Arvold Nils D, Pinnell Nancy E, Mahadevan Anand, Connelly Sheila, Silverman Rachel, Weiss Stephanie E, Kelly Paul J, Alexander Brian M
Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, Massachusetts.
Pract Radiat Oncol. 2016 Jul-Aug;6(4):e89-e96. doi: 10.1016/j.prro.2015.11.004. Epub 2015 Nov 10.
PURPOSE/OBJECTIVE(S): The risk of developing symptomatic edema or seizure following stereotactic radiosurgery (SRS) is poorly defined, and many practitioners prescribe prophylactic corticosteroids and/or anticonvulsants. Because there are no clear guidelines regarding appropriate use, we sought to characterize prescribing practices and factors associated with these recommendations.
We conducted a 1-time, internet-based survey among 500 randomly selected radiation oncologists self-described as specializing in central nervous system diseases who were registered in the American Society for Radiation Oncology directory. Physicians were contacted by e-mail and invited to complete the 22-question survey.
The response rate was 32% (n = 161). Sixty-six percent of respondents had been in practice for >10 years, and 45% of respondents practiced at an academic medical center. During/after SRS, 53% of respondents "always" or "usually" recommended corticosteroids, whereas 47% "never," "rarely," or "sometimes" recommended them. When prescribing corticosteroids, the recommended duration of use was <1 week, 1-2 weeks, or >2 weeks among 49%, 33%, and 18% of respondents, respectively. Respondents who worked in an academic medical center were less likely to prescribe corticosteroids, although this did not reach significance (P = .09). Seizure prophylaxis was less common overall, as 79% of respondents "rarely" or "never" prescribed anticonvulsants for SRS. Respondents who prescribed anticonvulsants more frequently had higher estimations of the risk of seizure within 2 weeks of SRS (P < .001), and their recommended duration of anticonvulsant use was <1 week, 1-2 weeks, and >2 weeks among 35%, 25%, and 41% of respondents, respectively.
There is extreme variation in physician recommendations regarding prophylactic corticosteroid and anticonvulsant use for patients undergoing SRS. Further investigation of the risks and benefits of these medications for SRS is warranted, which may promote guideline development and more patient-centered, rational prescribing practices.
立体定向放射外科手术（SRS）后出现症状性水肿或癫痫发作的风险尚不明确，许多从业者会开具预防性皮质类固醇和/或抗惊厥药物。由于在合理使用方面没有明确的指南，我们试图描述开具这些药物的处方行为以及与这些建议相关的因素。
我们对500名随机选择的放射肿瘤学家进行了一次基于网络的调查，这些医生自我描述为专门从事中枢神经系统疾病治疗，且登记在美国放射肿瘤学会名录中。通过电子邮件联系医生，并邀请他们完成这份包含22个问题的调查问卷。
回复率为32%（n = 161）。66%的受访者从业超过10年，45%的受访者在学术医疗中心工作。在SRS期间/之后，53%的受访者“总是”或“通常”推荐使用皮质类固醇，而47%的受访者“从不”、“很少”或“有时”推荐使用。在开具皮质类固醇药物时，分别有49%、33%和18%的受访者推荐使用时间<1周、1 - 2周或>2周。在学术医疗中心工作的受访者开具皮质类固醇药物的可能性较小，尽管这未达到显著水平（P = 0.09）。总体而言，癫痫预防用药较少见，79%的受访者“很少”或“从不”为SRS患者开具抗惊厥药物。更频繁开具抗惊厥药物的受访者对SRS后2周内癫痫发作风险的估计更高（P < 0.001），他们推荐的抗惊厥药物使用时间分别为<1周、1 - 2周和>2周的受访者比例分别为35%、25%和41%。
对于接受SRS治疗的患者，医生在预防性使用皮质类固醇和抗惊厥药物的建议方面存在极大差异。有必要进一步研究这些药物用于SRS的风险和益处，这可能会促进指南的制定以及更以患者为中心的合理处方行为。
