地塞米松在高级别脑胶质瘤患者中的应用：临床实践指南。
Use of dexamethasone in patients with high-grade glioma: a clinical practice guideline.
机构信息
Guideline Utilization Resource Unit, Alberta Health Services, CancerControl Alberta, Calgary, AB.
Department of Pharmacy, Tom Baker Cancer Centre, Calgary, AB.
出版信息
Curr Oncol. 2014 Jun;21(3):e493-503. doi: 10.3747/co.21.1769.
BACKGROUND
Dexamethasone is the corticosteroid most commonly used for the management of vasogenic edema and increased intracranial pressure in patients with brain tumours. It is also used after surgery (before embarking on radiotherapy), particularly in patients whose tumours exert significant mass effect. Few prospective clinical trials have set out to determine the optimal dose and schedule for dexamethasone in patients with primary brain tumours, and subsequently, fewer clinical practice guideline recommendations have been formulated.
METHODS
A review of the scientific literature published to November 2012 considered all publications that addressed dexamethasone use in adult patients with brain tumours. Evidence was selected and reviewed by a working group comprising 3 clinicians and 1 methodologist. The resulting draft guideline underwent internal review by members of the Alberta Provincial cns Tumour Team, and feedback was incorporated into the final version of the guideline.
RECOMMENDATIONS
Based on the evidence available to date, the Alberta Provincial cns Tumour Team makes these recommendations: Treatment with dexamethasone is recommended for symptom relief in adult patients with primary high-grade glioma and cerebral edema.After surgery, a maximum dose of 16 mg daily, administered in 4 equal doses, is recommended for symptomatic patients. This protocol should ideally be started by the neurosurgeon.A rapid dexamethasone tapering schedule should be considered where appropriate.Patients who have high-grade tumours, are symptomatic, or have poor life expectancy, can be maintained on a 0.5-1.0 mg dose of dexamethasone daily.Side effects with dexamethasone are common, and they increase in frequency and severity with increased dose and duration of therapy. Patients should be carefully monitored for endocrine, muscular, skeletal, gastrointestinal, psychiatric, and hematologic complications, and for infections and other general side effects.
背景
地塞米松是最常用于治疗脑肿瘤患者血管源性水肿和颅内压升高的皮质类固醇。它也用于手术后（开始放疗前），特别是在肿瘤有明显占位效应的患者中。很少有前瞻性临床试验旨在确定原发性脑肿瘤患者使用地塞米松的最佳剂量和方案，因此制定的临床实践指南建议也较少。
方法
对截至 2012 年 11 月发表的科学文献进行了综述，综述了所有涉及成人脑肿瘤患者使用地塞米松的文献。证据由一个由 3 名临床医生和 1 名方法学家组成的工作组选择和审查。由此产生的指南草案在艾伯塔省中枢神经系统肿瘤团队成员内部进行了审查，并将反馈意见纳入了指南的最终版本。
建议
根据目前的证据，艾伯塔省中枢神经系统肿瘤团队提出以下建议：治疗成人原发性高级别胶质瘤和脑水肿患者的症状，推荐使用地塞米松。手术后，建议对有症状的患者每天给予最大剂量 16 毫克，分 4 次给予。该方案应由神经外科医生开始。在适当的情况下，应考虑快速地塞米松逐渐减量方案。有高级别肿瘤、有症状或预期寿命较短的患者可以维持每天 0.5-1.0 毫克地塞米松的剂量。地塞米松的副作用很常见，并且随着剂量和治疗时间的增加，其频率和严重程度会增加。应仔细监测患者是否出现内分泌、肌肉骨骼、胃肠道、精神、血液学并发症以及感染和其他一般副作用。
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