Corticosteroid-use in primary and secondary brain tumour patients: a review
Topic Review
First Online:
Received:
Accepted:
- 648 Downloads
- 15 Citations
Abstract
Corticosteroids have been effective in the management of cerebral oedema, in the context of brain tumours, for many decades. Though their effectiveness is well-established, this needs to be balanced against their potential to cause significant side effects. There is currently little consensus in the literature about how this should be done. This article reviews the literature, specifically in relation to the role of corticosteroids in primary and secondary brain tumour patients. Areas reviewed include corticosteroid pharmacology, indications, mechanism of action, toxicity profile, prescribing practices, and corticosteroid-sparing agents.
Keywords
Brain neoplasms Corticosteroids Quality of lifeNotes
Conflict of interest
The authors declare that they have no conflict of interest.
References
- 1.Galicich JH, French LA, Melby JC (1961) Use of dexamethasone in treatment of cerebral edema associated with brain tumors. Lancet 81:46–53Google Scholar
- 2.Galicich JH, French LA (1961) Use of dexamethasone in the treatment of cerebral edema resulting from brain tumors and brain surgery. Am Pract Dig Treat 12:169–174PubMedGoogle Scholar
- 3.Weissman DE, Dufer D, Vogel V, Abeloff MD (1987) Corticosteroid toxicity in neuro-oncology patients. J Neurooncol 5:125–128PubMedCrossRefGoogle Scholar
- 4.McClelland S, 3rd, Long DM (2008) Genesis of the use of corticosteroids in the treatment and prevention of brain edema. Neurosurgery 62:965–967 discussion 967–968PubMedCrossRefGoogle Scholar
- 5.Prados M, Strowger B, Feindel WH (1945) Studies on cerebral edema: reaction of the brain to air exposure; pathologic changes. Arch Neurol Psychiatry 54:163–174PubMedGoogle Scholar
- 6.Ingraham FD, Matson DD, Mc LRL (1952) Cortisone and ACTH as an adjunct to the surgery of craniopharyngiomas. New Eng J Med 246:568–571PubMedCrossRefGoogle Scholar
- 7.McKay L, Cidlowski J (2000) Corticosteroids. In: Bast RC, Kufe DW, Pollock RE, Weichselbaum R, Holland JF, Frei E (eds) Holland-Frei Cancer Medicine. BC Decker Inc, Hamilton (ON)Google Scholar
- 8.Talar-Williams C, Sneller MC (1994) Complications of corticosteroid therapy. Eur Arch Oto-Rhino Laryngol 251:131–136Google Scholar
- 9.Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280PubMedGoogle Scholar
- 10.Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, Degroot J, Wick W, Gilbert MR, Lassman AB, Tsien C, Mikkelsen T, Wong ET, Chamberlain MC, Stupp R, Lamborn KR, Vogelbaum MA, van den Bent MJ, Chang SM (2010) Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 28:1963–1972PubMedCrossRefGoogle Scholar
- 11.Millar BM, Bezjak A, Tsao M, Sturdza A, Laperriere N (2004) Defining the impact and contribution of steroids in patients receiving whole-brain irradiation for cerebral metastases. Clin Oncol (R Coll Radiol) 16:339–344CrossRefGoogle Scholar
- 12.Sandercock PA, Soane T (2011) Corticosteroids for acute ischaemic stroke. Cochrane Database Syst RevGoogle Scholar
- 13.Andersen C, Astrup J, Gyldensted C (1994) Quantitation of peritumoural oedema and the effect of steroids using NMR-relaxation time imaging and blood-brain barrier analysis. Acta Neurochir Suppl 60:413–415Google Scholar
- 14.Kaal EC, Vecht CJ (2004) The management of brain edema in brain tumors. Curr Opin Oncol 16:593–600PubMedCrossRefGoogle Scholar
- 15.Stamatovic SM, Keep RF, Andjelkovic AV (2008) Brain endothelial cell–cell junctions: how to “open” the blood brain barrier. Curr Neuropharmacol 6:179–192PubMedCrossRefGoogle Scholar
- 16.Wolburg H, Lippoldt A (2002) Tight junctions of the blood-brain barrier: development, composition and regulation. Vascul Pharmacol 38:323–337PubMedCrossRefGoogle Scholar
- 17.Papadopoulos MC, Saadoun S, Woodrow CJ, Davies DC, Costa-Martins P, Moss RF, Krishna S, Bell BA (2001) Occludin expression in microvessels of neoplastic and non-neoplastic human brain. Neuropathol Appl Neurobiol 27:384–395PubMedCrossRefGoogle Scholar
- 18.Liebner S, Fischmann A, Rascher G, Duffner F, Grote EH, Kalbacher H, Wolburg H (2000) Claudin-1 and claudin-5 expression and tight junction morphology are altered in blood vessels of human glioblastoma multiforme. Acta Neuropathol 100:323–331PubMedCrossRefGoogle Scholar
- 19.Saadoun S, Papadopoulos MC, Davies DC, Krishna S, Bell BA (2002) Aquaporin-4 expression is increased in oedematous human brain tumours. J Neurol Neurosurg Psychiatry 72:262–265PubMedCrossRefGoogle Scholar
- 20.Machein MR, Plate KH (2000) VEGF in brain tumors. J Neuro-Oncol 50:109–120CrossRefGoogle Scholar
- 21.Machein MR, Kullmer J, Fiebich BL, Plate KH, Warnke PC (1999) Vascular endothelial growth factor expression, vascular volume, and, capillary permeability in human brain tumors. Neurosurgery 44:732–740 discussion 740–731PubMedCrossRefGoogle Scholar
- 22.Peak SJ, Levin VA (2010) Role of bevacizumab therapy in the management of glioblastoma. Cancer Manag Res 2:97–104PubMedGoogle Scholar
- 23.Roberts WG, Palade GE (1997) Neovasculature induced by vascular endothelial growth factor is fenestrated. Cancer Res 57:765–772PubMedGoogle Scholar
- 24.Black KL, Hoff JT, McGillicuddy JE, Gebarski SS (1986) Increased leukotriene C4 and vasogenic edema surrounding brain tumors in humans. Ann Neurol 19:592–595PubMedCrossRefGoogle Scholar
- 25.Nathoo N, Barnett GH, Golubic M (2004) The eicosanoid cascade: possible role in gliomas and meningiomas. J Clin Pathol 57:6–13PubMedCrossRefGoogle Scholar
- 26.Heiss JD, Papavassiliou E, Merrill MJ, Nieman L, Knightly JJ, Walbridge S, Edwards NA, Oldfield EH (1996) Mechanism of dexamethasone suppression of brain tumor-associated vascular permeability in rats. Involvement of the glucocorticoid receptor and vascular permeability factor. J Clin Invest 98:1400–1408PubMedCrossRefGoogle Scholar
- 27.Criscuolo GR, Balledux JP (1996) Clinical neurosciences in the decade of the brain: hypotheses in neuro-oncology. VEG/PF acts upon the actin cytoskeleton and is inhibited by dexamethasone: relevance to tumor angiogenesis and vasogenic edema. Yale J Biol Med 69:337–355PubMedGoogle Scholar
- 28.Ohnishi T, Sher PB, Posner JB, Shapiro WR (1990) Capillary permeability factor secreted by malignant brain tumor. Role in peritumoral brain edema and possible mechanism for anti-edema effect of glucocorticoids. J Neurosurg 72:245–251PubMedCrossRefGoogle Scholar
- 29.Bruce JN, Criscuolo GR, Merrill MJ, Moquin RR, Blacklock JB, Oldfield EH (1987) Vascular permeability induced by protein product of malignant brain tumors: inhibition by dexamethasone. J Neurosurg 67:880–884PubMedCrossRefGoogle Scholar
- 30.Kim H, Lee JM, Park JS, Jo SA, Kim YO, Kim CW, Jo I (2008) Dexamethasone coordinately regulates angiopoietin-1 and VEGF: a mechanism of glucocorticoid-induced stabilization of blood-brain barrier. Biochem Biophys Res Commun 372:243–248PubMedCrossRefGoogle Scholar
- 31.Kreisl TN, Kim L, Moore K, Duic P, Royce C, Stroud I, Garren N, Mackey M, Butman JA, Camphausen K, Park J, Albert PS, Fine HA (2009) Phase II trial of single-agent bevacizumab followed by bevacizumab plus irinotecan at tumor progression in recurrent glioblastoma. J Clin Oncol 27:740–745PubMedCrossRefGoogle Scholar
- 32.Badie B, Schartner JM, Paul J, Bartley BA, Vorpahl J, Preston JK (2000) Dexamethasone-induced abolition of the inflammatory response in an experimental glioma model: a flow cytometry study. J Neurosurg 93:634–639PubMedCrossRefGoogle Scholar
- 33.Leenders KL, Beaney RP, Brooks DJ, Lammertsma AA, Heather JD, McKenzie CG (1985) Dexamethasone treatment of brain tumor patients: effects on regional cerebral blood flow, blood volume, and oxygen utilization. Neurology 35:1610–1616PubMedGoogle Scholar
- 34.Behrens PF, Ostertag CB, Warnke PC (1998) Regional cerebral blood flow in peritumoral brain edema during dexamethasone treatment: a xenon-enhanced computed tomographic study. Neurosurgery 43:235–241PubMedCrossRefGoogle Scholar
- 35.Sturdza A, Millar BA, Bana N, Laperriere N, Pond G, Wong RK, Bezjak A (2008) The use and toxicity of steroids in the management of patients with brain metastases. Support Care Cancer 16:1041–1048PubMedCrossRefGoogle Scholar
- 36.Pilkey J, Daeninck PJ (2008) A retrospective analysis of dexamethasone use on a Canadian palliative care unit. Prog Palliat Care 16:63–68CrossRefGoogle Scholar
- 37.Hardy JR, Rees E, Ling J, Burman R, Feuer D, Broadley K, Stone P (2001) A prospective survey of the use of dexamethasone on a palliative care unit. Palliat Med 15:3–8PubMedCrossRefGoogle Scholar
- 38.McGirt MJ, Chaichana KL, Gathinji M, Attenello F, Than K, Ruiz AJ, Olivi A, Quinones-Hinojosa A (2008) Persistent outpatient hyperglycemia is independently associated with decreased survival after primary resection of malignant brain astrocytomas. Neurosurgery 63:286–291PubMedCrossRefGoogle Scholar
- 39.The Boston Collaborative Drug Surveillance Program (1972) Acute adverse reactions to prednisone in relation to dosage. Clin Pharmacol Ther 13: 694–698Google Scholar
- 40.Adachi JD, Papaioannou A (2001) Corticosteroid-induced osteoporosis: detection and management. Drug Safety 24:607–624PubMedCrossRefGoogle Scholar
- 41.Vecht CJ, Hovestadt A, Verbiest HB, van Vliet JJ, van Putten WL (1994) Dose-effect relationship of dexamethasone on Karnofsky performance in metastatic brain tumors: a randomized study of doses of 4, 8, and 16 mg per day. Neurology 44:675–680PubMedGoogle Scholar
- 42.Stanbury RM, Graham EM (1998) Systemic corticosteroid therapy—side effects and their management. Br J Ophthalmol 82:704–708PubMedCrossRefGoogle Scholar
- 43.Benvenuti S, Brandi ML (2000) Corticosteroid-induced osteoporosis: pathogenesis and prevention. Clin Exp Rheumatol 18:S64–S66PubMedGoogle Scholar
- 44.Manson SC, Brown RE, Cerulli A, Vidaurre CF (2009) The cumulative burden of oral corticosteroid side effects and the economic implications of steroid use. Respir Med 103:975–994PubMedCrossRefGoogle Scholar
- 45.Huizenga NA, Koper JW, de Lange P, Pols HA, Stolk RP, Grobbee DE, de Jong FH, Lamberts SW (1998) Interperson variability but intraperson stability of baseline plasma cortisol concentrations, and its relation to feedback sensitivity of the hypothalamo-pituitary-adrenal axis to a low dose of dexamethasone in elderly individuals. J Clin Endocrinol Metab 83:47–54PubMedCrossRefGoogle Scholar
- 46.Huizenga NA, Koper JW, De Lange P, Pols HA, Stolk RP, Burger H, Grobbee DE, Brinkmann AO, De Jong FH, Lamberts SW (1998) A polymorphism in the glucocorticoid receptor gene may be associated with and increased sensitivity to glucocorticoids in vivo. J Clin Endocrinol Metab 83:144–151PubMedCrossRefGoogle Scholar
- 47.van Rossum EF, Lamberts SW (2004) Polymorphisms in the glucocorticoid receptor gene and their associations with metabolic parameters and body composition. Recent Prog Horm Res 59:333–357PubMedCrossRefGoogle Scholar
- 48.Van Rossum EFC, Koper JW, Van Den Beld AW, Uitterlinden AG, Arp P, Ester W, Janssen JAMJL, Brinkmann AO, De Jong FH, Grobbee DE, Pols HAP, Lamberts SWJ (2003) Identification of the Bc/I polymorphism in the glucocorticoid receptor gene: Association with sensitivity to glucocorticoids in vivo and body mass index. Clin Endocrinol 59:585–592CrossRefGoogle Scholar
- 49.Mitchell CD, Richards SM, Kinsey SE, Lilleyman J, Vora A, Eden TO, Medical Research Council Childhood Leukaemia Working (2005) Benefit of dexamethasone compared with prednisolone for childhood acute lymphoblastic leukaemia: results of the UK Medical Research Council ALL97 randomized trial. Br J Haematol 129:734–745PubMedCrossRefGoogle Scholar
- 50.Hanks GW, Trueman T, Twycross RG (1983) Corticosteroids in terminal cancer - a prospective analysis of current practice. Postgrad Med J 59:702–706PubMedCrossRefGoogle Scholar
- 51.Aulakh R, Singh S (2008) Strategies for minimizing corticosteroid toxicity: a review. Indian J Pediatr 75:1067–1073PubMedCrossRefGoogle Scholar
- 52.Pereira RMR, Freire JC (2011) Glucocorticoid-induced myopathy. Joint Bone Spine 78:41–44PubMedCrossRefGoogle Scholar
- 53.Kirkham SR (1988) The palliation of cerebral tumours with high-dose dexamethasone: a review. Palliat Med 2:27–33CrossRefGoogle Scholar
- 54.Nesher G, Rubinow A, Sonnenblick M (1997) Efficacy and adverse effects of different corticosteroid dose regimens in temporal arteritis: a retrospective study. Clin Exp Rheumatol 15:303–306PubMedGoogle Scholar
- 55.Marantidou A, Levy C, Duquesne E, Ursu R, Bailon O, Coman I, Belin C, Carpentier AF (2010) Steroid requirements during radiotherapy for malignant gliomas. J Neuro-Oncol 100:89–94CrossRefGoogle Scholar
- 56.Hempen C, Weiss E, Hess CF (2002) Dexamethasone treatment in patients with brain metastases and primary brain tumors: do the benefits outweigh the side-effects? Support Care Cancer 10:322–328PubMedCrossRefGoogle Scholar
- 57.Weissman DE, Janjan NA, Erickson B, Wilson FJ, Greenberg M, Ritch PS, Anderson T, Hansen RM, Chitambar CR, Lawton CA et al (1991) Twice-daily tapering dexamethasone treatment during cranial radiation for newly diagnosed brain metastases. J Neuro-Oncol 11:235–239CrossRefGoogle Scholar
- 58.Ryken TC, McDermott M, Robinson PD, Ammirati M, Andrews DW, Asher AL, Burri SH, Cobbs CS, Gaspar LE, Kondziolka D, Linskey ME, Loeffler JS, Mehta MP, Mikkelsen T, Olson JJ, Paleologos NA, Patchell RA, Kalkanis SN (2010) The role of steroids in the management of brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96:103–114PubMedCrossRefGoogle Scholar
- 59.Frauman AG (1996) An overview of the adverse reactions to adrenal corticosteroids. Adverse Drug React Toxicol Rev 15:203–206PubMedGoogle Scholar
- 60.Gannon C, McNamara P (2002) A retrospective observation of corticosteroid use at the end of life in a hospice. J Pain Symptom Manage 24:328–335PubMedCrossRefGoogle Scholar
- 61.Gannon C (2001) The prescription of steroids in the terminal phase. Palliat Med 15:522PubMedCrossRefGoogle Scholar
- 62.Mercadante S, Villari P, Intravaia G (2007) Withdrawal acute psychosis after corticosteroid discontinuation. J Pain Symptom Manage 34:118–119PubMedCrossRefGoogle Scholar
- 63.Vredenburgh J, Cloughesy TF, Samant M, Fang L, Das A, Friedman H (2009) Corticosteroid use in patients with glioblastoma at first or second relapse treated with bevacizumab in the brain study. Neuro-Oncology 11:1329–1334Google Scholar
- 64.Cohen MH, Shen YL, Keegan P, Pazdur R (2009) FDA drug approval summary: Bevacizumab (Avastin) as treatment of recurrent glioblastoma multiforme. Oncologist 14:1131–1138PubMedCrossRefGoogle Scholar
- 65.Shapiro WR, Mechtler L, Cher L, Wheeler H, Hines V, Milsted R, O’Connor PC, Ryan RP, Recht L (2009) A randomized, double-blind study comparing corticorelin acetate with dexamethasone in patients with primary malignant glioma who require increased dexamethasone doses to control symptoms of peritumoral brain edema. J Clin Oncol 27; (abstract)Google Scholar
- 66.PN KesariS, Vick N (2003) Corticosteroids in neuro-oncology. In: Schiff D, Kesari S, Wen PY (eds) Cancer neurology in clinical practice. Humana Press, Totowa, pp 47–56Google Scholar
- 67.Chamberlin P, Meyer WJ 3rd (1981) Management of pituitary-adrenal suppression secondary to corticosteroid therapy. Pediatrics 67:245–251PubMedGoogle Scholar
- 68.Pezner RD, Lipsett JA (1982) Peptic ulcer disease and other complications in patients receiving dexamethasone palliation for brain metastasis. West J Med 137:375–378PubMedGoogle Scholar
- 69.Batchelor TT, Taylor LP, Thaler HT, Posner JB, DeAngelis LM (1997) Steroid myopathy in cancer patients. Neurology 48:1234–1238PubMedGoogle Scholar
Copyright information
© Springer Science+Business Media, LLC. 2011