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Departments of Neuro-Oncology and Biostatistics, Dr. Daniel den Hoed Cancer Center, and the Department of Neurology, University Hospital Rotterdam, Rotterdam, The Netherlands.
The purpose of this study was to determine whether lower doses of dexamethasone for treatment of brain tumor edema are as effective as the conventional dose of 16 mg/d. We consecutively executed two double-blind randomized trials in patients with CT-proven brain metastasis and Karnofsky scores of 80 or less. In the first series, we compared 8 mg dexamethasone per day versus 16 mg/d; in the second series, 4 mg/d versus 16 mg/d. Standardized evaluation of quality of life and side effects took place at days 0, 7, 28, and 56. We randomized a total of 96 patients and evaluated eighty-nine. The Karnofsky score improved in the 8-mg group, which had improvement of 8.0 ± 10.1 (mean ± SD) points at day 7 versus 7.3 ± 14.2 points in the 16-mg group. In the second series, the 4-mg group had improvement of 6.7 ± 11.3 points at day 7 and 7.1 ± 18.2 points at day 28 versus 9.1 ± 12.4 and 5.6 ± 18.5 points in the 16-mg group. Toxic effects occurred more frequently in the 16-mg group (p < 0.03). We conclude that administration of 4 mg dexamethasone per day for treatment of brain tumor edema results in the same degree of improvement as does administration of 16 mg/d after 1 week of treatment in patients who have no signs of impending herniation. Toxic effects are dose-dependent and, during a 4-week period, occurred more frequently in patients using 16 mg/d. Following radiotherapy to the brain or other antitumor therapy, tapering of dexamethasone from 4 mg/d should preferably be temporized over about 4 weeks.
Address correspondence and reprint requests to Dr. Charles J. Vecht, Department of Neuro-Oncology, Dr. Daniel den Hoed Cancer Center, P.O. BOX 5201,3008 EA Rotterdam, The Netherlands.
Presented in part at the 45th annual meeting of the American Academy of Neurology, New York, NY, April 1993.
Received July 29, 1993. Accepted for publication in final form September 16, 1993.
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