INTRODUCTION: Steroids are commonly used for managing brain edema in patients with glioblastoma multiforme (GBM), treated with surgery and concomitant temozolomide-based chemoradiotherapy (CTRT). The adverse effects of glucocorticoids include lymphopenia, hyperglycemia, and risk of infection. We report the results of a meta-analysis evaluating the effects of steroids on outcome when associated with the treatment of GBM. METHODS: PubMed, the Cochrane Library, and Embase were searched from inception until September 2019 for observational or prospective studies reporting prognosis of adult patients with GBM and treated or not treated with steroids. Overall survival (OS) was the primary endpoint, and progression-free survival (PFS) was the secondary endpoint. The effect size was reported as hazard ratios (HRs) with a 95% confidence interval (CI), and an HR > 1 associated with the worst outcome in steroid users compared to non-users. RESULTS: Twenty-two publications were retrieved from studies selected for a total of 8,752 patients. In the primary analysis (n = 22 studies reporting data), OS was reduced in GBM patients taking steroids during treatment (HR = 1.54, 95% CI 1.37-1.75; p < 0.01). Similarly, PFS was inferior in steroid users in n = 9 studies with data available (HR = 1.28, 95% CI 1.1-1.49; p < 0.01). CONCLUSIONS: In patients with GBM and treated with RT and/or CT, association with steroids significantly reduces survival and PFS. Use of the lowest dose of glucocorticoids for the shortest period needed to achieve the treatment goals and prevention of steroid-associated complications are essential aims of treatment of this disease.
INTRODUCTION:Steroids are commonly used for managing brain edema in patients with glioblastoma multiforme (GBM), treated with surgery and concomitant temozolomide-based chemoradiotherapy (CTRT). The adverse effects of glucocorticoids include lymphopenia, hyperglycemia, and risk of infection. We report the results of a meta-analysis evaluating the effects of steroids on outcome when associated with the treatment of GBM. METHODS: PubMed, the Cochrane Library, and Embase were searched from inception until September 2019 for observational or prospective studies reporting prognosis of adult patients with GBM and treated or not treated with steroids. Overall survival (OS) was the primary endpoint, and progression-free survival (PFS) was the secondary endpoint. The effect size was reported as hazard ratios (HRs) with a 95% confidence interval (CI), and an HR > 1 associated with the worst outcome in steroid users compared to non-users. RESULTS: Twenty-two publications were retrieved from studies selected for a total of 8,752 patients. In the primary analysis (n = 22 studies reporting data), OS was reduced in GBMpatients taking steroids during treatment (HR = 1.54, 95% CI 1.37-1.75; p < 0.01). Similarly, PFS was inferior in steroid users in n = 9 studies with data available (HR = 1.28, 95% CI 1.1-1.49; p < 0.01). CONCLUSIONS: In patients with GBM and treated with RT and/or CT, association with steroids significantly reduces survival and PFS. Use of the lowest dose of glucocorticoids for the shortest period needed to achieve the treatment goals and prevention of steroid-associated complications are essential aims of treatment of this disease.
Authors: S Bhavsar; K Hagan; R Arunkumar; Y Potylchansky; R Grasu; A Dang; R Carlson; C Cowels; B Arnold; T F Rahlfs; I Lipski; C Walsh; A T Nguyen; L Feng; J P Cata Journal: J Clin Neurosci Date: 2016-07-07 Impact factor: 1.961
Authors: Stuart A Grossman; Xiaobu Ye; Glenn Lesser; Andrew Sloan; Hetty Carraway; Serena Desideri; Steven Piantadosi Journal: Clin Cancer Res Date: 2011-07-07 Impact factor: 12.531
Authors: Thierry Gorlia; Roger Stupp; Alba A Brandes; Roy R Rampling; Pierre Fumoleau; Christian Dittrich; Mario M Campone; Chris C Twelves; Eric Raymond; Monika E Hegi; Denis Lacombe; Martin J van den Bent Journal: Eur J Cancer Date: 2012-03-28 Impact factor: 9.162
Authors: Thierry Gorlia; Martin J van den Bent; Monika E Hegi; René O Mirimanoff; Michael Weller; J Gregory Cairncross; Elizabeth Eisenhauer; Karl Belanger; Alba A Brandes; Anouk Allgeier; Denis Lacombe; Roger Stupp Journal: Lancet Oncol Date: 2007-12-21 Impact factor: 41.316
Authors: Ivan Caramanna; Julie M de Kort; Alba A Brandes; Walter Taal; Michael Platten; Ahmed Idbaih; Jean Sebastien Frenel; Wolfgang Wick; Chandrakanth Jayachandran Preetha; Martin Bendszus; Philipp Vollmuth; Jaap C Reijneveld; Martin Klein Journal: Neurooncol Pract Date: 2022-03-13
Authors: Akshitkumar M Mistry; Sumeeth V Jonathan; Meredith A Monsour; Bret C Mobley; Stephen W Clark; Paul L Moots Journal: Neurooncol Pract Date: 2021-06-23
Authors: R J Slegers; T A M Bouwens van der Vlis; L Ackermans; A Hoeben; A A Postma; I Compter; J G J Hoeijmakers; J Beckervordersandforth; M P G Broen; O E M G Schijns Journal: Acta Neurochir (Wien) Date: 2021-10-29 Impact factor: 2.216
Authors: J K Wiencke; Annette M Molinaro; Gayathri Warrier; Terri Rice; Jennifer Clarke; Jennie W Taylor; Margaret Wrensch; Helen Hansen; Lucie McCoy; Emily Tang; Stan J Tamaki; Courtney M Tamaki; Emily Nissen; Paige Bracci; Lucas A Salas; Devin C Koestler; Brock C Christensen; Ze Zhang; Karl T Kelsey Journal: Nat Commun Date: 2022-09-20 Impact factor: 17.694