The use and toxicity of steroids in the management of patients with brain metastases.
OBJECTIVE
To document the use of steroids and frequency of their side effects in patients with brain metastases.


METHODS
A survey of oncologists who manage patients with brain metastases was conducted to document steroid prescribing practice in our institution. In addition, a retrospective chart review of 88 patients treated with whole brain radiotherapy (WBRT), identified through the Palliative Radiation Oncology Program database, was conducted for a 6-month period to documents steroid doses prescribed, tapering schedules, and steroid side effects.


RESULTS
Ninety percent of physicians responded to the survey. Forty-five percent routinely used dexamethasone 4 mg qid (16 mg/day). The others determined the dose of steroid according to the presence or absence of neurological symptoms. Sixty percent tapered the patient's steroids over the 4 weeks following completion of WBRT. The most common side effects noted by physicians were: increased appetite or weight gain (46%), insomnia (24%), gastro-intestinal symptoms (20%). In the retrospective study, dexamethasone 4 mg qid was prescribed to 52% patients prior and during WBRT. Sixty-six percent of patients were instructed to taper dexamethasone after WBRT, but details were not provided. The most frequently documented steroid-related side effects were: increased appetite (32%), proximal muscle weakness (28%), and insomnia (21%).


CONCLUSIONS
There is considerable variation in the prescribing practices even within a single institution, with many patients receiving high dose of steroids for considerable periods of time and developing related side effects. Strategies to reduce the amount and length of steroids may result in improved therapeutic ratio; we are currently accruing onto such a trial.
Sturdza
Alina
A
Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, Ontario, Canada.
Millar
Barbara-Ann
BA
Bana
Neelufer
N
Laperriere
Normand
N
Pond
Gregory
G
Wong
Rebecca K S
RK
Bezjak
Andrea
A
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D019992:Databases as Topic; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
D000305:Adrenal Cortex Hormones; D018931:Antineoplastic Agents, Hormonal; D003907:Dexamethasone