title: Steroid and anticonvulsant prophylaxis for stereotactic radiosurgery: Large variation in physician recommendations.
abstract: OBJECTIVE
  The risk of developing symptomatic edema or seizure following stereotactic radiosurgery (SRS) is poorly defined, and many practitioners prescribe prophylactic corticosteroids and/or anticonvulsants. Because there are no clear guidelines regarding appropriate use, we sought to characterize prescribing practices and factors associated with these recommendations.
  
  
  METHODS
  We conducted a 1-time, internet-based survey among 500 randomly selected radiation oncologists self-described as specializing in central nervous system diseases who were registered in the American Society for Radiation Oncology directory. Physicians were contacted by e-mail and invited to complete the 22-question survey.
  
  
  RESULTS
  The response rate was 32% (n = 161). Sixty-six percent of respondents had been in practice for >10 years, and 45% of respondents practiced at an academic medical center. During/after SRS, 53% of respondents "always" or "usually" recommended corticosteroids, whereas 47% "never," "rarely," or "sometimes" recommended them. When prescribing corticosteroids, the recommended duration of use was <1 week, 1-2 weeks, or >2 weeks among 49%, 33%, and 18% of respondents, respectively. Respondents who worked in an academic medical center were less likely to prescribe corticosteroids, although this did not reach significance (P = .09). Seizure prophylaxis was less common overall, as 79% of respondents "rarely" or "never" prescribed anticonvulsants for SRS. Respondents who prescribed anticonvulsants more frequently had higher estimations of the risk of seizure within 2 weeks of SRS (P < .001), and their recommended duration of anticonvulsant use was <1 week, 1-2 weeks, and >2 weeks among 35%, 25%, and 41% of respondents, respectively.
  
  
  CONCLUSIONS
  There is extreme variation in physician recommendations regarding prophylactic corticosteroid and anticonvulsant use for patients undergoing SRS. Further investigation of the risks and benefits of these medications for SRS is warranted, which may promote guideline development and more patient-centered, rational prescribing practices.
authors: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors: Nils D
authors: ND
authors: Arvold
authors: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts.
authors: Nancy E
authors: NE
authors: Pinnell
authors: Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors: Anand
authors: A
authors: Mahadevan
authors: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts.
authors: Sheila
authors: S
authors: Connelly
authors: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts.
authors: Rachel
authors: R
authors: Silverman
authors: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors: Stephanie E
authors: SE
authors: Weiss
authors: Department of Radiation Oncology, Cork University Hospital, Cork, Ireland.
authors: Paul J
authors: PJ
authors: Kelly
authors: Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: bmalexander@partners.org.
authors: Brian M
authors: BM
authors: Alexander
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016634:Radiosurgery / Q000009:adverse effects; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*; D011795:Surveys and Questionnaires
chemical_list: D000927:Anticonvulsants; D013256:Steroids