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    Home > Active Ingredient News > Antitumor Therapy > Latest recommendations for the use of steroid hormones in the treatment of adult brain metastatic tumors

    Latest recommendations for the use of steroid hormones in the treatment of adult brain metastatic tumors

    • Last Update: 2020-06-03
    • Source: Internet
    • Author: User
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    Timothy CRyken of Dartmouth-Hitchcock Medical Center in New Hampshire, USA, wrote the recommendations of the American Association of Neurosurgeons (Congress of Neurosurgeon, CNS) on the systematic review and evidence-based guidelines for the treatment of brain metastatic tumors on corticosteroid hormones, published in the March 2019 issue of the journal Neurosurgery- From the article(Ref: Ryken TC, et alNeurosurgery2019 Mar 1;84(3): E189-E191doi: 10.1093/neuros/nyy546in the treatment of newly diagnosed brain metastatic tumors, corticosteroid hormones are often used to aid in controlling cerebral edema around tumorsDexamethasone has the lowest effect on salcorticoids and is therefore the most commonly used corticosteroidIn addition, corticosteroid hormones, as palliative care, can reduce treatment-related toxicity when used in combination with surgery and radiotherapyTimothy CRyken of Dartmouth-Hitchcock Medical Center in New Hampshire, USA, wrote the recommendations of the American Association of Neurosurgeons (Congress of Neurosurgeon, CNS) on the systematic review and evidence-based guidelines for the treatment of brain metastatic tumors on corticosteroid hormones, published in the March 2019 issue of the journal Neurosurgeryon the basis of the clinical practice that corticosteroid hormones can improve neurological symptoms in patients with brain metastases, the recommendations are as follows:1Adapting to corticosteroid hormones:patients with asymptomatic brain metastasis without aprecon effect: There is currently insufficient evidence to support the clinical treatment of corticosteroid hormonespatients with brain metastatic tumors with mild occupancy effects: Corticosteroid hormones are recommended to temporarily relieve the symptoms of secondary intracranial pressure and cerebral edema For patients with symptomatic brain metastasis, a recommended starting dose of dexamethasone is 4 to 8 mg/d (Class III recommended) patients with cerebral metastatic tumors with moderate to severe occupancy effect symptoms: Corticosteroid hormones are recommended to temporarily relieve symptoms of secondary intracranial pressure and cerebral edema When the patient's symptoms are as severe as the increase in intracranial pressure, it is recommended to increase the dose of use, such as 16 mg/d or more (Grade III recommended) 2 The choice of corticosteroid hormones, considered dexamethasone to be the best drug (Class III recommended) 3 The duration of corticosteroid hormone administration, based on a personalized treatment plan and a good understanding of the long-term side effects of corticosteroid hormone therapy, should be decreased as quickly as possible, but note that the rate of decline should not exceed the rate of clinical tolerance (Level III Recommendation) is the only methodological recommendation due to the very limited number of research data that meet the criteria for inclusion in the system overview There is currently no comparative study of various corticosteroid hormone formulations, and the toxicity of corticosteroid hormones is continuing The study was based on the principle of the lowest effective dose of corticosteroid hormones It is worth noting that in the design of large clinical trials, the corticosteroid hormone therapy group alone was considered to be the "best supportive treatment" group, highlighting the strong belief of most doctors that corticosteroid hormones play a key role in treating patients with symptomated brain metastatic tumors In addition, on the basis of available evidence, it is difficult to resolve drug-administration programmes Therefore, only opinions on the daily total are recommended The toxicity of corticosteroid hormones after surgery or radiation therapy is still worth further study According to the literature cited in the guidelines, it is necessary to consider larger prospective studies or well-planned retrospective studies to determine more specific patient-dependent doses, and to continue to detect complications associated with corticosteroid hormones, including adrenal insufficiency at reduced doses In addition, it is necessary to find alternative ways to reduce edema around the tumor, thereby eliminating the common side effects of corticosteroid hormones altogether.
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