Scheffler, Pierre; Fung, Christian; Momjian, Shahan; Koessinger, Dominik; Häni, Levin; Neidert, Nicolas; Straehle, Jakob; Volz, Florian; Schnell, Oliver; Beck, Jürgen; El Rahal, Amir (2024). Dexamethasone in Patients with Glioblastoma: A Systematic Review and Meta-Analysis. Cancers, 16(7) MDPI AG 10.3390/cancers16071393
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OBJECTIVE
Glioblastomas are the most common primary central nervous system (CNS) tumors. Although modern management strategies have modestly improved overall survival, the prognosis remains dismal, with treatment side effects often impinging on the clinical course. Glioblastomas cause neurological dysfunction by infiltrating CNS tissue and via perifocal oedema formation. The administration of steroids such as dexamethasone is thought to alleviate symptoms by reducing oedema. However, despite its widespread use, the evidence for the administration of dexamethasone is limited and conflicting. Therefore, we aimed to review the current evidence concerning the use and outcomes of dexamethasone in patients with glioblastoma.
METHODS
We performed a systematic review and meta-analysis according to the PRISMA-P guidelines. We performed a restricted search using the keywords "Dexamethasone" and "Glioblastoma" on PubMed, Web of Science, Cochrane Library, and Academic Search Premier. We included studies reporting on overall survival (OS) and progression-free survival (PFS) in glioblastoma patients receiving higher or lower dexamethasone doses. The risk of bias was assessed using ROBINS-I. We performed a meta-analysis using a random effects model for OS and PFS.
RESULTS
Twenty-two retrospective studies were included. Higher doses of dexamethasone were associated with poorer OS (hazard ratio 1.62, confidence interval 1.40-1.88) and PFS (1.49, 1.23-1.81). OS remained worse even when studies corrected for clinical status (1.52, 1.38-1.67).
CONCLUSION
Despite the widespread use of dexamethasone in glioblastoma patients, its use is correlated with worse long-term outcomes. Consequently, Dexamethasone administration should be restricted to selected symptomatic patients. Future prospective studies are crucial to confirm these findings.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery |
UniBE Contributor: |
Häni, Levin |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2072-6694 |
Publisher: |
MDPI AG |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
15 Apr 2024 09:34 |
Last Modified: |
15 Apr 2024 09:40 |
Publisher DOI: |
10.3390/cancers16071393 |
PubMed ID: |
38611071 |
Uncontrolled Keywords: |
complications dexamethasone dosing evidence-based glioblastoma |
BORIS DOI: |
10.48350/195946 |
URI: |
https://boris.unibe.ch/id/eprint/195946 |
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