AIMS: To assess the impact of steroid therapy in the management of brain metastases by review of the published literature on whole-brain radiotherapy (WBRT) for multiple cerebral metastases. MATERIALS AND METHODS: Twenty-one full manuscripts of published randomised controlled trials (RCTs) involving WBRT for multiple cerebral metastases were identified from a literature search and included studies from 1971--2003. Details on the use and type of steroid, timing of steroids relative to radiotherapy, response assessment and contribution of steroids to overall outcome were extracted. RESULTS: Eighteen out of 21 trials commented on steroid use. All studies used overall survival as an assessment of outcome; 13 studies assessed neurological response and 10 used imaging assessment. Ten studies acknowledged a contribution from steroids in the response assessment or analysis, but only one study gave a fixed steroid dose to control for its palliative effect. CONCLUSIONS: Reporting of steroid use in published RCTs assessing treatment for patients with brain metastases is non-uniform and not sufficiently detailed. As such, it is difficult to assess the additional benefit of WBRT. A standardised approach to the incorporation of steroid effect in assessment of WBRT would be advantageous to determine symptom response or durability of response. Side-effects of steroid use and the ability to taper off steroids after treatment intervention are also important outcomes of interest.
AIMS: To assess the impact of steroid therapy in the management of brain metastases by review of the published literature on whole-brain radiotherapy (WBRT) for multiple cerebral metastases. MATERIALS AND METHODS: Twenty-one full manuscripts of published randomised controlled trials (RCTs) involving WBRT for multiple cerebral metastases were identified from a literature search and included studies from 1971--2003. Details on the use and type of steroid, timing of steroids relative to radiotherapy, response assessment and contribution of steroids to overall outcome were extracted. RESULTS: Eighteen out of 21 trials commented on steroid use. All studies used overall survival as an assessment of outcome; 13 studies assessed neurological response and 10 used imaging assessment. Ten studies acknowledged a contribution from steroids in the response assessment or analysis, but only one study gave a fixed steroid dose to control for its palliative effect. CONCLUSIONS: Reporting of steroid use in published RCTs assessing treatment for patients with brain metastases is non-uniform and not sufficiently detailed. As such, it is difficult to assess the additional benefit of WBRT. A standardised approach to the incorporation of steroid effect in assessment of WBRT would be advantageous to determine symptom response or durability of response. Side-effects of steroid use and the ability to taper off steroids after treatment intervention are also important outcomes of interest.
Authors: D Rodin; B Banihashemi; L Wang; A Lau; S Harris; W Levin; R Dinniwell; B A Millar; C Chung; N Laperriere; A Bezjak; R K S Wong Journal: Curr Oncol Date: 2016-06-09 Impact factor: 3.677
Authors: Alina Sturdza; Barbara-Ann Millar; Neelufer Bana; Normand Laperriere; Gregory Pond; Rebecca K S Wong; Andrea Bezjak Journal: Support Care Cancer Date: 2008-02-07 Impact factor: 3.603
Authors: Timothy C Ryken; Michael McDermott; Paula D Robinson; Mario Ammirati; David W Andrews; Anthony L Asher; Stuart H Burri; Charles S Cobbs; Laurie E Gaspar; Douglas Kondziolka; Mark E Linskey; Jay S Loeffler; Minesh P Mehta; Tom Mikkelsen; Jeffrey J Olson; Nina A Paleologos; Roy A Patchell; Steven N Kalkanis Journal: J Neurooncol Date: 2009-12-03 Impact factor: 4.130