Are steroids detrimental to survival in brain tumours?

As I update neurochecklists I come across some papers which make me go, ‘really!’ Such studies challenge established theories and threaten conventional practice. Such is the case with a recent paper in Brain titled, unequivocally, Corticosteroids compromise survival in glioblastoma.

By Christaras A - Created myself from anonymized patient MR, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=1247035
By Christaras A – Created myself from anonymized patient MR, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=1247035

Glioblastoma is the worst form of primary brain tumour, and survival is already poor. Treatment is usually palliative with debulking surgery and radiotherapy. Dexamethasone, a corticosteroid, effectively reduces the swelling or oedema that the tumour evokes around it. Corticosteroids are therefore often the first treatment for glioblastoma because they  almost immediately improve symptoms such as reduced consciousness, headache, and visual blurring.

By LHcheM - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18648311
By LHcheMOwn work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18648311

It is, therefore, surprising when a study suggests that corticosteroids cause harm. But this is no ordinary study; it is a classic bench-to-bedside research which looked at patients with glioblastoma, and then devised a mouse model to study the real impact of steroids on the tumour.

By Jensflorian - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=11814552
By JensflorianOwn work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=11814552

 

The authors show that a ‘ dexamethasone-associated gene expression signature correlated with shorter survival’. They pass the verdict that corticosteroids are detrimental to survival and urge caution when prescribing dexamethasone.

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You may be feeling a bit low after reading. You may, however, lift your spirits by reading my previous posts titled maggots, viruses and lasers: some innovations for brain tumours and calming the rage of brain tumours.

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