Use of glucocorticoids in the palliative treatment of metastatic brain tumors

Ruderman, Neil B.; Hall, Thomas C.

doi:10.1002/1097-0142(196503)18:3<298::aid-cncr2820180306>3.0.co;2-h

Cited by 153 publications

(48 citation statements)

References 22 publications

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“…However, the benefit of corticosteroids is temporary. The median survival time of patients with CNS metastases on corticosteroids alone is 2 months, similar to that expected in response to palliative treatment in patients with all types of brain metastases [6,13,14,40,41].…”

Section: Corticosteroidssupporting

confidence: 67%

Brain Metastases from Epithelial Ovarian Cancer: A Review of the Literature

2006

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Key Words. Brain metastases • Surgery • Stereotactic radiosurgery • Whole-brain radiotherapy • Chemotherapy Learning ObjectivesAfter completing this course, the reader will be able to:1. Select the appropriate treatment strategies for ovarian cancer patients with solitary brain metastases and extracranial disease.2. Describe the most important prognostic factors for ovarian cancer patients with brain metastases.3. List the diagnostic steps needed to establish the diagnosis of brain metastases in ovarian cancer patients.

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Section: Corticosteroidssupporting

confidence: 67%

Brain Metastases from Epithelial Ovarian Cancer: A Review of the Literature

2006

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“…Glucocorticoids reduce brain tumor-associated vascular permeability and cerebral edema, reduce intracranial pressure, improve accompanying symptoms, and provide palliation of patients with malignant gliomas by prolonging useful neurologic function and life span (5)(6)(7). Although dexamethasone is a mainstay in the treatment of brain tumor patients, the mechanisms by which glucocorticoids reduce brain tumor-associated cerebral edema are poorly understood, and considerable morbidity is associated with their use.…”

Section: Introductionmentioning

confidence: 99%

Mechanism of dexamethasone suppression of brain tumor-associated vascular permeability in rats. Involvement of the glucocorticoid receptor and vascular permeability factor.

Heiss¹,

Papavassiliou²,

Merrill³

et al. 1996

J. Clin. Invest.

241

139

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Brain tumor-associated cerebral edema arises because tumor capillaries lack normal blood-brain barrier function; vascular permeability factor (VPF, also known as vascular endothelial growth factor, VEGF) is a likely mediator of this phenomenon. Clinically, dexamethasone reduces brain tumor-associated vascular permeability through poorly understood mechanisms. Our goals were to determine if suppression of permeability by dexamethasone might involve inhibition of VPF action or expression, and if dexamethasone effects in this setting are mediated by the glucocorticoid receptor (GR). In two rat models of permeability (peripheral vascular permeability induced by intradermal injection of 9L glioma cell-conditioned medium or purified VPF, and intracerebral vascular permeability induced by implanted 9L glioma), dexamethasone suppressed permeability in a dose-dependent manner. Since 80% of the permeability-inducing activity in 9L-conditioned medium was removed by anti-VPF antibodies, we examined dexamethasone effects of VPF expression in 9L cells. Dexamethasone inhibited FCS-and PDGF-dependent induction of VPF expression. At all levels (intradermal, intracranial, and cell culture), dexamethasone effects were reversed by the GR antagonist mifepristone (RU486). Dexamethasone may decrease brain tumor-associated vascular permeability by two GR-dependent mechanisms: reduction of the response of the vasculature to tumor-derived permeability factors (including VPF), and reduction of VPF expression by tumor cells. ( J. Clin. Invest . 1996. 98:1400-1408.)

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“…Several studies present in literature demonstrated that the median survival after brain metastases involvement diagnosis in patients treated with corticosteroids alone is about 2 months, and that this value is similar to the median survival obtained in patients treated with palliative therapy with any kind of central nervous system metastatic disease. (Cohen, 2004;Kaminsky-Forrett, 2000;Pectasides, 2005;Pectasides, 2006;Markesbery, 1978;Ruderman, 1965) …”

Section: Corticosteroids Mannitol and Antiepileptic Agentsmentioning

confidence: 99%