The Role of Steroids

The American Association of Neurological Surgeons & the Congress of Neurological Surgeons

Do steroids improve neurologic symptoms in patients with metastatic brain tumors compared to no treatment? If steroids are given, what dose should be used? Comparisons include: (1) steroid therapy versus none. (2) comparison of different doses of steroid therapy.

Target population

These recommendations apply to adults diagnosed with brain metastases.

 

Recommendations

Steroid therapy versus no steroid therapy
 

Asymptomatic brain metastases patients without mass effect

Insufficient evidence exists to make a treatment recommendation for this clinical
scenario.

Brain metastases patients with mild symptoms related to mass effect

Level 3 Corticosteroids are recommended to provide temporary symptomatic relief of
symptoms related to increased intracranial pressure and edema secondary to brain
metastases. It is recommended for patients who are symptomatic from metastatic
disease to the brain that a starting dose of 4–8 mg/day of dexamethasone be
considered.

Brain metastases patients with moderate to severe symptoms related to mass effect

Level 3 Corticosteroids are recommended to provide temporary symptomatic relief of
symptoms related to increased intracranial pressure and edema secondary to brain
metastases. If patients exhibit severe symptoms consistent with increased intracranial
pressure, it is recommended that higher doses such as 16 mg/day or more be
considered.

Choice of Steroid

Level 3 If corticosteroids are given, dexamethasone is the best drug choice given the available evidence.

Duration of Corticosteroid Administration

Level 3 Corticosteroids, if given, should be tapered slowly over a 2 week time period, or longer in symptomatic patients, based upon an individualized treatment regimen and a full understanding of the long-term sequelae of corticosteroid therapy. Given the very limited number of studies (two) which met the eligibility criteria for the systematic review, these are the only recommendations that can be offered based on this methodology.
 
Please see “Discussion” and “Summary” section for additional details.