Factors responsible for the retention of fluid in human tumor edema and the effect of dexamethasone.

The components of vasogenic edema associated with brain tumors were investigated in human biopsy material sampled from tumor and peritumoral tissue during neurosurgical operations. Tissue from 60 patients with glioblastomas, gliomas, meningiomas, and metastases who had been treated with dexamethasone prior to surgery was used for measurement of water, electrolyte, hemoglobin, serum protein, and dexamethasone concentrations. In all samples except metastases, positive correlations were obtained between water content and both serum protein levels and sodium content in tumors and peritumoral edema, suggesting that these components simultaneously determine forces for extravasation of plasma-derived edema fluid. However, the mean serum protein content varied considerably, being high in glioblastomas (16 mg/ml) and low in peritumoral edema surrounding metastases (4 mg/ml). The mean cerebral blood volume in all samples, as calculated from the tissue hemoglobin content, was 2.5 ml/100 gm wet weight in tumor tissue and 1.6 to 2.0 ml/100 gm wet weight in peritumoral tissue. Sodium concentrations were not significantly different among the tumor types. Both water and serum protein content decreased with increasing dexamethasone concentrations in glioblastomas, while this effect was virtually absent in gliomas and meningiomas. A therapeutic threshold of dexamethasone at 500 mg/gm wet weight was obtained for tumoral and peritumoral tissue of glioblastomas and was effective in a dose-dependent manner as long as the water content and the serum protein concentration remained below 6 ml/gm dry weight and 30 mg/gm dry weight, respectively. These results suggest a previously unknown selectivity among tumor types for the reduction of both water content and serum proteins in corticosteroid-treated edematous tissue.