From the Guidelines
Prednisone can be used during radiation therapy for cancer to reduce inflammation and swelling, but its use should be carefully considered and monitored due to potential side effects. The decision to use prednisone during radiation therapy depends on the specific cancer type and treatment plan, as well as the patient's overall health and medical history 1. Oncologists may prescribe prednisone alongside radiation therapy to manage symptoms such as cough and pneumonitis, particularly in patients with lung cancer 1. Typical dosing ranges from 5-60 mg daily, with the specific amount determined by the patient's condition and treatment goals.
The medication is usually taken orally with food to minimize stomach irritation, and doses are often tapered rather than stopped abruptly. Prednisone works by suppressing the immune system and reducing inflammatory responses, which can help manage radiation-induced inflammation and provide symptom relief. However, it carries potential side effects including increased blood sugar, fluid retention, mood changes, and increased infection risk. Patients should never adjust their prednisone dose without consulting their oncologist, as the medication requires careful monitoring during cancer treatment.
Some studies suggest that corticosteroids, such as prednisone, may be used to increase appetite in patients with advanced cancer, but this should be done with caution and for a restricted period of time (1-3 weeks) due to potential side effects such as muscle wasting, insulin resistance, and infections 1. In patients with lung cancer, anti-inflammatory therapy with corticosteroids is recommended for troublesome cough attributed to chemotherapy or radiation-induced pneumonitis 1.
Key considerations for the use of prednisone during radiation therapy include:
- Careful monitoring of side effects and adjustment of dosage as needed
- Consideration of alternative treatments, such as macrolides, as steroid-sparing agents 1
- Individualized nutritional counseling and/or use of oral nutritional supplements to avoid nutritional deterioration and maintain intake during radiation therapy 1
- Regular physical activity and maintenance of a healthy weight and lifestyle to improve overall health and well-being 1.
From the Research
Use of Prednisone during Radiation Therapy for Cancer
- The use of prednisone during radiation therapy for cancer has been studied in various contexts, including its effects on radiation mucositis, symptom relief, and pain control 2, 3, 4, 5, 6.
- A double-blind placebo-controlled randomized trial found that patients with head and neck cancer who received 40 mg/day prednisone had a significantly lower median total tumour and biologically effective dose (BED) Gy10 compared to those who received a placebo 2.
- Another study found that patients treated with immune checkpoint inhibitors and radiation therapy were not at increased risk for requiring corticosteroid therapy, but were at a higher risk of hospitalization 3.
- Prednisone has been used for symptom relief in patients with metastatic prostate cancer, and has been shown to improve quality of life for a few months by relieving symptoms in 20% to 40% of patients 4.
- Corticosteroids, including prednisone, have been used for pain control in patients with bone metastases, and have been shown to provide moderate pain relief in 30% to 70% of patients 5.
- A systematic review found that corticosteroids, including prednisone, resulted in less pain compared to control at one week, but the evidence was limited by the risk of bias and small sample size 6.
Key Findings
- Prednisone may be used during radiation therapy for cancer to reduce radiation mucositis and improve symptom relief 2.
- The use of prednisone during radiation therapy may not increase the risk of requiring corticosteroid therapy, but may increase the risk of hospitalization 3.
- Prednisone may be effective for pain control in patients with bone metastases, but the risk of adverse events should be carefully considered 5.
- The evidence for the efficacy of corticosteroids, including prednisone, for pain control in cancer patients is weak, and further trials are needed to establish an ideal dose, duration of therapy, and route of administration 6.