title: Defining the impact and contribution of steroids in patients receiving whole-brain irradiation for cerebral metastases.
abstract: OBJECTIVE
  To assess the impact of steroid therapy in the management of brain metastases by review of the published literature on whole-brain radiotherapy (WBRT) for multiple cerebral metastases.
  
  
  METHODS
  Twenty-one full manuscripts of published randomised controlled trials (RCTs) involving WBRT for multiple cerebral metastases were identified from a literature search and included studies from 1971--2003. Details on the use and type of steroid, timing of steroids relative to radiotherapy, response assessment and contribution of steroids to overall outcome were extracted.
  
  
  RESULTS
  Eighteen out of 21 trials commented on steroid use. All studies used overall survival as an assessment of outcome; 13 studies assessed neurological response and 10 used imaging assessment. Ten studies acknowledged a contribution from steroids in the response assessment or analysis, but only one study gave a fixed steroid dose to control for its palliative effect.
  
  
  CONCLUSIONS
  Reporting of steroid use in published RCTs assessing treatment for patients with brain metastases is non-uniform and not sufficiently detailed. As such, it is difficult to assess the additional benefit of WBRT. A standardised approach to the incorporation of steroid effect in assessment of WBRT would be advantageous to determine symptom response or durability of response. Side-effects of steroid use and the ability to taper off steroids after treatment intervention are also important outcomes of interest.
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada. barbara-ann.millar@rmp.uhn.on.ca
authors.forename: B M
authors.initials: BM
authors.lastname: Millar
authors.forename: A
authors.initials: A
authors.lastname: Bezjak
authors.forename: M
authors.initials: M
authors.lastname: Tsao
authors.forename: A
authors.initials: A
authors.lastname: Sturdza
authors.forename: N
authors.initials: N
authors.lastname: Laperriere
mesh_terms: D001932:Brain Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000556:secondary; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013256:Steroids / Q000009:adverse effects / Q000627:therapeutic use*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D013256:Steroids