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 language | English (US) |
|---|---|
| Pages (from-to) | E189-E191 |
| Journal | Clinical Neurosurgery |
| Volume | 84 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 1 2019 |
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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 journal › Review article
}
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 -