Yennurajalingam Sriram, Bruera Eduardo
Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Curr Opin Support Palliat Care. 2014 Dec;8(4):346-51. doi: 10.1097/SPC.0000000000000093.
Although corticosteroids are frequently used to palliate cancer-related symptoms, limited published studies are available. This review summarizes recent literature on the impact of corticosteroids on fatigue, its related symptoms, and the role of 'corticosteroid rotation' in improving the corticosteroid-related side-effects.
Only two placebo-controlled double-blinded randomized studies on corticosteroid for symptoms that met the inclusion criteria were published recently, despite the criteria being extended beyond 2012 and 2013. These two studies confirm the preliminary data that corticosteroids significantly improve cancer-related fatigue and anorexia with no significant side-effects. However, these studies were of short duration. Long-term use of corticosteroids is not recommended at this time because of the risk of debilitating side-effects and no evidence of its long-term benefits. Recent studies also suggest the possible role of corticosteroid rotation or switching similar to opioid rotation for improvement of these side-effects.
Recent studies confirm the short-term benefit of corticosteroids for the symptomatic treatment of cancer-related fatigue and anorexia cachexia in advanced incurable cancer. Future studies are needed to determine the optimal dose, type, and the role of corticosteroid rotation so as to optimize long-term efficacy and minimize side-effects.
尽管皮质类固醇常用于缓解癌症相关症状，但已发表的研究有限。本综述总结了近期关于皮质类固醇对疲劳及其相关症状的影响，以及“皮质类固醇轮换”在改善皮质类固醇相关副作用方面作用的文献。
尽管纳入标准在2012年和2013年之后有所扩展，但近期仅发表了两项关于皮质类固醇用于符合纳入标准症状的安慰剂对照双盲随机研究。这两项研究证实了初步数据，即皮质类固醇可显著改善癌症相关疲劳和厌食，且无明显副作用。然而，这些研究持续时间较短。目前不建议长期使用皮质类固醇，因为存在导致虚弱副作用的风险，且尚无其长期益处的证据。近期研究还表明，类似于阿片类药物轮换，皮质类固醇轮换或换药可能有助于改善这些副作用。
近期研究证实了皮质类固醇对晚期不可治愈癌症中癌症相关疲劳和厌食恶病质进行对症治疗的短期益处。未来需要开展研究以确定最佳剂量、类型以及皮质类固醇轮换的作用，从而优化长期疗效并将副作用降至最低。
