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Corticosteroids in the management of central nervous system tumours
  1. Adam W Glasera,
  2. Neil Buxtonb,
  3. David Walker on behalf of the Kids Neuro-Oncology Workshop (KNOWS)a
  1. aUniversity Hospital, Nottingham: Department of Child Health, bDepartment of Paediatric Neurosurgery
  1. Dr A W Glaser, Division of Hematology/Oncology, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.

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Central nervous system (CNS) tumours account for 20% of childhood malignancy.1 Long term survival is still only 50%.2 3 Hence, symptomatic management remains a key area of specialist care during treatment, rehabilitation, and terminal care. A key component of adjunctive treatment is the use of corticosteroids to control symptoms related to peritumoral oedema and consequently raised intracranial pressure (ICP).

Rationale for glucocorticoids

Kofman et al first reported the beneficial role of glucocorticoids in managing brain tumours in 1957 after prednisolone was given to 20 adults with brain metastases.4 These drugs are now routinely administered to children with symptomatic CNS tumours.5 The rationale for their use is to improve neurological function by reducing associated brain or spinal oedema, although the mechanism by which this occurs is unresolved.6 7 Glucocorticoids increase membrane stability and thereby correct flux of sodium, potassium, and water across the cell membrane.8 There is evidence that they may reduce vascular permeability.9 10

Whether glucocorticoids are tumoricidal remains contentious. Inhibition of glioma cells by dexamethasome was reported for in vivo and in vitro studies.11-13 A process involving membrane modification leading to alteration of cell-cell interactions and reduction in their malignant potential has been postulated.14 For the clinician, however, concern exists that corticosteroid induced membrane stabilisation may decrease permeability of the blood-brain barrier and inhibit entry of water soluble cytotoxic agents into the tumour.15

Clinical dilemma

Few attempts have been made to systematically study the optimum corticosteroid dose regimen and the incidence of short and long term side effects in children with CNS tumours. Consequently, the risk-benefit ratio remains undetermined.

Lack of consensus regarding steroid treatment is exmplified by the wide variance of doses and duration of courses prescribed by clinicians between and within treatment centres. This issue is potentiated by the complex pattern of …

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