title: Steroid requirements during radiotherapy for malignant gliomas.
abstract: Radiotherapy (RT) is the standard treatment for high-grade gliomas. However, toxicity may develop during RT, such as brain edema or worsening of neurological symptoms. Surprisingly, no dedicated study had focused on steroid requirements during RT in adult patients with malignant gliomas. We evaluated prospectively all patients with malignant gliomas treated by RT in a single center from July 2006 to May 2009. Age, sex, initial Karnofsky performance status (KPS), tumor localization and histology, type of surgical resection, clinical target volume, total dose and duration of RT, concomitant treatment with temozolomide, and steroid dosage during RT and at 1 and 3 months after RT were recorded in all patients. Most of the 80 patients (70%) were already taking steroids before RT. Half of them (55%) required initiation or further steroids increase during RT. The median time to steroid increase was 8 days. Only 13% of patients remained free of steroids during RT, and the mean maximal dosage of prednisone was 55 ± 48 mg. At 3 months after RT, 29% of patients were free of steroids, and the mean prednisone dosage was 32 ± 50 mg. Unresected tumors and initial KPS ≤80% were the only variables associated with higher steroid requirements on multivariate analysis. In our series, almost all patients required steroids during RT. Poor initial KPS and biopsy were associated with higher steroid requirements.
authors.affiliation: Service de Neurologie, Hôpital Avicenne, Assistance Publique des Hopitaux de Paris, 125 route de Stalingrad, 75013, Bobigny, France.
authors.forename: Athina
authors.initials: A
authors.lastname: Marantidou
authors.forename: Christine
authors.initials: C
authors.lastname: Levy
authors.forename: Alyette
authors.initials: A
authors.lastname: Duquesne
authors.forename: Renata
authors.initials: R
authors.lastname: Ursu
authors.forename: Olivier
authors.initials: O
authors.lastname: Bailon
authors.forename: Irene
authors.initials: I
authors.lastname: Coman
authors.forename: Catherine
authors.initials: C
authors.lastname: Belin
authors.forename: Antoine F
authors.initials: AF
authors.lastname: Carpentier
mesh_terms: D000367:Age Factors; D000368:Aged; D001932:Brain Neoplasms / Q000378:metabolism* / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005910:Glioma / Q000378:metabolism* / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage* / Q000378:metabolism*; D013997:Time Factors
chemical_list: D013256:Steroids