Practical Review of Role and Usage of Corticosteroids in Modern Neuro-Oncology Care.

PURPOSE OF REVIEW: Corticosteroids are commonly used in the treatment of neuro-oncology patients. Unfortunately, the benefits of steroids must be balanced against the potential development of complications. This review provides guidance for the usage of steroids in the management of neuro-oncology patients.

RECENT FINDINGS: Steroids should only be used as a temporizing measure in brain tumor patients to minimize symptoms secondary to mass effect from the tumor. For instance, because of the long half-life of corticosteroids, dosing should be limited to daily or twice per day, with the second dose given no later than early afternoon. Owing to its effects on multiple organ systems including endocrine, dermatologic, immunologic, gastrointestinal, orthopedic, and neuropsychiatric, prolonged steroid use can increase patient morbidity. They can also directly alter the potency of cancer-directed therapy including immunotherapy and chemoradiation. Steroid-sparing options, including bevacizumab, have emerged as means to minimize toxicity. Finally, the effects of steroid on tumor response has been formally integrated into imaging response assessment.

SUMMARY: Corticosteroids are an integral and useful treatment of neuro-oncology patients. We recommend using the lowest effective dose, with its frequency limited to 1 to 2 times per day and to taper them off as soon as possible to minimize toxicity and morbidity. The use of corticosteroids in clinical practice warrants specific consideration in the setting of immunotherapy and with assessments of imaging response.