higher doses such as 16 mg/d or more be considered. CHOICE OF STEROID: Level 3: If corticosteroids are given, dexamethasone is the best drug choice given the available evidence. Duration of Corticosteroid Administration Level 3: Corticosteroids, if given, should be tapered as rapidly as possible but no faster than clinically tolerated, based upon an individualized treatment regimen and a full understanding of the long-term sequelae of corticosteroid therapy. Given the very limited number of studies (2) which met the eligibility criteria for the systematic review, these are the only recommendations that can be offered based on this methodology. The full guideline can be found at https://www.cns.org/guidelines/guidelines-treatment -adults-metastatic-brain-tumors/chapter-7.

KW - Brainmetastases

KW - Cerebral metastases

KW - Corticosteroids

KW - Neurological symptoms

KW - Practice guideline

KW - Steroid dosage

KW - Systematic review

UR - http://www.scopus.com/inward/record.url?scp=85061576084&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061576084&partnerID=8YFLogxK

U2 - 10.1093/neuros/nyy546

DO - 10.1093/neuros/nyy546

M3 - Review article

C2 - 30629207

AN - SCOPUS:85061576084

VL - 84

SP - E189-E191

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 3

ER -