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How do you taper steroids for patients with symptomatic edema following standard chemoradiation for GBM?
Do you have a preference for specific steroids? Some practices may switch to prednisone during this time.
Patients with gliomas are often on decadron through the 6 week radiation course and often continue at some dose through the ensuing adjuvant chemo. Our endocrinology colleagues recommend a very slow taper after prolonged steroids (longer than is typically done by med oncs/rad oncs). The sxs of adrenal insufficiency are vague and similar to those of brain tumors.
Answer from: Radiation Oncologist at Academic Institution
I agree with above and would add that decreased production of corticosteroids by the adrenals does not typically occur until after a patient has been on steroids for at least 3 weeks. If you have a patient on steroids for less than this time period I suggest a rapid taper that is based on symp...
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Answer from: Radiation Oncologist at Academic Institution
We tend to use dexamethasone, although one of our neuro-oncologists likes prednisone better than dexamethasone as it may be easier to wean.
We used to keep patients on even a low dose of dexamethasone throughout treatment, but given concerns that dexamethasone will result in immunosuppression that ...
Answer from: Radiation Oncologist at Academic Institution
If the problem is less an adrenal one, consider overlapping with celebrex- this can be enormously helpful in helping a taper due to persistant edema. Also consider bevicizumab if there is persistant mass effect from tumor (as opposed to pseudonecrosis). As always, consider side effects of these ther...