Evidence-based dexamethasone dosing in malignant brain tumors: what do we really know?
| Autor: | Marike L. D. Broekman, Linda S. Aglio, Charissa A. C. Jessurun, Alexander F. C. Hulsbergen, Logan D. Cho, Rishi Nandoe Tewarie |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Oncology
Cancer Research medicine.medical_specialty Evidence-based medicine Evidence-based practice Anti-Inflammatory Agents Dexamethasone 03 medical and health sciences 0302 clinical medicine Internal medicine Glioma medicine Humans Dosing Adverse effect Dose-Response Relationship Drug business.industry Brain Neoplasms Brain metastases medicine.disease Symptomatic relief Neurology 030220 oncology & carcinogenesis Neurology (clinical) Topic Review business 030217 neurology & neurosurgery Brain metastasis medicine.drug |
| Zdroj: | Journal of Neuro-Oncology Journal of Neuro-Oncology, 144(2), 249-264 |
| ISSN: | 1573-7373 0167-594X |
| Popis: | Purpose The present study aims to conduct a systematic review of literature reporting on the dose and dosing schedule of dexamethasone (DXM) in relation to clinical outcomes in malignant brain tumor patients, with particular attention to evidence-based practice. Methods A systematic search was performed in PubMed, Embase, Web of Science, Cochrane, Academic Search Premier, and PsycINFO to identify studies that reported edema volume reduction, symptomatic relief, adverse events and survival in relation to dexamethasone dose in glioma or brain metastasis (BM) patients. Results After screening 1812 studies, fifteen articles were included for qualitative review. Most studies reported a dose of 16 mg, mostly in a schedule of 4 mg four times a day. Due to heterogeneity of studies, it was not possible to perform quantitative meta-analysis. For BMs, best available evidence suggests that higher doses of DXM may give more adverse events, but may not necessarily result in better clinical condition. Some studies suggest that higher DXM doses are associated with shorter survival in the palliative setting. For glioma, DXM may lead to symptomatic improvement, yet no studies directly compare different doses. Results regarding edema reduction and survival in glioma patients are conflicting. Conclusions Evidence on the safety and efficacy of different DXM doses in malignant brain tumor patients is scarce and conflicting. Best available evidence suggests that low DXM doses may be noninferior to higher doses in certain circumstances, but more comparative research in this area is direly needed, especially in light of the increasing importance of immunotherapy for brain tumors. Electronic supplementary material The online version of this article (10.1007/s11060-019-03238-4) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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