From the Guidelines
Patients with glioblastoma should be prescribed corticosteroids, such as dexamethasone 8-16 mg/day, to rapidly reduce tumor-associated edema and improve clinical symptoms, but only when necessary and with careful monitoring of glucose levels and potential side effects. The use of corticosteroids in glioblastoma patients is a common practice to manage symptoms associated with tumor-related edema 1. Key considerations for steroid use in glioblastoma include:
- Starting with a dose of 8-16 mg/day of dexamethasone, with the option to use lower doses if effective 1
- Monitoring patients' glucose levels due to the potential for steroid-induced hyperglycemia 1
- Avoiding prolonged steroid therapy to minimize the risk of toxicity, including myopathy, weakness, lymphopenia, infection, osteoporosis, and Cushing syndrome 1
- Tapering and discontinuing corticosteroids rapidly after tumor resection or when symptoms improve to reduce the risk of long-term side effects 1
- Using steroids only in patients with increased intracranial pressure or edema-associated neurological deficits, as they are not necessary in asymptomatic patients 1.
From the Research
Glioblastoma and Steroids
- The use of steroids, such as dexamethasone, is a common practice in the management of glioblastoma, particularly for reducing cerebral edema and alleviating symptoms 2, 3, 4, 5, 6.
- However, the evidence suggests that the use of dexamethasone may be associated with poorer overall survival (OS) and progression-free survival (PFS) in patients with glioblastoma 2, 3, 5.
- A systematic review and meta-analysis found that higher doses of dexamethasone were associated with poorer OS and PFS, with a hazard ratio of 1.62 for OS and 1.49 for PFS 3.
- Another study found that the use of dexamethasone during radiotherapy with concurrent temozolomide was a poor prognostic indicator of both OS and PFS, unless bevacizumab was also administered 2.
- The optimal dose and schedule for dexamethasone in patients with primary brain tumors is not well established, but a clinical practice guideline recommends a maximum dose of 16 mg daily for symptomatic patients after surgery 4.
- A pooled analysis of 8,752 patients found that the use of steroids during treatment was associated with reduced OS and PFS, with a hazard ratio of 1.54 for OS and 1.28 for PFS 5.
- However, dexamethasone has been shown to reduce the emergence of neurological deficits during radiotherapy, and its use may be beneficial in preventing the appearance of neurological symptoms in patients with brain tumors 6.