title: Twice-daily tapering dexamethasone treatment during cranial radiation for newly diagnosed brain metastases.
abstract: Twenty evaluable patients with newly diagnosed brain metastases underwent treatment with a novel dose/schedule of dexamethasone aimed at reducing steroid toxicity during palliative radiation therapy. All patients received twice daily dexamethasone starting at 8 mg bid for four days then 4 mg bid for four days then 2 mg bid until the last day of radiation therapy. The radiation prescriptions were not standardized varying from 2000 cGy/5 fractions to 5800 cGy/29 fractions. Fourteen patients received dexamethasone for a minimum of 24 hours before their first radiation treatment and 7 (50%) experienced improvement in neurologic symptoms/signs prior to starting radiation treatments. Fourteen patients completed the planned course of radiation and dexamethasone. Only 1 patient needed to restart dexamethasone within 30 days of finishing radiation because of steroid reversible neurologic deficits. Steroid toxicity was mild including hyperglycemia (1), candida esophagitis (1), steroid pseudorheumatism (2), peripheral edema (1) and steroid withdrawal syndrome (1). Only two toxic events were recorded in patients receiving steroids less than 21 days. Twice daily dexamethasone appears to provide good clinical results with minimal morbidity.
authors.affiliation: Department of Medicine, Medical College of Wisconsin.
authors.forename: D E
authors.initials: DE
authors.lastname: Weissman
authors.forename: N A
authors.initials: NA
authors.lastname: Janjan
authors.forename: B
authors.initials: B
authors.lastname: Erickson
authors.forename: F J
authors.initials: FJ
authors.lastname: Wilson
authors.forename: M
authors.initials: M
authors.lastname: Greenberg
authors.forename: P S
authors.initials: PS
authors.lastname: Ritch
authors.forename: T
authors.initials: T
authors.lastname: Anderson
authors.forename: R M
authors.initials: RM
authors.lastname: Hansen
authors.forename: C R
authors.initials: CR
authors.lastname: Chitambar
authors.forename: C A
authors.initials: CA
authors.lastname: Lawton
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000188:drug therapy* / Q000209:etiology; D001932:Brain Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000556:secondary*; D016371:Cranial Irradiation / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010865:Pilot Projects; D012216:Rheumatic Diseases / Q000139:chemically induced; D013375:Substance Withdrawal Syndrome / Q000209:etiology
chemical_list: D003907:Dexamethasone